Implementation of flipped classroom combined with problem-based learning: an approach to promote learning about hyperthyroidism in the endocrinology internship.

BACKGROUND: With the development of medicine, new teaching methods, such as flipped classroom and problem-based learning (PBL), have received much attention in medical education. However, the implementation of flipped classroom combined with PBL in endocrinology education has not been well investigated. Considering that both two teaching methods may complement each other, therefore, the aim of this study was to evaluate students' learning effectiveness acceptability of the pedagogy between traditional lecture-based teaching methods and the combination of flipped classrooms with PBL teaching methods in the endocrinology internship. METHODS: 74 fourth-year medical students at the Bengbu Medical College were enrolled in the endocrinology internship. Hyperthyroidism was chosen for the content of this study. The participants were randomly allocated into either the combination group of flipped classroom with PBL (CG) or the traditional lecture-based classroom group (TG). Both a pre-quiz and a post-quiz were conducted before and after the classes, respectively. All questions in the quizzes were classified into two aspects, basic theoretical knowledge and clinical case analyses based on the Bloom's Taxonomy. The scores were compared and students were required to complete the questionnaire to evaluate their perceptions and experience. RESULTS: The mean post-quiz scores of both the TG and the CG were higher than those of the pre-quiz. Additionally, the post-quiz showed that students in the CG had significantly higher scores in the TG. Further analysis found that after class, only the difference in clinical case analysis between CG and TG was significant. The scores of all items in the questionnaires were higher in the CG than in the TG. More students agreed that the combined teaching method could help to improve their performance, at the same time, it could increase their workload. CONCLUSIONS: The combination of the flipped classroom and PBL teaching approach could be a better option over the traditional lecture-based classroom in the teaching of hyperthyroidism during endocrinology internship, although it can increase students' workload. To be widely accepted and implemented, further optimizations are required.

Sex differences in symptom network structure of depression, anxiety, and self-efficacy among people with diabetes: a network analysis.

Aims: The present study aims to explore the relations between symptoms of depression and anxiety and self-efficacy among people with diabetes. At the same time, we also examined the sex difference between network structures. Methods: This study recruited 413 participants with diabetes, and they completed Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and the Self-efficacy for Diabetes (SED). Symptom network analysis and network comparison test were used to construct and compare the depression-anxiety symptom network models of the female and male groups. Finally, we conducted flow diagrams to explore the symptoms directly or indirectly related to self-efficacy. Results: The strongest edges in the depression-anxiety symptom networks are the edge between "GAD3" (Excessive worry) and "GAD4" (Trouble relaxing) and the edge between "PHQ1" (Anhedonia) and "PHQ4" (Energy) in the female and male groups, respectively. Most of the symptoms with the highest EI and bridge EI are related to worry and nervousness. Additionally, in the flow diagram of the female group, "PHQ6" (Guilt) has a high negative association with self-efficacy. Conclusion: Females with diabetes are more vulnerable to depression and anxiety. Interventions targeting key symptoms in the network may be helpful in relieving the psychological problems among people with diabetes.

Autologous Platelet-Rich Gel Accelerates Diabetic Wound Healing Through Inhibition of Ferritinophagy.

Aims: The objective was to examine the efficacy of autologous platelet-rich gel (APG) in treating diabetic wound and investigate the association between APG and ferritinophagy. Methods: A total of 32 patients with diabetic foot (DF) and Wagner grade 1 to 2 were included. Within the APG group, individuals with DF received weekly APG treatment. In the non-APG group, DF patients received daily dressing changes. Flow cytometry quantified the proportion of endothelial progenitor cells (EPCs) in peripheral blood on days 0 and 10. The diabetic rat model was induced using Streptozotocin. Two circular skin wounds were created on the backs of rats. The normal glucose group received daily dressing changes on the wound. In the diabetic group, the left wound underwent daily dressing changes, whereas the right wound was treated with APG once a week. CD34 levels were tested 7 days after the skin damage. The levels of glutathione peroxidase 4 (GPX4), Nuclear Receptor Coactivator 4 (NCOA4), Light chain 3 (LC3), and Masson staining were quantified on 14 days. The wound area and wound healing rate were separately measured at 0 and 14 days after the injury, regardless of DF patients or diabetic rats. Results: The wound healing rate was higher in the APG group than in the non-APG group, regardless of DF patients or diabetic rats. The APG group had a greater ΔEPCs% in DF patients than the non-APG group. Regarding rat experiment, the APG group exhibited lower levels of NCOA4, and LC3 expressions and a shorter wound healing time. However, the APG group showed higher levels of CD34 expression, GPX4 protein, and collagen fibers than the non-APG group. Conclusions: Autologous platelet-rich gel accelerated the wound healing rate in diabetic populations and rats. Autologous platelet-rich gel promoted EPCs counts, collagen fiber volume, and vessel numbers. Autologous platelet-rich gel decreased LC3 and NCOA4 expression, but increased GPX4 protein expression. The possible mechanism was the inhibition of ferritinophagy.

Autoimmune Polyendocrinopathy Induced by an Antibody (KN046) That Simultaneously Inhibits PD-L1 and CTLA-4: A Case Report and Literature Review.

Endocrine adverse reactions are one of the most common adverse reactions in the treatment of immune checkpoint inhibitors (ICIs), mainly involving the pituitary gland, pancreas, thyroid gland, adrenal gland and other glands, resulting in corresponding endocrine dysfunction. We report a 45-year-old man with non-small-cell lung cancer who developed hypophysitis 11 months after initiation of treatment with an anti-PD-L1/CTLA-4 bispecific antibody (KN046) that blocks both programmed death ligand-1 (PD-L1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4), followed by regular oral replacement doses of prednisone and levothyroxine tablets. The patient was diagnosed with type 1 diabetes mellitus (T1DM) with diabetic ketoacidosis (DKA) 25 months after the start of immunotherapy, presenting with acute hyperglycemic symptoms, ketoacidosis, and negative diabetic autoantibodies. By describing a case of KN046 immunotherapy involving multiple endocrine glands and reviewing relevant literature, we were able to summarize the clinical characteristics of KN046 immunotherapy-induced endocrine system-related immune-related adverse events (irAEs) for use in early detection, diagnosis and treatment.

Simultaneous Adsorption of Cu2+ and Cd2+ by a Simple Synthesis of Environmentally Friendly Bamboo Pulp Aerogels: Adsorption Properties and Mechanisms.

The highly efficient, pollution-free and degradable biomass-based adsorbents used for the purification of wastewater are currently being highlighted in the research. Bamboo is an excellent raw material for pulp production due to its characteristics of fast growth, wide distribution and high cellulose content. In this study, a tannin/chitosan/bamboo pulp aerogel (TCPA), an environmentally friendly, renewable and low-density adsorbent, was synthesized using a simple freeze-drying method and analyzed by FTIR, XPS, SEM, TEM, TGA and surface area and porosity methods. TCPA has a large specific surface area (137.33 m2/g) and 3D porous structure, and its surface has multiple functional groups including amino, carboxyl and hydroxyl groups, which lead to a simultaneous absorption effect with Me2+ (Cu2+ and Cd2+). The maximum adsorption capacity for Cu2+ and Cd2+ of the TCPA was 72.73 mg/g and 52.52 mg/g, respectively. The adsorption processes of Me2+ by TCPA follow the pseudo-second-order model and Langmuir isotherm mode, and the adsorption processes are spontaneous and endothermic. The study provides a promising candidate for the treatment of wastewater containing heavy metal mixtures.

Soluble ST2 is associated with increased carotid intima-media thickness in patients with type 2 diabetes mellitus: A case-control study.

Soluble suppression of tumorigenicity 2 (sST2) is a free form of membrane-bound ST2, which is a member of the interleukin-1 receptor family. Previous research has shown that sST2 is associated with diabetes, but cardiovascular risk factors have not been established.To analyze the relationship between sST2 and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM).After screening, a total of 118 subjects with T2DM were divided into 2 groups according to the measurement of CIMT (normal CIMT (NCIMT), n = 58; abnormal CIMT (ACIMT), n = 60), and 60 healthy subjects (normal control (NC), n = 60) were recruited in this study. CIMT was measured by a color Doppler ultrasound, and sST2 and other metabolic parameters were measured as well.The median concentration of sST2 was elevated in the ACIMT group (31.30 ng/ml) compared with the NCIMT group (28.29 ng/ml, P < .01) and the NC group (20.15 ng/ml, P < .01). After adjustment for age and sex, log sST2 was strongly associated with smoking history (ß = 0.197, 95% CI, 0.084-0.311, P < .01), FPG level (ß = 0.302, 95% CI, 0.162-0.442, P < .01) and HbA1c level (ß = 0.296, 95% CI, 0.165-0.426, P < .01) and negatively correlated with HDL level (ß = -0.153, 95% CI, -0.259 to -0.046, P < .01). Furthermore, sST2 level was a risk factor for increased CIMT in patients with T2DM.Increased sST2 level not only was associated with indicators of glucose and lipid metabolism but also was a risk factor for increased CIMT in patients with T2DM. Thus, sST2 may be a potential novel marker to assess the progression of diabetic macrovascular complications.

The inhibition of SGK1 suppresses epithelial-mesenchymal transition and promotes renal tubular epithelial cell autophagy in diabetic nephropathy.

Diabetic nephropathy (DN) is a common complication of diabetes that is the dominant cause of end-stage renal disease. However, the pathological mechanism of DN is yet to be elucidated. Serum and glucocorticoid induced kinase (SGK) 1, a ubiquitously expressed kinase, was employed in the current study to assess its effect on DN in vivo and in vitro. Male BALB/C mice and a human tubular epithelial cell line (HK-2) were utilized for experimentation. Male BALB/C mice and a human tubular epithelial cell line (HK-2) were utilized for experimentation. Pathological changes were measured via HE and staining and immunohistochemistry was performed to measure the expression of SGK 1. An SGK1 inhibitor, GSK650394, was applied to analyze the role of SGK1 in HK-2 cell epithelial-mesenchymal transition (EMT). Associated protein expressions were assessed via western blotting. In addition, migration was measured using a scratch wound healing assay. 3-methyladenine (3-MA), an autophagy inhibitor, was used to determine the variation of autophagy following SGK1 inhibition. The expression of autophagy proteins were analyzed. Furthermore, the expression of PI3K, AKT, mTOR and their levels of phosphorylation were measured. The results revealed that the ultrastructure of renal tissue suffered damage and that the expression of SGK1 was markedly increased. After SGK1 inhibition, HK-2 cell EMT was suppressed and cell migration was attenuated. Furthermore, the autophagy of HK-2 cells was promoted, an increased expression of Beclin-1 and LC3 II was detected, and a decreased expression of p62 was observed. Additionally, the phosphorylation of PI3K, AKT and mTOR were markedly upregulated. The results indicated that blocking autophagy signaling via 3-MA muted SGK1-protected against HG-evoked cell injury. Our study demonstrated that SGK1 inhibition promoted autophagy and suppressed renal tubular epithelial cell EMT in DN, indicating that SGK1 may serve as a potential therapeutic target of DN.

Geniposide improves hepatic inflammation in diabetic db/db mice.

The current study was designed to investigate the protective role of geniposide (GE) in liver injury in diabetic C57BL/KsJ-db/db mice and to explore the underlying mechanisms. The oral glucose tolerance test was performed, and the levels of insulin, alanine aminotransferase (ALT), aspartate aminotransaminase (AST), total cholesterol (TC) and triglyceride (TG) were determined. The levels of the pro-inflammatory cytokines interleukin (IL)-1ß, IL-6 and tumour necrosis factor-α were decreased by GE, metformin and fasudil in diabetic db/db mice. Western blotting analysis showed that the expression levels of Rho, ROCK1, ROCK2, p-NF-κBp65 and p-IκBα were significantly reversed by GE treatment. These findings demonstrated that GE exhibits a protective effect on diabetic hepatic inflammation.

Geniposide reduces development of streptozotocin-induced diabetic nephropathy via regulating nuclear factor-kappa B signaling pathways.

Renal pathology was a commonly seen complication in patients with diabetes. Geniposide (GPO) was previously demonstrated to modulate glucose metabolism in diabetes. This study was to investigate effects of GPO in streptozotocin-induced diabetic rats and its underlying mechanism. Renal function in diabetic rats was evaluated by levels of serum creatinine (Scr), blood urea nitrogen (BUN), and urinary albumin. Renal inflammation was appraised by inflammatory cells infiltration and pro-inflammatory cytokines production. Renal monocytes, T lymphocytes infiltration, and intercellular adhesion molecule-1 (ICAM-1) expression were quantitated by immunohistochemistry. Moreover, renal nuclear factor-kappa B (NF-κB) was assayed by Western blotting. Diabetic rats showed renal dysfunction as evidenced by increased levels of Scr, BUN, urinary albumin, and elevator renal index. Histological examination revealed significant glomerular basement membrane (GBM) thickening. However, GPO notably improved renal function and diabetes-induced GBM changes. Additionally, diabetic rats showed noteworthy renal inflammation,as reflected by enhancement of monocytes and T lymphocytes infiltration, increased expression of ICAM-1, tumor necrosis factor-α, interleukin-1 (IL-1), and IL-6. Interestingly, the level of monocytes infiltration positively correlated with the severity of GBM. Further study indicated diabetic rats displayed increased activation of NF-κB, indicated by increased expression of NF-κB p65, IKKα, and p-IκBα in renal tissue. However, all the changes in renal inflammation and NF-κB pathway were obviously reversed in GPO-treated diabetic rats. Our works indicate GPO ameliorates structural and functional abnormalities of kidney in diabetic rats, which is associated with its suppression of NF-κB-mediated inflammatory response.

Horner syndrome as a postoperative complication after minimally invasive video-assisted thyroidectomy: A case report.

RATIONALE: Horner syndrome is an unusual complication after thyroidectomy. PATIENT CONCERNS: We report a case of Horner syndrome in a 34-year-old female patient with Graves disease associated with papillary thyroid carcinoma who underwent left-side minimally invasive video-assisted thyroidectomy and neck dissection. DIAGNOSIS: Horner syndrome was diagnosed based on left myosis, eyelid ptosis, and mild enophthalmos, which developed in the patient on postoperative day 2. INTERVENTIONS: The patient was administered glucocorticoids and neurotrophic drugs on postoperative day 3. OUTCOME: The symptoms of Horner syndrome were significantly relieved 1 year later. LESSONS: Surgeons must be aware that Horner syndrome may be a source of iatrogenic complications, and patients also should be informed of these complications before surgery.