Evaluation of a Virtual Reality-Based Open Educational Resource Software.

OBJECTIVES: Virtual reality (VR) teaching methods have potential to support medical students acquire increasing amounts of knowledge. EVENT (Easy VR EducatioN Tool) is an open educational resource software for immersive VR environments, which is designed for use without programming skills. In this work, EVENT was used in a medical student VR course on pancreatic cancer. METHODS: Medical students were invited to participate in the course. Before and after VR simulation, participants completed a multiple-choice knowledge assessment, with a maximum score of 10, and a VR experience questionnaire. The primary endpoint compared pre- and post-VR simulation test scores. Secondary endpoints included usability and factors that could affect learning growth and test results. RESULTS: Data from 117 of the 135 participating students was available for analysis. Student test scores improved by an average of 3.4 points (95% CI 3.1-3.7, P < 0.001) after VR course. The secondary endpoints of gender, age, prior knowledge regarding the medical subject, professional training completed in the medical field, video game play, three-dimensional imagination skills, or cyber-sickness had no major impact on test scores or final ranking (top or bottom 25%). The 27 students whose post-VR simulation test scores ranked in the top 25% had no prior experience with VR. The average System Usability Scale score was 86.1, which corresponds to an excellent outcome for user-friendliness. Questionnaire responses post-VR simulation show students (81.2% [95/117]) interest in more VR options in medical school. CONCLUSIONS: We present a freely available software that allows for the development of VR teaching lessons without programming skills.

[The elective planetary health: Climate, environment and health at the faculty of medicine in Würzburg: Concept, didactic methods and evaluation results]. / Das Wahlpflichtfach Planetare Gesundheit: Klima.Umwelt.Gesundheit an der Medizinischen Fakultät Würzburg ­ Konzeption, didaktische Methoden und Evaluationsergebnisse.

BACKGROUND: The connections between climate, environment, and health as well as the concept of planetary health need to be integrated into the education of health professionals, as is increasingly demanded both internationally and nationally. Planetary health education should also aim to foster transformative action for climate protection and sustainability. In recent years, innovative teaching formats and objective catalogues have emerged internationally. In Germany, these topics have not yet been integrated into medical education everywhere. Since 2021, the Faculty of Medicine in Würzburg has offered an elective course as a first step of a longitudinal curriculum currently in development. The design, content, structure, and results of the evaluation are discussed in this article and will be used for quality assurance as well as the (further) development of this kind of educational interventions elsewhere. METHODOLOGY: We developed an elective course for students in their second to tenth semester with 30 onsite and online face-to-face teaching units and an additional project phase. We used an innovative mix of didactic methods with online simulations, training in climate-sensitive health counselling, and interdisciplinary climate communication as well as local sustainability projects in small groups, with a large amount of peer-teaching. A quantitative and qualitative evaluation was done immediately after the teaching units through feedback rounds and online with the evaluation software Evasys®, using closed and open-ended questions exploring learning progress (summer semester) and achievement of learning objectives (winter semester), motivation to participate, acceptance of teaching methods, attitudes, relevance, and further interest. The evaluation questionnaire was slightly modified for the winter semester. RESULTS: In the summer and winter semester of 2021/2022, a total of 34 students (17 per semester) participated in the elective course; of these, 33 participated in the written evaluation. The evaluation in the summer semester (n = 17) showed a significant increase in self-assessed learning gain, the evaluation in the winter semester (n = 16) indicated a substantial achievement of learning objectives (mean = 3.96 of a 5-point Likert scale). Participants of both semesters (n = 33) regarded peer-teaching as a suitable method (mean = 4.2) and well-implemented (mean = 4.3). The topics were considered highly relevant but not adequately integrated into the main curriculum. There was a high level of interest in local impacts of climate and environmental changes and local measures for climate protection and sustainability. The specific projects in small groups may serve as examples of how transformative action can be promoted in education. DISCUSSION: In the current dynamic development of the widely demanded integration of planetary health education into curricula, this elective course shows a possible and well-accepted example with a combination of various innovative didactic methods aiming at the levels of knowledge, attitudes, skills, and self-efficacy (or confidence) alike. The positive evaluation by the students and the high interest in local sustainability projects show the potential for future integration into the main curriculum. CONCLUSION: The elective can serve as an inspiration to tackle the challenge of taking the steps from knowledge to action in planetary health education. While an elective cannot replace the integration of all relevant aspects of planetary health into the main curriculum, it can serve as a space for piloting of future curricular educational interventions and offer opportunities for developing transformative competencies.

Pre-post evaluation of the emotions and motivations for transformative action of medical students in Germany after two different planetary health educational interventions.

BACKGROUND: Climate change is the greatest threat to human health. Medical students, as future health-care workers, are important in promoting sustainable behaviours, which are strongly associated with individuals' emotional responses to climate change. At Würzburg University Hospital (Würzburg, Germany), a one-term optional course (40 learning units) about planetary health and two lectures within the curricular course Environmental Medicine were introduced in 2021. We aimed to examine the effects of these courses on the emotions and motivations of students in acting against climate change. METHODS: We surveyed medical students from both courses during four consecutive terms during 2021-23 with a pre-post design using an anonymous online questionnaire on EvaSys. The survey consisted of 20 closed questions based on a 5-point Likert scale and six open questions. Quantitative data were analysed with SPSS version 28.0.1.1. Qualitative data were analysed with Kuckartz' qualitative content analysis. FINDINGS: 458 students were initially involved (349 [76%] in the lectures and 109 [24%] in the optional course) and 396 students were involved until the final date (288 [73%] in the lectures and 108 [27%] in the optional course). Mean response rate was 389 (85%) of 458 students pre-survey and 315 (80%) of 396 post-survey. The most frequently reported initial emotions of medical students from both cohorts were "helplessness" (220 [57%] of 389), "fear" (197 [51%]), and "disappointment" (171 [44%]). Only 82 (21%) of 389 students reported having "motivation to act" and 45 (12%) reported having "confidence". When comparing 176 matched pre-lecture and post-lecture Likert scale values of reported emotions, we observed a significant decrease in "helplessness" (mean difference -0·37, 95% CI -0·2 to -0·53; p<0·0001; d=0·34) and "disappointment" (-0·35, -0·2 to -0·49; p<0·0001; d=0·36) and a significant increase in "confidence" (0·67, 0·82 to 0·51; p<0·0001; d=0·65 and "motivation to act" (0·4, 0·53 to 0·27; p<0·0001; d=0·46). Students associated these changes with options for action offered in the lecture. INTERPRETATION: This pre-post evaluation provides evidence for a positive effect of planetary health education at the university level. Educators should focus on options for action and create space for improving emotional resilience within courses. FUNDING: None.

Combatting the occurrence of needle-stick injuries in a medical school: why is it still an issue?

BACKGROUND: Needle-stick injuries (NSIs) pose a safety risk for healthcare workers with great potential for serious infections. The aim was to determine numbers and causes of NSIs as well as the frequency with which medical students report NSIs in the final stages of study. METHODS: An online questionnaire was developed and made available in January and February 2023 to all undergraduate medical students (n = 423) in the last 1.5 years of their degree course at Würzburg University, Germany. RESULTS: The response rate was 19.6% (n = 84). Among respondents, 27.4% (n = 23) reported at least one NSI. Occurrence was particularly frequent in surgery, obstetrics and gynaecology, and internal medicine. Assisting with procedures, suturing, and blood sampling were considered high-risk activities. Lack of concentration, distraction, and time pressure played a role in incidents. Respondents did not report 18.8% of NSIs with the main reasons being fear of the consequences, self-assessment of the injury as minor, or the opinion of supervisors that reporting was unnecessary. Students with previous practice on simulators or patients were significantly more likely to suffer NSIs. Instructions from occupational health specialists beforehand correlated with fewer NSIs. CONCLUSION: We assume that trained students are more experienced in handling invasive procedures, leading to a greater adoption of corresponding activities and thus an increased risk of injuries in absolute numbers. This does not counter the need for didactic interventions prior to workplace-based training to raise awareness of NSI risks. Simultaneously, concepts must be developed and implemented to support reporting and alleviate fears regarding consequences.

Development of a strategy for the expansion of online teaching at the University of Würzburg based on the experiences of lecturers and students in the pandemic years 2020/21.

Background: Owing to the COVID-19 pandemic, the summer of 2020 saw face-to-face teaching replaced by online teaching. The question arose as to how digitalisation may be implemented meaningfully. The views of lecturers and students on past online programmes were gathered in order to identify potential and future prospects. Project description: An exploratory, guidelines-based interview study was conducted during the clinical phase of the medicine degree at the Faculty of Medicine in Würzburg. Five lecturers and five students were interviewed in the winter semester of 2020/21. This was followed by a content analysis evaluation according to Kuckartz, with the help of MAXQDA. Results: Online teaching offers more flexibility and security for the future. Hybrid formats (e.g., blended learning) are in demand. While theoretical knowledge can be taught online, face-to-face teaching remains essential in practical training. Digital elements must be developed didactically and anchored in the curriculum. Interaction and direct feedback between students and lecturers are key aspects of this. Discussion: Online teaching in medicine offers numerous potentials and didactic design options that can improve the degree programme in a competency-based manner. Combined teaching formats are particularly effective in this regard. Fittingly conceived, multimedia teaching formats enable students to approach their studies in a focused manner. The points raised during the interviews correspond with the fundamental principles of the ARCS model, which was developed to strengthen continuous motivation in students. Conclusion: Well-thought-out design and integration of online teaching can contribute to attractive, efficient, and future-oriented teaching/learning activities. Decisive factors are the collaboration of everyone involved and adequate provision of both time and financial resources.

Effects of the COVID-19 pandemic on the mental health of medical students and young physicians in Germany: Gender-specific results of an online survey.

Background: Healthcare workers and medical students faced new challenges during the COVID-19 pandemic. Processes within many hospitals were completely disrupted. In addition, the face to face teaching of medical students was drastically reduced. Those at risk of developing mental health problems appear to be younger health care workers and women. Objective: To investigate potential COVID-19 pandemic-related gender differences in psychological distress among medical students and physicians in their first years of practice. Design and setting: An anonymous survey was carried out online between December 1, 2021, and March 31, 2022, at the Mannheim Medical Faculty and the Würzburg Medical Faculty, Germany, after obtaining informed consent. Primary outcome measures were changes in anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS), and changes in participants' current quality of life using the WHO Quality of Life BREF. Results: The results show wave-like courses for perceived anxiety and burden overlapping with the course of the COVID-19 incidence. In comparison to men, women showed a significant higher increase in HADS (p = 0.005) and a reduced life quality (p = 0.007) after COVID-19. Both sexes showed different frequencies of the factors influencing quality of life, with the presence of a previous mental illness and mean anxiety having a significant higher negative impact in women. Conclusion: Future and young female physicians reported a disproportionate higher burden during COVID-19 compared to their male colleges. These observations suggest an increased need for support and prevention efforts especially in this vulnerable population.

[Repetitio est mater studiorum-implementation of ENT cases in case-based e-learning]. / Repetitio est mater studiorum ­ Implementierung von HNO-Fällen in fallbasiertes E-Learning.

BACKGROUND: German university otorhinolaryngology has a need for digital teaching content. Case-based e­learning represents a digital teaching methodology. The data on student use of case-based e­learning in university teaching of ENT medicine are limited. OBJECTIVE: The aim of this work was to determine the extent to which voluntary case-based e­learning is used by otolaryngology students and what influence the quality of the e­learning has on motivation to use e­learning and on the interest in otolaryngology. MATERIALS AND METHODS: Fifteen voluntary e­learning cases were created based on the content of the ENT lecture in the winter semester 2022/2023. Subsequently, a descriptive evaluation of the usage statistics of the cases of 157 students was conducted. Likewise, an evaluation of the quality of the e­learning as well as the motivation to complete it and the interest in otorhinolaryngology was carried out using a voluntary questionnaire. RESULTS: Voluntary case-based e­learning was used to varying degrees by 66% of the students. The quality of e­learning correlated significantly with the motivation and the interest in otolaryngology. CONCLUSION: The teaching content of otorhinolaryngology can be implemented sufficiently in case-based e­learning and is characterized by satisfactory student acceptance. Integration should be accomplished in a high-quality manner to increase motivation and interest in otorhinolaryngology.

The influenza A virus promotes fungal growth of Aspergillus fumigatus via direct interaction in vitro.

Seasonal influenza A virus (IAV) infections still pose a major burden for public health worldwide. Severe disease progression or even death is often related to superinfections of the virus and a secondary bacterial pathogen. However, fungi, especially Aspergillus fumigatus, are also frequently diagnosed during IAV infection. Although, clinical studies have reported the severity of influenza-associated pulmonary aspergillosis, the molecular mechanisms underlying this type of disease are poorly understood. Here, a new in vitro model is introduced that allows the investigation of complex pathogen-host and pathogen-pathogen interactions during coinfection of lung epithelial cells with IAV and A. fumigatus. Our data reveal a reduced IAV load and IAV-induced cytokine and chemokine expression in the presence of A. fumigatus. At the same time, IAV infection promotes the growth of A. fumigatus. Even in the absence of the human host cell, purified IAV particles are able to induce hyphal growth, due to a direct interaction of the virus particles with the fungal surface. Thus, our study gives first insights into the complex interplay between IAV, A. fumigatus and the host cell as well as the two pathogens alone.

[Goal-setting in Plastic Surgery using the SMART principle]. / Operative Ausbildungsziele in der Plastischen und Ästhetischen Chirurgie einfach "SMART".

INTRODUCTION: The process of continuous acquisition of surgical expertise is a key element in registrar training. The principle of active, self-directed learning, which is regularly applied in medical school, can also be used to gain surgical expertise in registrar training. METHODS: Surgical training can be compared to acquiring expertise in music or sport, where both intellectual and manual capabilities are required. Specific training principles, including analysis, goal setting, practice and reflection on the process, are commonly encountered in these fields. Smart goal setting is preferred in order to ensure compliance and a successful strategy. This can also be used in plastic surgery training. APPLICATION: Surgical principles as well as partial or complete surgical procedures can be practiced using the smart principle. The fragmentation of a larger task into smaller units allows rapid acquisition of surgical expertise without impeding patient safety. DISCUSSION: Surgical training today happens in a setting caught between economic and medicolegal challenges. The reduction of case load requires simulation practice as well as self-directed learning - which has been shown to improve outcomes. The smart principle allows distinct goal setting which can improve compliance of the student and increase success. As this form of learning is not intuitive to all individuals, supervisors and mentor can support trainees in the acquisition of surgical expertise using this principle.

Tablet-based versus presentation-based seminars in radiology: Effects of student digital affinity and teacher charisma on didactic quality.

Aims: Tablets are being adopted as teaching medium in medical education more frequently. Here we compared two teaching formats in a radiology seminar using a tablet-based student-centred approach guided by teachers and traditional presentation-based, teacher-centred instruction. The aim was to investigate the effects on academic performance, estimated learning gain, didactic quality, as well as how teacher charisma and student digital affinity influence these elements. Methods: Data from 366 students were collected. Student digital affinity, didactic quality of, and overall satisfaction with the seminars were rated for each teaching format over three semesters, whereby in the last semester, students additionally estimated their learning gain, took a knowledge and image interpretation test, and rated teacher charisma. Results: The tablet-based seminars yielded significantly higher ratings for didactic quality and overall satisfaction. However, the presentation-based seminars proved superior with respect to academic performance as well as estimated learning gain. When employing tablets, teacher charisma correlated with estimated learning gain, and digital affinity affected didactic quality. Additionally, good seminar organization, comprehensible learning objectives, and optimal variation of learning activities were identified as important factors. Conclusion: This study suggests a complex interplay of various factors concerning teachers, students, and didactics that can be assessed and improved to assure the successful curricular implementation of tablets. Of note, tablet integration and thereby active engagement of students with imaging analysis skills does not automatically result in greater declarative knowledge. Nevertheless, understanding the complexities of structuring and delivering tablet-based, teacher-guided instruction is essential to creating meaningful educational experiences.

The impact of COVID-19 pandemic on mental burden and quality of life in medical students - results of an online survey.

Objectives: Changes in academic conditions due to the COVID-19 pandemic are potential stressors for medical students and can make them vulnerable for the development of psychiatric disorders.Previous pandemics had a negative impairment on well-being due to social isolation and the perceived threat, an increase in fear, anger and frustration and an increase in post-traumatic stress disorder among health professionals. Therefore, this study examines the impact of the COVID-19 pandemic on medical students' mental health and possible psychological consequences. Methods: In this anonymous online survey (online 12/01/2021-03/31/2022), we examined the impact of COVID-19 pandemic on mental health of 561 German medical students aged between 18 und 45 years. Perceived anxiety and burden were assessed retrospectively from spring 2020 to autumn 2021. Changes in symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), quality of life was assessed using the WHO Quality of Life Questionnaire (WHOQOL BREF). Results: Anxiety and burden showed wavelike courses with higher scores in autumn, winter and spring. The scores for depression and anxiety increased after the outbreak of the COVID-19 pandemic compared to the time before (p<.001). Results of a multifactorial ANOVA showed, that previous psychiatric illness (p<.001), being in the first two years of studies (p=.006), higher burden (p=.013) and greater differences in symptoms of depression (p<.001) were associated with a decreased quality of life in medical students. Conclusion: The COVID-19 pandemic has a negative impact on mental health of medical students and their actual quality of life. Therefore, medical faculties should establish specific support to prevent the development of psychiatric sequelae probably resulting in long-term medical leaves.

Concept and implementation of the longitudinal mosaic curriculum planetary health at the Faculty of Medicine in Würzburg, Germany.

Background of the project: Stakeholders in healthcare and science increasingly demand the rapid integration of teaching content on planetary health (PIH) into the curricula of all the healthcare professions. In medical education, such topics are currently only covered inadequately and are mostly limited to elective courses. Why was the project initiated?: In order to reach all medical students in the sense of a learning spiral and promote an interdisciplinary understanding of planetary health, a longitudinal mosaic curriculum is being developed that introduces aspects of planetary health throughout the entire course of study. We share the first experiences of the start of this project as an example to inspire similar activities elsewhere. Implementation of the project: We mapped all the courses at the Faculty of Medicine in Würzburg and compared them with existing learning objectives on planetary health topics from the National Competency-Based Catalog of Learning Objectives for Medical Education. We then identified curricular injection points and held consultations with teaching staff and course coordinators from 26 different specialities in order to integrate the respective contents into the courses and, if necessary, develop new content. An overview of all curricular injection points with the corresponding topics, learning objectives, and teaching and examination methods is under development. Evaluation of the project: The lecturers exchanged ideas with the project team of the teaching clinic of the Faculty of Medicine; further networking meetings to coordinate a learning spiral are to follow. The lecturers were asked to provide structured learning objectives in the categories "knowledge", "attitudes", "skills", and "confidence" on the topics integrated into the courses. Oral as well as written evaluations using Evasys® questionnaires among students and lecturers are planned. Final overall assessment outlook: Planetary Health topics have been introduced in several courses following our intervention. In the context of a learning spiral, teaching staff from further medical disciplines will be contacted so that more perspectives can be highlighted at different points in the curriculum. In addition, interdisciplinary teaching formats will be developed in order to take the complexity of the interrelationships into account.

The impact of COVID-19 pandemic on mental burden and quality of life in physicians: Results of an online survey.

Background: In previous pan-/epidemics such as the SARS epidemic of 2002/2003, negative effects on the wellbeing and an increase in symptoms of depression and anxiety were observed in doctors due to social isolation and the threat they experienced. Therefore, it is feared that the COVID-19 pandemic will also have a negative impact on the mental health and quality of life of doctors. Objective: The impact of the COVID-19 pandemic on the mental health of physicians. In particular, on the subjective anxiety and burden, depression and quality of life for the total sample and subsamples (work in COVID-19 units vs. no work in COVID-19 units). Materials and methods: In an online survey, 107 physicians (23-42 years) were asked about their mental health during the COVID-19 pandemic. In addition to socio-demographic data, pandemic- and work-related data were also included. For example, infection control measures, deployment on COVID-19 wards and the subjective perceived threat posed by the pandemic. The physicians were asked to rate their perceived anxiety and stress, retrospectively, at 7 different points in time during the pandemic. The Hospital Anxiety and Depression Scale (HADS) was used to retrospectively assess symptoms of anxiety and depression before and after the onset of the pandemic. The quality of life of the participants after 2 years of the pandemic was assessed using the WHO Quality of Life (WHOQOL-BREF). Results: Both subjective anxiety and burden showed wave-like patterns with higher scores in autumn, winter and spring. We observed significant differences between the seven measurement time points for anxiety [Chi2(6) = 197.05, p < 0.001] as well as for burden [Chi2(6) = 106.33, p < 0.001]. Symptoms of depression and anxiety increased significantly during the COVID-19 pandemic (M = 14.16, SD = 7.83) compared to the pre-pandemic time [M = 7.31, SD = 5.14, t (106) = -10.67, p < 0.001]. Physicians who worked at COVID-19 units showed higher scores in quality of life related to social relationships (M = 70.39, SD = 17.69) than physicians not working at COVID-19 units [M = 61.44, SD = 24.55, t (90.14) = -2.145, p = 0.035]. The multi-factorial ANOVA showed that previous psychiatric illness (p < 0.001), greater difference in depression scores (p = 0.014), higher anxiety scores (p = 0.048) and less work experience (p = 0.032) led to lower quality of life. Conclusion: Hospitals should offer specific support, such as supervision, to prevent the development of longer-term psychiatric sequelae likely to lead to sick leave and high costs for the healthcare system. Trial registration: The study has been registered at the German Clinical Trials Registry (DRKS-ID: DRKS00028984).

Burnout among hospital staff during the COVID-19 pandemic: Longitudinal results from the international Cope-Corona survey study.

OBJECTIVE: Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study. METHODS: Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age. RESULTS: A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients. CONCLUSION: Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions. REGISTRATION: Müller, M. M. (2020, August 30). Cope-Corona: Identifying and strengthening personal resources of hospital staff to cope with the Corona pandemic. Open Science Foundation.

Item format statistics and readability of extended matching questions as an effective tool to assess medical students.

Testing based on multiple choice questions (MCQ) is one of the most established forms of assessment, not only in the medical field. Extended matching questions (EMQ) represent a specific type of MCQ designed to require higher levels of cognition, such as problem-solving. The purpose of this evaluation was to assess the suitability and efficiency of EMQ as an assessment method. EMQ were incorporated into the end-of-semester examination in internal medicine, in which 154 students participated, and compared with three established MCQ types. Item and examination quality were investigated, as well as readability and processing time. EMQ were slightly more difficult to score; however, both item discrimination and discrimination index were higher when compared to other item types. EMQ were found to be significantly longer and required more processing time, but readability was improved. Students judged EMQ as clearly challenging, but attributed significantly higher clinical relevance when compared to established MCQ formats. Using the Spearman-Brown prediction, only ten EMQ items would be needed to reproduce the Cronbach's alpha value of 0.75 attained for the overall examination. EMQ proved to be both efficient and suitable when assessing medical students, demonstrating powerful characteristics of reliability. Their expanded use in favor of common MCQ could save examination time without losing out on statistical quality.

D,L-Lysine-Acetylsalicylate + Glycine (LASAG) Reduces SARS-CoV-2 Replication and Shows an Additive Effect with Remdesivir.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the coronavirus disease-19 (COVID-19) is still challenging healthcare systems and societies worldwide. While vaccines are available, therapeutic strategies are developing and need to be adapted to each patient. Many clinical approaches focus on the repurposing of approved therapeutics against other diseases. However, the efficacy of these compounds on viral infection or even harmful secondary effects in the context of SARS-CoV-2 infection are sparsely investigated. Similarly, adverse effects of commonly used therapeutics against lifestyle diseases have not been studied in detail. Using mono cell culture systems and a more complex chip model, we investigated the effects of the acetylsalicylic acid (ASA) salt D,L-lysine-acetylsalicylate + glycine (LASAG) on SARS-CoV-2 infection in vitro. ASA is commonly known as Aspirin® and is one of the most frequently used medications worldwide. Our data indicate an inhibitory effect of LASAG on SARS-CoV-2 replication and SARS-CoV-2-induced expression of pro-inflammatory cytokines and coagulation factors. Remarkably, our data point to an additive effect of the combination of LASAG and the antiviral acting drug remdesivir on SARS-CoV-2 replication in vitro.

The C-terminus of a diatom plant-like cryptochrome influences the FAD redox state and binding of interaction partners.

A plant-like cryptochrome of diatom microalgae, CryP, acts as a photoreceptor involved in transcriptional regulation. It contains FAD and 5,10-methenyltetrahydrofolate as chromophores. Here, we demonstrate that the unstructured C-terminal extension (CTE) of CryP has an influence on the redox state of the flavin. In CryP lacking the CTE, the flavin is in the oxidized state (FADox), whereas it is a neutral radical (FADH•) in the full-length protein. When the CTE of CryP is coupled to another diatom cryptochrome that naturally binds FADox, this chimera also binds FADH•. In full-length CryP, FADH• is the most stable redox state and oxidation to FADox is extremely slow, whereas reduction to FADH2 is reversible in the dark in approximately 1 h. We also identified novel interaction partners of this algal CRY and characterized two of them in depth regarding their binding activities. BolA, a putative transcription factor, binds to monomeric and to dimeric CryP via the CTE, independent of the redox state of the flavin. In contrast, an unknown protein, ID42612, which occurs solely in heterokont algae, binds only to CryP dimers. This binding is independent of the CTE and shows slight differences in strength depending on the flavin's redox state.

[Online Teaching in Surgery]. / Online-Lehre in der Chirurgie.

For quite some time, the development and implementation of online teaching has been a controversial issue in surgical education for the degree in medicine. This has become more important with the progression of digitalisation and not least as a result of the current pandemic. It is becoming increasingly urgent to establish the opportunities and limits of online teaching, which has already proved successful under the current developmental pressure, and there are promising concepts. This article addresses the framework and the various online teaching formats in surgery, and illustrates the interplay between technical feasibility, practical experience, and didactic objectives.

Students' perception of three-dimensionally printed teeth in endodontic training.

INTRODUCTION: In endodontic education, there is a need for thorough training prior to students embarking on clinical treatment. The aim of this study was to use three-dimensional printing technology to create a new model and to compare its suitability for training purposes with resin blocks and extracted teeth. MATERIALS AND METHODS: Multi-jet-modelling (MJM) produced the 3D model replicating a common difficulty in root-canal morphology. An evaluation study comprising 88 students was run in the sixth semester (summer 2018 and winter 2018/2019). A new questionnaire assessed students' perception of training models and educational environment. Welch's t-test analysed significant differences. RESULTS: The most pronounced differences between models were noted when rating material hardness, radiopacity, root-canal configuration and suitability for practising. Students estimated their learning outcome as greater with 3D-printed teeth compared to resin blocks. Three-dimensionally printed teeth received significantly lower ratings with regard to enthusiasm, the learning of fine motor skills and spatial awareness, when compared to human teeth (p ≤ .001). However, 3D-printed teeth were appreciated for additional benefits, such as their cleanliness, availability and standardisation of training opportunities with complex root-canal configurations. CONCLUSION: Students preferred extracted human teeth to 3D-printed teeth with respect to their physical characteristics and training experience. However, educational advantages may compensate for the shortcomings. The new questionnaire proved both adequate and accurate to assess the models and educational environment in endodontic training. The new 3D-printed teeth enhanced the learning opportunities.