Perception of enhanced learning in medicine through integrating of virtual patients: an exploratory study on knowledge acquisition and transfer.

INTRODUCTION: Virtual Patients (VPs) have been shown to improve various aspects of medical learning, however, research has scarcely delved into the specific factors that facilitate the knowledge gain and transfer of knowledge from the classroom to real-world applications. This exploratory study aims to understand the impact of integrating VPs into classroom learning on students' perceptions of knowledge acquisition and transfer. METHODS: The study was integrated into an elective course on "Personalized Medicine in Cancer Treatment and Care," employing a qualitative and quantitative approach. Twenty-two second-year medical undergraduates engaged in a VP session, which included role modeling, practice with various authentic cases, group discussion on feedback, and a plenary session. Student perceptions of their learning were measured through surveys and focus group interviews and analyzed using descriptive statistics and thematic analysis. RESULTS: Quantitative data shows that students highly valued the role modeling introduction, scoring it 4.42 out of 5, and acknowledged the practice with VPs in enhancing their subject matter understanding, with an average score of 4.0 out of 5. However, students' reflections on peer dialogue on feedback received mixed reviews, averaging a score of 3.24 out of 5. Qualitative analysis (of focus-group interviews) unearthed the following four themes: 'Which steps to take in clinical reasoning', 'Challenging their reasoning to enhance deeper understanding', 'Transfer of knowledge ', and ' Enhance Reasoning through Reflections'. Quantitative and qualitative data are cohered. CONCLUSION: The study demonstrates evidence for the improvement of learning by incorporating VPs with learning activities. This integration enhances students' perceptions of knowledge acquisition and transfer, thereby potentially elevating students' preparedness for real-world clinical settings. Key facets like expert role modeling and various authentic case exposures were valued for fostering a deeper understanding and active engagement, though with some mixed responses towards peer feedback discussions. While the preliminary findings are encouraging, the necessity for further research to refine feedback mechanisms and explore a broader spectrum of medical disciplines with larger sample sizes is underscored. This exploration lays a groundwork for future endeavors aimed at optimizing VP-based learning experiences in medical education.

Molecular and cellular pruritus mechanisms in the host skin.

Pruritus, also known as itching, is a complex sensation that involves the activation of specific physiological and cellular receptors. The skin is innervated with sensory nerves as well as some receptors for various sensations, and its immune system has prominent neurological connections. Sensory neurons have a considerable impact on the sensation of itching. However, immune cells also play a role in this process, as they release pruritogens. Disruption of the dermal barrier activates an immune response, initiating a series of chemical, physical, and cellular reactions. These reactions involve various cell types, including keratinocytes, as well as immune cells involved in innate and adaptive immunity. Collective activation of these immune responses confers protection against potential pathogens. Thus, understanding the molecular and cellular mechanisms that contribute to pruritus in host skin is crucial for the advancement of effective treatment approaches. This review provides a comprehensive analysis of the present knowledge concerning the molecular and cellular mechanisms underlying itching signaling in the skin. Additionally, this review explored the integration of these mechanisms with the broader context of itch mediators and the expression of their receptors in the skin.

Effects of green tide on microbial communities in waters of the Jiangsu coastal area, China.

Recently, green tide outbreaks have resulted in severe coastal ecology and economic effects in China. Jiangsu coastal areas are usually the site of early green tide outbreaks. To clarify the effects of green tide outbreaks in Jiangsu coastal areas, this study analyzed microbial communities during green tide-free and green tide outbreak periods (May and July, respectively) through 16S rDNA sequencing. Sequences were clustered into 4117 operational taxonomic units (OTUs), 1044 and 3834 of which were obtained from the May and July groups, respectively. Redundancy analysis indicated that green tide occurrence was closely associated with the temperature, pH, and concentrations of various nutrients. Diversity analysis revealed that the July group had a richer microbial community than the May group, in agreement with the results of propagule culture. Moreover, comparative analysis revealed that samples in the May and July groups clustered together. According to Megan analysis, the May group had much more Psychrobacter, Sulfitobacter, and Marinomonas than the July group, whereas the other genera were predominantly found in July, such as Ascidiacerhabitans, Synechococcus Hydrotalea, and Burkholderia-Paraburkholderia. These findings suggest that green tide outbreaks affect marine microbial communities, and detecting the changes in the identified genera during green tide outbreaks may contribute to green tide forecasting. PRACTITIONER POINTS: Jiangsu coastal areas are usually the site of early green tide outbreaks. Green tide occurrence was related to the concentrations of various nutrients. Microbial species and community structure significantly changed after green tide outbreak.

Assessment of heavy metals in water, sediment and shellfish organisms in typical areas of the Yangtze River Estuary, China.

Identifying the transformations of heavy metal in different media is a scientific issue, and geographical detector is applied to evaluate the spatiotemporal stratified heterogeneity mechanisms for heavy metals in the Yangtze River Estuary. Heavy metal concentrations in water and sediment were consistent with lognormal distributions. Their concentrations were organized into four classes. Class 1 included concentrations that were less than or equal to 25%, Class 2 included those between 25%-50%, Class 3 concentrations were between 50%-75% and Class 4 were >75%, which were based on their lognormal distributions. In water and sediment, the mean heavy metal concentrations yearly decreased from 2012 to 2016. The Chongming area was significantly lower than those found in the other areas, which is the least affected area by anthropogenic activities. The explanatory power of sediment to spatiotemporal stratified heterogeneity of heavy metals in shellfish organisms was much greater than that of water.

Spatiotemporal assessment of marine environmental monitoring programme based on DIN concentration in the Yangtze River estuary and its adjacent sea.

The marine environment is rigorously protected in the Yangtze River Estuary (YRE) and its adjacent sea, and routine monitoring is constantly upgraded. Therefore, scientific and efficient monitoring programmes are needed. Nitrogen is one of the most serious pollutants in the YRE. Obtaining the precise pollution areas of water quality grades (WQGs) are a scientific and management issue that requires optimization of monitoring programmes and interpolation methods. Based on spatiotemporal regression point means of surface with non-homogeneity (STR-PMSN), dissolved inorganic nitrogen (DIN) concentrations were estimated in a stratified heterogeneous estuary. The annual average areas of DIN Grades I and II were classified by interpolating the concentrations; the values were 3145 km2, 1626 km2, 2320 km2 and 3758 km2 for February, May, August and November, respectively. This means that November had the best water condition, and May had the worst. Meanwhile, DIN area changes showed that the water condition changed due to removal of data much more in August and May than in February and November. The descending order of importance was August, May, February and November. Every month represented different runoff periods. Monitoring frequency should not be reduced. Removal of sampling data for the third stratum had a significant effect on the area. When the sampling data for outer boundary meshes of the third stratum were removed, the water condition became worse. However, when the sampling data for inner boundary meshes were removed, the water condition improved. New sites should be added to the outer boundary region to avoid interpolation instability and reduce the sensitivity of the existing sites. This study assesses the spatiotemporal effect of the marine environmental monitoring programmes on pollutant distribution by STR-PMSN, and it offers guidance for more precise data acquisition and processing methods in the YRE and its adjacent sea.

Assessment of dissolved heavy metal in the Yangtze River estuary and its adjacent sea, China.

The purpose of this paper is to determine the concentrations of dissolved heavy metals namely mercury (Hg), lead (Pb), cadmium (Cd), and copper (Cu) and to investigate the relationships between nutrients (nitrate-nitrogen and phosphate) and dissolved heavy metals. For this purpose, the concentrations of dissolved heavy metals were measured through 51 voyages form 1984 to 2006 in the Yangtze river estuary and its adjacent sea. Results analysis showed that dissolved heavy metals were not the main pollutants in the Yangtze river estuary, and the main source of heavy metal contamination was industrial wastewater from terrestrial pollution during the past 20 years. Heavy metal values showed significant abundance in the south branch of the Yangtze River estuary and Hangzhou Bay. In addition, Pb showed negative correlation with nutrients, while the positive correlations between Hg, Cd, and nutrients were shown. The obtained molar ratios, DeltaCd/DeltaN = 1.68 x 10(-5) and DeltaCd/DeltaP = 1.66 x 10(-4), are close to those in plankton, showing the biogeochemical behavior and process of dissolved cadmium.

Extension of life span and improvement of vitality of Drosophila melanogaster by long-term supplementation with different molecular weight polysaccharides from Porphyra haitanensis.

Polysaccharides isolated from Porphyra (porphyran) have been known to have diverse biological activities, including immunomodulatory and antioxidant activities. The molecular weight-antiaging activity relationship of degraded porphyrans was examined in this study. Natural porphyran was extracted from P. haitanensis, and then was degraded into different molecular weight fractions, P1 molecular weight 49 kDa, P2 molecular weight 30 kDa, P3 molecular weight 8.2 kDa, by free radical. The influence on life span and vitality of porphyrans were carried out on Drosophila melanogaster. We found that all the degraded porphyrans and natural porphyran (P), added daily to the diet, can significantly increase the life span of D. melanogaster, except for P3. Among them, P1 exhibited the most prolonging life span activity. Furthermore, vitality of middle-aged flies (assessed by measuring their mating capacity) receiving porphyrans was increased considerably in comparison with the controls. Finally, in the heat-stress test, we observed a remarkable increase in survival time, especially in P3-diet groups. These results suggest that porphyrans may be effective in reducing the rate of the aging process and molecular weight has important influence on the effects. It seems that P1 and P2, possessed higher molecular weight, may be more useful in normal metabolic condition and P3, possessed the lowest molecular weight, may be more beneficial for D. melanogaster in stress condition.

Antioxidant activity of sulfated polysaccharide fractions extracted from Laminaria japonica.

Fucoidan, a group of sulfated heteropolysaccharide, was extracted from Laminaria japonica, an important economic alga species in China. Three sulfated polysaccharide fractions (F1, F2, and F3) were successfully isolated through anion-exchange column chromatography and had their antioxidant activities investigated employing various established in vitro systems, including superoxide and hydroxyl radical scavenging activity, chelating ability, and reducing power. Chemical analysis suggested that F1 and F3 were heteropolysaccharide in which galactose was the major component, while F2 was a typical fucoidan. All fractions possessed considerable antioxidant activity, and F1, F2 and F3 had stronger antioxidant ability than fucoidan in certain tests. The correlation between the sulfate content and scavenging superoxide radical ability was positive. Available data obtained with in vitro models suggested that the ratio of sulfate content/fucose was an effective indicator to antioxidant activity of the samples.

In vitro antioxidant activity of acetylated and benzoylated derivatives of polysaccharide extracted from Ulva pertusa (Chlorophyta).

The antioxidant activity of natural ulvan and its derivatives (acetylated and benzoylated ulvans) in vitro was determined, including scavenging activity against superoxide and hydroxyl radicals, reducing power, and chelating ability. Obvious differences in antioxidant activity between natural ulvan and its derivatives were observed, moreover, the antioxidant activity of acetylated and benzoylated ulvans was stronger than that of natural ulvan.

Degradation of porphyran from Porphyra haitanensis and the antioxidant activities of the degraded porphyrans with different molecular weight.

In the present paper, ascorbate and hydrogen peroxide (H2O2) were used to degrade porphyran. It was found that porphyran could be degraded by free radical that was generated by ascorbate and H2O2 in combination. It was possible to prepare desired porphyran products with different molecular weight by adjusting ascorbate to H2O2 proportions and their concentrations. The molar ratio of 1 was demonstrated more effective than in other ratios. Higher concentrations accelerated the degradation. Moreover, results of chemical analysis and FT-IR spectra suggested that the main structure of degraded products still remained although some changes happened. The degraded and natural porphyrans possessed scavenging 1,1-diphenyl-2-picrylhydrazyl (DPPH)-radical activity and reducing power. Higher antioxidant activities were found in both systems when the molecular weight was reduced. The results indicated that the antioxidant activities were closely related to the molecular weight. The degraded porphyrans are potential antioxidant in vitro.

Antioxidant activity of different sulfate content derivatives of polysaccharide extracted from Ulva pertusa (Chlorophyta) in vitro.

Polysaccharide extracted from Ulva pertusa (Chlorophyta) is a group of sulfated heteropolysaccharide; for simplicity, the sulfated polysaccharide is referred to as ulvan in this paper. In this study, different sulfate content ulvans were prepared with sulfur trioxide/N,N-dimethylformamide (SO3-DMF) in formamide, and their antioxidant activities were investigated including scavenging activity of superoxide and hydroxyl radicals, reducing power and metal chelating ability. As expected, we obtained several satisfying results, as follows: firstly, high sulfate content ulvans had more effective scavenging activity on hydroxyl radical than natural ulvan. Secondly, comparing with natural ulvan, high sulfate content ulvans exhibited stronger reducing power. Thirdly, HU4 (sulfate content, 30.8%) and HU5 (sulfate content, 32.8%) showed more pronounce chelating ability on ferrous ion at high concentration than other samples.

[Determination of trace arsenic and selenium in jellyfish by microwave digestion-hydride generation-atomic fluorescence spectrometry].

A method of hydride generation-atomic fluorescence spectrometry was proposed in the present paper for the determination of trace arsenic and selenium in jellyfish. The samples were treated by the combination of microwave digestion and lyophilization. The optimal conditions for treating and analyzing samples were established. The problem of the effect of the superfluous acid in the digesting solution on the results was solved, and the influence of coexisting foreign ions on the determination of arsenic and selenium was investigated. The accuracy of the method was confirmed by the method of standard additions. This method proved to be simple, rapid and repeatable, and is suitable for the analysis of biologic samples containing water.

Salt-assisted acid hydrolysis of chitosan to oligomers under microwave irradiation.

The effect of inorganic salts such as sodium chloride on the hydrolysis of chitosan in a microwave field was investigated. While it is known that microwave heating is a convenient way to obtain a wide range of products of different molecular weights only by changing the reaction time and/or the radiation power, the addition of some inorganic salts was shown to effectively accelerate the degradation of chitosan under microwave irradiation. The molecular weight of the degraded chitosan obtained by microwave irradiation was considerably lower than that obtained by traditional heating. Moreover, the molecular weight of degraded chitosan obtained by microwave irradiation assisted under the conditions of added salt was considerably lower than that obtained by microwave irradiation without added salt. Furthermore, the effect of ionic strength of the added salts was not linked with the change of molecular weight. FTIR spectral analyses demonstrated that a significantly shorter time was required to obtain a satisfactory molecular weight by the microwave irradiation-assisted inorganic salt method than by microwave irradiation without inorganic salts and conventional technology.

Fucoidan inhibits the development of proteinuria in active Heymann nephritis.

Fucoidan, the sulphated polysaccharide extracted from brown seaweed, has various biological activities. The effect of fucoidan on the formation of proteinuria and renal functions in active Heymann nephritis was investigated in this study. Active Heymann nephritis was induced by administering brush border protein of rat proximal uriniferous tubules (FX1A). Fucoidan was administered by oral intubation to Heymann nephritis rats at three doses (50, 100 and 200 mg/kg) once daily for 4 weeks. The elevated urinary protein excretion and plasma creatinine due to the induction of Heymann nephritis were significantly reduced by fucoidan at doses of 100 and 200 mg/kg. The results indicated that fucoidan has a renoprotective effect on active Heymann nephritis and is a promising therapeutic agent for nephritis.

Relevance of molecular weight of chitosan and its derivatives and their antioxidant activities in vitro.

The antioxidant potency of different molecular weight (DMW) chitosan and sulfated chitosan derivatives was investigated employing various established in vitro systems, such as superoxide (O(2)(.-))/hydroxyl ((-.)OH) radicals scavenging, reducing power, iron ion chelating. As expected, we obtained several satisfying results, as follows: firstly, low molecular weight chitosan had stronger scavenging effect on O(2)(.-) and (-.)OH than high molecular weight chitosan. For example the O(2)(.-) scavenging activity of low molecular weight chitosan (9 kDa) and high molecular weight chitosan (760 kDa) were 85.86% and 35.50% at 1.6 mg/mL, respectively. Secondly, comparing with DMW chitosan, DMW sulfated chitosans had the stronger inhibition effect on O(2)(.-). At 0.05 mg/mL, the scavenging activity on O(2)(.-) reached 86.26% for low molecular weight chitosan sulfate (9 kDa), but that of low molecular weight chitosan (9 kDa) was 85.86% at 1.6 mg/mL. As concerning chitosan and sulfated chitosan of the same molecular weight, scavenging activities of sulfated chitosan on superoxide and hydroxyl radicals were more pronounced than that of chitosan. Thirdly, low molecular weight chitosan sulfate had more effective scavenging activity on O(2)(.-) and (-.)OH than that of high molecular weight chitosan sulfate. Fourthly, DMW chitosans and sulfated chitosans were efficient in the reducing power, especially LCTS. Their orders were found to be LCTS>CTS4>HCTS>CTS3>CTS2>CTS1>CTS. Fifthly, CTS4 showed more considerable ferrous ion-chelating potency than others. Finally, the scavenging rate and reducing power of DMW chitosan and sulfated derivatives increased with their increasing concentration. Moreover, change of DMW sulfated chitosans was the most pronounced within the experimental concentration. However, chelating effect of DMW chitosans were not concentration dependent except for CTS4 and CTS1.

Antioxidant activity of differently regioselective chitosan sulfates in vitro.

Differently regioselective chitosan sulfates were prepared according to Hanno Baumann's methods. Their antioxidant potencies were investigated employing various established in vitro systems, such as 1,1-diphenyl-2-picrylhydrazyl (DPPH)/superoxide/hydroxyl radicals scavenging, reducing power, iron ion chelating and total antioxidant activity. All kinds of sulfated chitosans (HCTS, TSCTS, SCTS, TCTS) showed strong inhibitory activity toward superoxide radical by the PMS-NADH system compared to Vc. According to the above-mentioned order their IC50 were 0.012, 0.040, 0.015, 0.022 mg/mL, respectively, however, scavenging activity of Vc on superoxide radical was 68.19% at 2.0 mg/mL. Scavenging activity of superoxide radical was found to be in the order of HCTS>SCTS>TCTS>TSCTS>Vc. Furthermore, all kinds of sulfated chitosans exhibited strong concentration-dependent inhibition of deoxyribose oxidation. Except for HCTS, others had stronger scavenging activity on hydroxyl radical than Vc. Scavenging effect of TSCTS on 1,1-diphenyl-2-picrylhydrazyl radical was little lower than that of BHA, but better than that of others. All kinds of sulfated chitosans were efficient in the reducing power, especially TSCTS. TSCTS and TCTS showed considerable ferrous ion chelating potency. The data obtained in vitro models clearly establish the antioxidant potency of all kinds of sulfated chitosans. These in vitro results suggested the possibility that sulfated chitosans could be effectively employed as ingredient in health or functional food, to alleviate oxidative stress. However, comprehensive studies need to be conducted to ascertain the in vivo safety of sulfated chitosans in experimental animal models.

In vivo growth-inhibition of S180 tumor by mixture of 5-Fu and low molecular lambda-carrageenan from Chondrus ocellatus.

Lambda-carrageenan is a sulfated galactan isolated from some red algae and have been reported to have many kinds of biological activities. Chondrus ocellatus is an important economic alga in China and many other parts of the world. The sample was obtained after lambda-carrageenan from the alga was degraded by microwave and its molecular weight is 9.3 kDa. In this study, tumor inhibiting activity of low molecular weight lambda-carrageenan and its mixture with 5-Fu on mice transplanted with S180 tumor was investigated. Weight of immune organ, proliferation ratio of lymphocyte concentration of TNF-alpha and histopathology of spleen and tumor from the transplanted S180 tumor mice were also determined. Results indicated that the degraded lambda-carrageenan could enhance antitumor activity of 5-Fu and improve immunocompetence damaged by 5-Fu.

Preparation of low-molecular-weight and high-sulfate-content chitosans under microwave radiation and their potential antioxidant activity in vitro.

In the present paper microwave radiation has been used to introduce N-sulfo and O-sulfo groups into chitosan with a high degree of substitution and low-molecular weight. The sulfation of chitosan was performed in microwave ovens. It was found that microwave heating is a convenient way to obtain a wide range of products of different degrees of substitution and molecular weight only by changing reaction time or/and radiation power. Moreover, microwave radiation accelerated the degradation of sulfated chitosan, and the molecular weight of sulfated chitosan was considerably lower than that obtained by traditional heating. There are no differences in the chemical structure of sulfated chitosan obtained by microwave and by conventional technology. FTIR and 13C NMR spectral analyses demonstrated that a significantly shorter time is required to obtain a satisfactory degree of substitution and molecular weight by microwave radiation than by conventional technology. In this present paper, we also determined antioxidant activity of low-molecular-weight and high-sulfate-content chitosans (LCTS). The results showed LCTS could scavenge superoxide and hydroxyl radical. Its IC50 is 0.025 and 1.32 mg/mL, respectively. It is a potential antioxidant in vitro.

In vivo antitumor and immunomodulation activities of different molecular weight lambda-carrageenans from Chondrus ocellatus.

lambda-Carrageenan is a sulfated galactan isolated from some red algae and have been reported to have many kinds of biological activities. lambda-Carrageenan from Chondrus ocellatus, an important economic alga in China and many other parts of the world, was degraded by microwave, and obtained five products that have different molecular weight: 650, 240, 140, 15, 9.3 kDa. Analytical results confirmed that microwave degradation might not change the chemical components and structure of polysaccharides under certain condition. In this study, tumor-inhibiting activities, weight of immune organ, nature killer cells activity, lymphocyte proliferation ratio and pathological slice of spleen and tumor cells from the control group and lambda-carrageenan-treated mice of transplanted S180 and H22 tumor were investigated. The results indicated that the five lambda-carrageenan samples all showed antitumor and immunomodulation activities in different degree. Molecular weight of polysaccharides had notable effect on the activities. In addition, their antitumor and immunomodulation have some relevance and the five lambda-carrageenans probably inhibited tumor by means of activating the immunocompetence of the body. Among all the experiment results, samples with the highest activities are PC4 and PC5 whose molecular weight are 15 and 9.3 kDa.

The structure of a sulfated galactan from Porphyra haitanensis and its in vivo antioxidant activity.

The sulfated galactan fraction F1 isolated from the red seaweed, Porphyra haitanensis, showed typical porphyran structure. It has a linear backbone of alternating 3-linked beta-D-galactosyl units and 4-linked alpha-L-galactosyl 6-sulfate and 3,6-anhydro-alpha-L-galactosyl units. The L-residues are mainly composed of alpha-L-galactosyl 6-sulfate units, and the 3,6-anhydrogalactosyl units are minor. Partial methylation occurred at the C-6 position of the D-galactosyl units and at the C-2 position of the 3,6-anhydro-alpha-L-galactosyl units. Intraperitoneal administration of F1 significantly decreased the lipid peroxidation in aging mice. F1 treatment increased the total antioxidant capacity and the activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in aging mice. The results indicated that F1 had significant in vivo antioxidant activity.