Polyethylenimine Inclusion to Develop Aqueous Alginate-Based Core-Shell Capsules for Biomedical Applications.

Aqueous core-shell structures can serve as an efficient approach that allows cells to generate 3D spheroids with in vivo-like cell-to-cell contacts. Here, a novel strategy for fabricating liquid-core-shell capsules is proposed by inverse gelation of alginate (ALG) and layer-by-layer (LbL) coating. We hypothesized that the unique properties of polyethylenimine (PEI) could be utilized to overcome the low structural stability and the limited cell recognition motifs of ALG. In the next step, alginate dialdehyde (ADA) enabled the Schiff-base reaction with free amine groups of PEI to reduce its possible toxic effects. Scanning electron microscopy and light microscopy images proved the formation of spherical hollow capsules with outer diameters of 3.0 ± 0.1 mm for ALG, 3.2 ± 0.1 mm for ALG/PEI, and 4.0 ± 0.2 mm for ALG/PEI/ADA capsules. The effective modulus increased by 3-fold and 5-fold when comparing ALG/PEI/ADA and ALG/PEI to ALG capsules, respectively. Moreover, PEI-coated capsules showed potential antibacterial properties against both Staphylococcus aureus and Escherichia coli, with an apparent inhibition zone. The cell viability results showed that all capsules were cytocompatible (above 75.5%). Cells could proliferate and form spheroids when encapsulated within the ALG/PEI/ADA capsules. Monitoring the spheroid thickness over 5 days of incubation indicated an increasing trend from 39.50 µm after 1 day to 66.86 µm after 5 days. The proposed encapsulation protocol represents a new in vitro platform for developing 3D cell cultivation and can be adapted to fulfill the requirements of various biomedical applications.

Breaking down barriers and building up facilitators of lecture free curriculum in medical education: An interpretive structural modeling.

INTRODUCTION: The field of medical education has seen a growing interest in lecture free curriculum. However, it comes with its own set of challenges and obstacles. In this article, we aim to identify the prerequisites, facilitators, challenges, and barriers of lecture-free curriculum in medical education and examine their interrelationships using interpretive structural modeling (ISM) technique. METHODS: In this mixed-method study initially, we performed a scoping review and semi-structured interviews and determined the main prerequisites, facilitators, challenges, and barriers of lecture-free curriculum in medical education using qualitative content analysis approach. The interrelationships among these components were investigated using ISM. Therefore, self-interactive structural matrices were formed, initial and final reachability matrices were achieved, and MICMAC analysis was conducted to classify the factors. RESULTS: Finally, two ISM models of prerequisites and facilitators with 27 factors in 10 levels and challenges and obstacles with 25 factors in eight levels were developed. Each of the models was divided into three parts: key, strategic, and dependent factors. 'Providing relevant evidence regarding lecture free curriculum' emerged as the most important prerequisite and facilitator, and 'insufficient support from the university' was identified as the most critical barrier and challenge. CONCLUSIONS: The study highlights the significant importance of lecture-free curriculum in medical education and provides insights into its prerequisites, facilitators, challenges, and barriers. The findings can be utilized by educational managers and decision-makers to implement necessary changes in the design and implementation of lecture-free in medical education, leading to more effective improvements in the quality and success of education.

A blueprint for success: lessons learned from developing the official guide to Iranian undergraduate medical education accreditation.

We are excited to contribute our thoughts and insights to the discussion initiated by Gandomkar et al. in their article on the accreditation system in Iran (Gandomkar et al., BMC Med Educ 23:379, 2023). As individuals who have been directly involved in the process of meta-accreditation and possess a comprehensive understanding of the various stages of Undergraduate Medical Education (UME) accreditation in Iran, we would like to highlight additional points that were identified through a rigorous hermeneutic phenomenology process proposed by Gadamer (Gadamer, Truth and Method, 2013) and offer a complementary point of view to the previous work. By sharing our insights, we hope to contribute to the ongoing discourse surrounding UME accreditation.

Metamotivation in medical education: The 4F conceptual framework.

INTRODUCTION: Several models and frameworks have been developed in the past two decades to explain motivation regulation in different fields. However, a comprehensive framework that explains the dimensions of metamotivation in medical education is lacking. This study aims to address this gap by presenting a conceptual framework to understand metamotivation in medical education. METHOD: This study was conducted at Tehran University of Medical Sciences in 2022-2023. We applied Crawford's guidance on developing a conceptual framework via collecting data from three sources: experience, literature, and theory. We developed the initial draft of the conceptual framework by identifying gaps in existing models. A panel of experts reviewed the draft and provided feedback on the framework's generation, explanation, and argumentation. The final model was designed in the form of a graphical presentation. FINDINGS: The study's conceptual framework clearly distinguishes between motivational challenges and motivational problems, and outlines four phases that explain each phase's importance, components, and implementation process. The first phase focuses on promoting metamotivational knowledge among learners. In the second phase, learners face motivational challenges and aim to manage them optimally to prevent motivational problems. The third phase occurs when a motivational problem arises, and learners use motivational regulation strategies to resolve it. In the fourth and final phase, learners use psychological skills to stabilize and strengthen the metamotivational process. CONCLUSION: This study's conceptual framework focuses specifically on the context of medical education to provide guidance for future research and interventions on metamotivation. By presenting this framework, we aim to capture the attention of researchers toward the topic of metamotivation and encourage further exploration of its dimensions.

Induction of proteome changes involved in the cloning of mcr-1 and mcr-2 genes in Escherichia coli DH5-α strain to evaluate colistin resistance.

OBJECTIVES: Plasmid genes, termed mobile colistin resistance-1 (mcr-1) and mobile colistin resistance-2 (mcr-2), are associated with resistance to colistin in Escherichia coli (E. coli). These mcr genes result in a range of protein modifications contributing to colistin resistance. This study aims to discern the proteomic characteristics of E. coli-carrying mcr-1 and mcr-2 genes. Furthermore, it evaluates the expression levels of various proteins under different conditions (with and without colistin). METHODS: Plasmid extraction was performed using an alkaline lysis-based plasmid extraction kit, whereas polymerase chain reaction was used to detect the presence of mcr-1 and mcr-2 plasmids. The E. coli DH5α strain served as the competent cell for accepting and transforming mcr-1 and mcr-2 plasmids. We assessed proteomic alterations in the E. coli DH5α strain both with and without colistin in the growth medium. Proteomic data were analysed using mass spectrometry. RESULTS: The findings revealed significant protein changes in the E. coli DH5α strain following cloning of mcr-1 and mcr-2 plasmids. Of the 20 proteins in the DH5α strain, expression in 8 was suppressed following transformation. In the presence of colistin in the culture medium, 39 new proteins were expressed following transformation with mcr-1 and mcr-2 plasmids. The proteins with altered expression play various roles. CONCLUSION: The results of this study highlight numerous protein alterations in E. coli resulting from mcr-1 and mcr-2-mediated resistance to colistin. This understanding can shed light on the resistance mechanism. Additionally, the proteomic variations observed in the presence and absence of colistin might indicate potential adverse effects of indiscriminate antibiotic exposure on treatment efficacy and heightened pathogenicity of microorganisms.

Hypothalamus and Post-Traumatic Stress Disorder: A Review.

Humans have lived in a dynamic environment fraught with potential dangers for thousands of years. While fear and stress were crucial for the survival of our ancestors, today, they are mostly considered harmful factors, threatening both our physical and mental health. Trauma is a highly stressful, often life-threatening event or a series of events, such as sexual assault, war, natural disasters, burns, and car accidents. Trauma can cause pathological metaplasticity, leading to long-lasting behavioral changes and impairing an individual's ability to cope with future challenges. If an individual is vulnerable, a tremendously traumatic event may result in post-traumatic stress disorder (PTSD). The hypothalamus is critical in initiating hormonal responses to stressful stimuli via the hypothalamic-pituitary-adrenal (HPA) axis. Linked to the prefrontal cortex and limbic structures, especially the amygdala and hippocampus, the hypothalamus acts as a central hub, integrating physiological aspects of the stress response. Consequently, the hypothalamic functions have been attributed to the pathophysiology of PTSD. However, apart from the well-known role of the HPA axis, the hypothalamus may also play different roles in the development of PTSD through other pathways, including the hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-gonadal (HPG) axes, as well as by secreting growth hormone, prolactin, dopamine, and oxytocin. This review aims to summarize the current evidence regarding the neuroendocrine functions of the hypothalamus, which are correlated with the development of PTSD. A better understanding of the role of the hypothalamus in PTSD could help develop better treatments for this debilitating condition.

Application of the Intracranial Arterial Pulsatility Index for Determination of Prognosis after Lacunar Infarct.

Background: We aimed to investigate the usefulness of intracranial arterial pulsatility index to assess the prognosis of lacunar infarcts. Materials and Methods: Forty-nine patients with confirmed acute lacunar infarct were enrolled in the study. A transcranial color-coded sonography was performed to assess the pulsatility index of bilateral middle cerebral, posterior cerebral, vertebral, and proximal internal carotid arteries. Patients' clinical status was assessed using a modified Rankin scale. Spearman correlation was used for reporting the relation between quantitative data. Statistical significance was defined as a two-tail p-value of less than 0.05. Results: The mean age ± standard deviation was 64.1 ± 9.07 years old, and 57.1% of the patients were male. Upon discharge, only 8.2% of the patients were ranked as 0 on the modified Rankin scale; however, after a 6-month follow-up period, this number increased to 49%. There were no significant differences between the left and right pulsatility index measurements in any of the assessed arteries. Patients with vertebral artery pulsatility indexes >1 on their primary assessment had significantly worse outcomes during the first, third, and sixth months follow-up (all r > 0.3, p-values < 0.01). Pulsatility indexes from other arteries did not predict the prognosis. Conclusion: Sonography-assisted assessment of the vertebral artery blood flow during the early stage of lacunar infarct provides a reliable reference for prognosis estimation.

Keeping motivation on track by metamotivational knowledge: AMEE Guide No. 160.

This AMEE guide seeks to improve the metamotivational knowledge of health professions educators as well as students. We present key models and frameworks of Metamotivation, identify several motivation regulation strategies and their measurement tools, and propose applications for health professions education (HPE). Since our work is grounded on evidence from the field, we include new findings about motivation regulation to encourage further exploration. Although much of the research on Metamotivation has been done outside the field of medical education, we share our six years of research experience and findings within the field to inspire others to replicate and expand.

The role of motivational components in metamotivational monitoring in medical students: a mixed method study.

BACKGROUND: In metamotivational monitoring, students try to identify the declined motivational component in order to regulate their motivation. There is scarcity of evidence on which motivational components are targeted by the medical students when they use each motivational regulation strategies. This study aims were identifying motivational components in motivational regulation process, developing a measurement tool and, testing the predictive relationship between the motivational components and motivational regulation strategies. METHODS: This exploratory sequential design mixed method study is part of a project has been started from 2018 with medical students at Tehran University of Medical Science. First, in a qualitative study conducting a semi-structured in-depth interview, the motivational components were explored. The interviews continued until saturation of data. Then, in a psychometric study the validity and reliability evidence of questionnaire obtained. In the quantitative study, applying the convenience sampling method, 508 students completed the questionnaires. Predictive relation between the motivational regulation strategies and motivational components was assessed utilising Structural Equation Modelling. Path coefficients, T-Value, and R2 index were reported by SmartPLS software. RESULTS: In the Exploratory Factor Analysis of Motivational Components Questionnaire (MCQ), 6 factors were discovered that explained 74% of the total variance. All paths in seven models of SEM showed a T-Value above 1.96 that means there is a significant correlation between all strategies and components. In examining the predictive relationships, each of the four components of self-efficacy, intrinsic value, self-relevant value and promotion value were specifically predicted by two motivational regulation strategies. CONCLUSIONS: Evidence of validity and reliability of the MCQ indicates that this questionnaire can be used in medical education contexts. Health Profession Educators can improve the academic motivation of students by identifying one or more declined motivational component and teaching specific motivational regulation strategies. It is recommended to hold training courses on motivational regulation strategies for medical school faculty, study-skills advisors, and students.

Tranexamic acid microinjections versus tranexamic acid mesoneedling in the treatment of facial melasma: A randomized assessor-blind split-face controlled trial.

BACKGROUND: Melasma is a hyperpigmentary disorder causing cosmetic disfigurement. We aimed to compare the efficacy and safety of tranexamic acid (TXA) microinjections with TXA mesoneedling for facial melasma. METHODS: This randomized assessor-blind split-face controlled trial included patients with symmetric facial melasma. One side of the face received TXA (100 mg/ml) mesoneedling and the other side intradermal TXA microinjections. The interventions were repeated three times with 4-week intervals (weeks 0, 4, and 8). The primary outcome was improvement in modified Melasma Area and Severity Index (mMASI) 4 weeks after the final treatment session. Secondary outcomes were complications and patient satisfaction with the treatments evaluated by a visual analog scale (VAS). RESULTS: All 27 patients included in the study were female (mean age: 44.22 ± 8.39 years). Both groups were comparable in terms of mMASI scores before and after treatment (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI] -0.22; 0.85, p = 0.248 and SMD = -0.13, 95% CI -0.66; 0.40, p = 0.633, respectively). The mMASI score change from baseline was not different (SMD = -0.39, 95% CI -0.93; 0.15, p = 0.157). However, patient satisfaction was significantly higher with TXA mesoneedling (SMD = 0.77, 95% CI 0.21; 1.32, p = 0.007). Post-inflammatory hyperpigmentation occurred in one patient in the TXA mesoneedling group. Erythema, scaling, and edema were significantly higher with TXA mesoneedling (p < 0.001). CONCLUSIONS: TXA mesoneedling was comparable with TXA microinjection in the treatment of facial melasma, while patient satisfaction was significantly higher with TXA mesoneedling; however, the high frequency of complications occurring with this treatment should be taken into account.

On genotype-phenotype relationship of dystrophinopathies among Iranian population.

Background: Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are inherited X-linked disorders resulting from alterations in the dystrophin gene. Genotype-phenotype matching studies have revealed a link between disease severity, the amount of muscle dystrophin, and the extent of mutation/deletion on the dystrophin gene. This study aimed to assess the relationship between genetic alterations in the dystrophin gene and the clinical status of patients with dystrophinopathies among the Iranian population. Methods: This cross-sectional study examined 54 patients with muscle weakness caused by abnormalities in the dystrophin gene at a hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, in 2021. The participants' demographic information, including age, family history of muscle dystrophies, and family history of other medical diseases as well as the type of muscular dystrophy were recorded. Furthermore, the number and region of deleted exons based on dystrophy types were also evaluated using multiplex ligation-dependent probe amplification (MLPA). The patients' gaits were also assessed as using a wheelchair, the presence of waddling gaits, or toe gaits. The patients' clinical status and the coexistence of pulmonary, bulbar, and mental conditions were also examined and compared between the two groups of dystrophinopathies. Results: In this study, 54 patients with dystrophinopathy with the mean age of 16.63 ± 12.10 years were evaluated, of whom 22 (40.7%) and 30 (55.6%) patients were classified as BMD and DMD, respectively. The most affected regions with deleted exons were exons 45-47 (n = 5) and 45-48 (n = 4) in patients with BMD, while exons 45, 48-52, 51-55, and 53 (2 cases per exon) were the most common affected exons in patients with DMD. Further analyses revealed that deletions in exons 45-47 and 51-55 were significantly associated with older and younger ages at the onset of becoming wheelchair-bound in patients with dystrophy, respectively. The hotspot range in both BMD and DMD was within exons 45-55 (n = 15 for each group); 63% of the patients had alterations on the dystrophin gene within this range [30 patients (68.18%) in the BMD group, 15 patients (53.57%) in the DMD group]. Conclusion: Exon deletion was the most common genetic alteration in patients with dystrophinopathies. No significant difference was observed between DMD and BMD regarding the number of deleted exons. Deletions in exons 45-47 and 51-55 were linked to later and earlier onset of becoming wheelchair-bound, respectively.

Metamotivation in medical students: Explaining motivation regulation strategies in medical students.

BACKGROUND: Metamotivation is a process that students use to monitor their motivational states to reach their academic goals. To date, few studies have addressed the ways that medical students manage their motivational states. This study aim to identify the motivational strategies of medical students as they use the metamotivational process to monitor and control their motivational states. MATERIALS AND METHODS: This qualitative study uses directed content analysis of the narrative responses of 18 medical students to draft an in-depth and semistructured interview protocol which were conducted through WhatsApp due to social distance restrictions of COVID-19. Data were collected, encoded, and analyzed using deductive content analysis approach descripted by Elo and Kyngäs. RESULTS: Seven main themes were extracted as the motivational strategies of medical students including "regulation of value," "regulation of situational interest," "self-consequating," "environmental structuring," "efficacy management," "regulation of relatedness," and "regulation of situational awareness." In this study by identifying new strategies, we provide a broader framework of metamotivational strategies in the field of the progression of learners in medical education. CONCLUSION: Medical students use a variety of strategies to regulate their academic motivation. To sustain and improve the motivation of medical students, identifying and strengthening metamotivational strategies is the first step.

The effect of functional training on level of brain-derived neurotrophic factor and functional performance in women with obesity.

Obesity is the underlying cause of various health conditions such as hypertension, diabetes, and respiratory diseases. It is associated with low self-confidence, emotional disorder, anxiety, depression, social isolation, and suicide. In the present study, we investigated the effect of functional training on obese women's brain-derived neurotrophic factor (BDNF) and executive functioning. To this end, 25 obese women were randomly assigned to 3 different groups labelled as active obese women-functional training, inactive obese women-functional training, and control group. The subjects performed 24 one-hour-long sessions of functional training three times a week. The intensity of activity for the research groups was moderate, which was equivalent to a level of 6-7 on the Borg scale. The analysis of intragroup results indicated that functional training increased serum BDNF significantly in both active and inactive obese women. It was also observed to improve executive functioning in both groups of the obese women via decreasing the number of errors, increasing the number of true responses, and reducing reaction time. The analysis of intergroup results, on the other hand, revealed that there were no significant differences between active and inactive obese women in terms of serum BDNF and executive functioning after functional training. Training promotes cognitive health, and this study adds that functional training may be important for improvement and maintenance of brain health and functional performance. Therefore, by increasing BDNF level through functional exercises, it is possible to help improve the cognitive functions of obese women.

Pregnancy-triggered pemphigus vulgaris with favorable fetal outcomes: A case report.

Pemphigus vulgaris is an autoimmune bullous dermatosis which if occurred during pregnancy may result in neonatal complications. In this study we report a 41 years old woman with pemphigus vulgaris that triggered by pregnancy in first trimester of pregnancy followed by the premature birth of a healthy neonate.

Verbal and oral apraxia in patients with acute stroke: Frequency, relationship, and some risk factors.

Verbal and oral apraxia are two possible consequences of stroke. It seems that there are not sufficient studies regarding the frequency of these disorders. This study aimed to evaluate the frequency of Verbal and oral apraxia. In addition, the relationship between apraxia and some variables such as age, gender, and education, as well as the relationship between types of apraxia with each other, and damaged areas of the brain in apraxia of the oral system in Persian-speaking patients with stroke were studied. In this descriptive-analytical study, 42 patients participated using the convenient sampling method. Verbal and oral apraxia were assessed using the oral and verbal apraxia tasks for adults test. Data were analyzed using independent t-test, Chi-square, and Fisher's exact test. The frequency of patients with oral apraxia was 35.7%, those with verbal apraxia was 2.3%, and the combination of both verbal and oral apraxia was 4.7%. People with apraxia were significantly older than those without apraxia. There was not any significant relationship between apraxia and gender, apraxia and education, and oral apraxia with verbal apraxia (p < 0.05). The present study's findings showed the high frequency of post-stroke apraxia and the high rate of its incidence with age.

Ant-induced alopecia: A new differential diagnosis for nonscarring alopecia.

Ant-induced alopecia is a rare condition caused by Pheidole pallidula species. This particular cause of nonscaring alopecia should be considered a new differential diagnosis.

MALDI-TOF Mass Spectroscopy Applications in Clinical Microbiology.

There is a range of proteomics methods to spot and analyze bacterial protein contents such as liquid chromatography-mass spectrometry (LC-MS), two-dimensional gel electrophoresis, and matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS), which give comprehensive information about the microorganisms that may be helpful within the diagnosis and coverings of infections. Microorganism identification by mass spectrometry is predicted on identifying a characteristic spectrum of every species so matched with an outsized database within the instrument. MALDI-TOF MS is one of the diagnostic methods, which is a straightforward, quick, and precise technique, and is employed in microbial diagnostic laboratories these days and may replace other diagnostic methods. This method identifies various microorganisms such as bacteria, fungi, parasites, and viruses, which supply comprehensive information. One of the MALDI-TOF MS's crucial applications is bacteriology, which helps identify bacterial species, identify toxins, and study bacterial antibiotic resistance. By knowing these cases, we will act more effectively against bacterial infections.

The development and validation of metamotivational strategies in medical students questionnaire.

INTRODUCTION: Understanding medical students' motivational regulation strategies is particularly salient to monitor their quality and quantity of motivation. This study aims to develop and validate a questionnaire to measure metamotivational strategies in medical students. METHODS: A Metamotivational Strategies in Medical Students Questionnaire (MSMQ) was developed by using the seven steps presented in 'developing questionnaires for educational research: AMEE Guide No. 87'. First, in a systematic search, related articles extracted and nine instruments were identified. Then, in a qualitative study, the metamotivational strategies of medical students were explained. In the next step, the identified strategies were conceptually compared with previous studies, and the MSMQ items were developed. Finally, expert validation, cognitive interviews, exploratory factor analysis, and reliability analysis were conducted. RESULTS: The MSMQ consisted of 7 factors and 28 items. CVI >0.79 in terms of relevance, clarity, and simplicity. In exploratory factor analysis, seven subscales explained 67.5% of the variance. Cronbach's alpha = 0.89. ICC = 0.76 - 0.87. CONCLUSION: The MSMQ has reasonable psychometric properties, with adequate internal reliability and strong evidence of structural validity. However, further validation in other settings applying various psychometric methods is recommended.