Search

OBJECTIVE: It is crucial that teaching faculties determine and remain informed of medical school learners' clinical reasoning competence. We created an innovative assessment method for fourth-year medical students to identify deficiencies in various components of their clinical reasoning ability. METHODS: This was a cross-sectional observational study of fourth-year medical students' reasoning assessments from 2019 to 2022. Teams of four–five trainees questioned standardized patients in clinical scenarios, including fever, abdominal pain, and weight loss. They then individually documented key information to reflect comprehension of patient problems. Trainees were tasked with differentiating diagnoses and associated statuses and reaching the most likely diagnosis along with two tentative diagnoses. The correlations observed between 2020 and 2022 for abdominal pain were analyzed using student t -tests. RESULTS: A total of 177 students participated in this study. Across the scenarios, there was no significant difference in key information representation scores (56%–58%). Reasoning ability scores were 49% for fever, 57% for abdominal pain, and 61% for weight loss. A comparison between 2020 and 2022 revealed a significant improvement in the objective structured clinical examination scores and differential diagnoses (P <.01). Shortcomings included brief chief complaint duration, lack of detailed presentation, and insufficient description of negative information. Differential diagnosis and diagnostic justification were inadequate for acute and chronic conditions, and disease location clarity within the organ system was lacking. On average, students presented two correct diagnoses. CONCLUSIONS: Fourth-year medical students exhibited inadequate reasoning abilities, particularly in fever and abdominal pain scenarios, with deficiencies in hypothesis generation and differential diagnosis. Group history-taking with individual reasoning assessment identified students' shortcomings and provided faculty feedback to improve their teaching strategies. [ABSTRACT FROM AUTHOR]

Halloysite nanotubes (HNTs) have a layered structure of clay silicate minerals and a tubular shape, which is suitable for the uniform loading of small substrates and drug molecules. The inner diameter of HNTs with an acidic solvent is selectively etched to increase the loading capacity of magnetic iron–platinum (FePt) nanoparticles. The FePt nanoparticles and etched HNTs (eHNT) are then composited by vacuum decompression. The resulting product is named FePt@eHNT and is used as a contrast agent for T2‐weighted magnetic resonance imaging. According to a comprehensive analysis of the material and its magnetic properties, by adding different proportions of HNTs before and after modification, the saturation magnetization can reach 23.769 emu g−1, which is higher than that of the composite materials studied in previous studies. This is because the tubular structure promotes the orderly displacement of the FePt nanoparticles under three‐dimensional space constraints and the uniform effect of the magnetic field. In addition, the magnetothermal effect of the composite material is observed and its potential as an imaging agent is investigated. In this study, the enhancement of its ferromagnetism and its potential to become a multifunctional composite material for applications in drug delivery, magnetic hyperthermia, and bioimaging is demonstrated. [ABSTRACT FROM AUTHOR]

Lymphoepithelioma-like cholangiocarcinoma (LEL-CC) is a rare variant of intrahepatic cholangiocarcinoma. Only a few cases of LEL-CC have been reported, and the understanding of LEL-CC remains limited. Herein, we describe a case involving a 38-year-old Asian man with hepatitis B virus infection and LEL-CC. The patient's liver tumor was incidentally discovered during routine abdominal ultrasonography without obvious clinical signs or symptoms. Dynamic magnetic resonance imaging (MRI) revealed features of hepatocellular carcinoma and he underwent laparoscopic partial hepatectomy. Histologically, the liver tumor exhibited a lymphoepithelioma-like appearance and features of cholangiocarcinoma with Epstein–Barr virus infection. [ABSTRACT FROM AUTHOR]

Serpentinites associated with metamafic and metaplagiogranitic rocks occur sporadically within metasedimentary schists in the Yuli belt. Such metaigneous rocks are considered to represent ophiolitic protoliths and some contain high-pressure (HP) metamorphic minerals or assemblages. However, the origin and metamorphism of these serpentinites have long been a mystery. This study systematically investigates the four major serpentinite-bearing exposures at the Fengtien, Wanjung, Tsunkuanshan, and Chinshuichi. The results reveal that the serpentinites are of two different protoliths on the basis of relict chromian spinel composition. Cr-spinel compositions of the Fengtien and Tsunkuanshan samples are characterised by moderate Cr# [Cr/(Cr + Al)] (0.45–0.57), relatively high Mg# [Mg/(Mg+Fe2+)] (0.59–0.79), but low Fe3+# [Fe3+/(Fe3++Cr+Al)] (0.02–0.06), reflecting an abyssal peridotite type protolith. By contrast, Cr-spinel compositions of the Wanjung and Chinshuichi samples show high Cr# (up to 0.74) and Fe3+# (0.03–0.08), but low Mg# (<0.6), indicating a forearc mantle peridotite origin. Peak metamorphic conditions of the serpentinites are represented by the assemblage of antigorite + magnetite + chlorite + olivine + diopside, which is estimated as up to 550°C but the pressure cannot be constrained quantitatively. Based on field relations, it is inferred that the serpentinites, associated HP metaigneous rocks, and garnet-bearing metasedimentary schists were metamorphosed isofacially. Despite two origins, the peridotitic protoliths were all subjected to hydration and subduction processes. We suggest that precursors of the serpentinites, metaigneous rocks, and metasedimentary schists were juxtaposed and metamorphosed at intermediate to great depths (~35–55 km) of a subduction zone. Therefore, the Yuli belt serpentinites and associated rocks likely represent exhumed materials from a palaeo-subduction interface. [ABSTRACT FROM AUTHOR]