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INTRODUCTION: Doxycycline is a commonly used antibiotic that is also a potent inhibitor of matrix metalloproteinase (MMPs). The use of doxycycline in repairing tendon lesions has been previously investigated and conflicting findings have been reported on its effectiveness. In this study, we sought to evaluate the effects of exposure to doxycycline on Achilles tendon repair. MATERIALS AND METHODS: Twenty healthy rats of the same breed and gender were randomly assigned to two groups of sham, and Doxycycline group therapy. The rats underwent a surgical intervention in which a 2mm incision was performed on the lateral sides of the right Achilles tendons. The treatment group received oral gavage administrations of 50mg/kg/day of doxycycline for 30 days. After this duration, tissue samples were taken from the site of the injuries, which were then histologically evaluated for alignment of the collagen fibres, inflammation reaction, cellular density, and fibroblastic activity. RESULTS: The histological assessment of the tissue samples, revealed significant changes in the repaired tissues of the treatment group in comparison to the sham group; namely more irregularity in the alignment of the collagen fibres, increased cellular density, and increased fibroblastic activity. However, only the alignment of the collagen fibres reached the statistical significance. CONCLUSION: The results of this study indicate that exposure to doxycycline may result in the improvement of repair of the Achilles tendon injuries, especially collagen filament integrity.

Jhia Jiat Teh,1 Ka Yan Cheung,1 Yusuf Patrick,1 Mona Panahi,1 Robert Boyle,2 Gareth Tudor-Williams2 1Department of Medicine, Imperial College London, London, UK; 2Department of Pediatrics, Imperial College London, London, UKCorrespondence: Jhia Jiat TehSchool of Medicine, Imperial College London Exhibition Road, London SW7 2AZ, UKTel +44 74 2132 1772Email jhia.teh15@imperial.ac.ukBackground: Pediatrics is a specialty reserved until later stages of the medical curriculum, with many students receiving early exposure via volunteering opportunities. Self-perceived confidence across the pediatric curriculum is crucial, due to limited clinical exposure before qualification. We aimed to assess the impact of a 7-week pediatric placement on medical students’ self-perceived confidence and factors that influenced self-perceived confidence.Methods: We conducted a prospective pilot survey on three cohorts of fifth-year students undertaking pediatric placements in 2018. A two-part questionnaire was distributed before and after the placement, evaluating the level of self-confidence in clinical skills using a 10-point scale.Results: Of 103 students, 62 (60%) students completed both questionnaires. Of these, 34 (55%) students reported previous professional experiences with children. There was a significant increase in self-reported confidence scores across ten questions before (mean 5.4 [IQR 4.1– 6.1]) and after the placement (7.6 [6.6– 8.5], p< 0.0001). Subgroup analyses between students with prior professional experience with children and those without revealed a significant difference in preplacement confidence in four pediatric practices: verbal communication, physical engagement, asking sensitive or probing questions, and explaining medical management (p< 0.05). There was no significant difference in postplacement confidence between these two groups.Conclusion: Medical students with prior professional experience with children reported higher self-confidence in interacting with pediatric patients prior to placement. However, a large and consistent increase in confidence across the cohort was such that there were no measurable differences at exit. This study supports the value of undergraduate pediatric training in promoting student self-confidence in managing pediatric clinical issues.Keywords: medical education, pediatrics, self-confidence, medical students

Jhia Jiat Teh,1 Ka Yan Cheung,1 Yusuf Patrick,1 Mona Panahi,1 Robert Boyle,2 Gareth Tudor-Williams2 1Department of Medicine, Imperial College London, London, UK; 2Department of Pediatrics, Imperial College London, London, UKCorrespondence: Jhia Jiat TehSchool of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UKTel +44 74 2132 1772Email jhia.teh15@imperial.ac.uk We appreciate the opportunity to respond to correspondence relating to our pilot survey regarding self-perceived confidence in medical students communicating with pediatric patients. View the original paper by Teh and colleagues This is in response to the Letter to the Editor

The present study evaluated carbon reduction policies (decarbonization) by comparing energy efficiency improvement in thermal power plants and the incremental development of renewable and clean power plants in different scenarios in the power generation sector. For this purpose, the optimal portfolio for power generation expansion was considered until 2050. Likewise, regarding environmental considerations, the values of environmental emissions and their external costs in different power generation methods were modeled for the first time in an inclusive electricity system. Then, the Matrix Laboratory and Long-Range Energy Alternative Planning software were used to model electricity supply and demand toward long-time planning and estimate and solve technical, economic, and environmental functions. The modeling outcomes showed that, under the Steam Power Plant repowering scenario, the efficiency-improving actions in thermal power plants were prioritized over the development of clean and renewable power plants, including large hydroelectric and nuclear power plants, and could reduce the total power generation cost by 38% until 2050 and environmental and greenhouse gases emissions by 3,572 MMT and 2,624 MMTDCO2E compared to the BAU scenario. It was also found that although developing renewable energies could decrease the external environmental costs by 73,188 million U.S dollars in the 2017–2050 period relative to the other scenarios, its development would not be optimal technically and economically since it was a function of technical, economic, environmental, and political factors and was not the sole approach to reducing carbon emissions in all countries. [ABSTRACT FROM AUTHOR]