Harmonizing and improving European education in prescribing: An overview of digital educational resources used in clinical pharmacology and therapeutics

Aim Improvement and harmonization of European clinical pharmacology and therapeutics (CPT) education is urgently required. Because digital educational resources can be easily shared, adapted to local situations and re-used widely across a variety of educational systems, they may be ideally suited for this purpose. Methods With a cross-sectional survey among principal CPT teachers in 279 out of 304 European medical schools, an overview and classification of digital resources was compiled. Results Teachers from 95 (34%) medical schools in 26 of 28 EU countries responded, 66 (70%) of whom used digital educational resources in their CPT curriculum. A total of 89 of such resources were described in detail, including e-learning (24%), simulators to teach pharmacokinetics and/or pharmacodynamics (10%), virtual patients (8%), and serious games (5%). Together, these resources covered 235 knowledge-based learning objectives, 88 skills, and 13 attitudes. Only one third (27) of the resources were in-part or totally free and only two were licensed open educational resources (free to use, distribute and adapt). A narrative overview of the largest, free and most novel resources is given. Conclusion Digital educational resources, ranging from e-learning to virtual patients and games, are widely used for CPT education in EU medical schools. Learning objectives are based largely on knowledge rather than skills or attitudes. This may be improved by including more real-life clinical case scenarios. Moreover, the majority of resources are neither free nor open. Therefore, with a view to harmonizing international CPT education, more needs to be learned about why CPT teachers are not currently sharing their educational materials.</div

Epicardial adipose tissue is related to arterial stiffness and inflammation in patients with cardiovascular disease and type 2 diabetes.

BACKGROUND: Epicardial adipose tissue (EAT) is an emerging cardio-metabolic risk factor and has been shown to correlate with adverse cardiovascular (CV) outcome; however the underlying pathophysiology of this link is not well understood. The aim of this study was to evaluate the relationship between EAT and a comprehensive panel of cardiovascular risk biomarkers and pulse wave velocity (PWV) and indexed left ventricular mass (LVMI) in a cohort of patients with cardiovascular disease (CVD) and diabetes compared to controls. METHODS: One hundred forty-five participants (mean age 63.9 ± 8.1 years; 61% male) were evaluated. All patients underwent cardiovascular magnetic resonance (CMR) examination and PWV. EAT measurements from CMR were performed on the 4-chamber view. Blood samples were taken and a range of CV biomarkers was evaluated. RESULTS: EAT measurements were significantly higher in the groups with CVD, with or without T2DM compared to patients without CVD or T2DM (group 1 EAT 15.9 ± 5.5 cm2 vs. group 4 EAT 11.8 ± 4.1 cm2, p = 0.001; group 3 EAT 15.1 ± 4.3 cm2 vs. group 4 EAT 11.8 ± 4.1 cm2, p = 0.024). EAT was independently associated with IL-6 (beta 0.2, p = 0.019). When added to clinical variables, both EAT (beta 0.16, p = 0.035) and IL-6 (beta 0.26, p = 0.003) were independently associated with PWV. EAT was significantly associated with LVMI in a univariable analysis but not when added to significant clinical variables. CONCLUSIONS: In patients with cardio-metabolic disease, EAT was independently associated with PWV. EAT may be associated with CVD risk due to an increase in systemic vascular inflammation. Whether targeting EAT may reduce inflammation and/or cardiovascular risk should be evaluated in prospective studies

Pathology and Cardiotoxicity of the Epicardial Adipose Tissue

Intra-organ fatty infiltration is associated with end-organ damages and increased cardiovascular risk. Ectopic fat deposition occurs also within the heart and may cause a metabolic cardiomyopathy. Epicardial fat (EAT) can be considered ectopic fat accumulation of the heart. Epicardial fat and intra-myocardial triglycerides content are related. Excessive EAT can produce lipotoxic effects throughout an abnormal lipid deposition and fatty infiltration in the myocardium. As cardiomyocytes fat storage capacity is very limited, high levels of plasma lipids cause cardiac steatosis, hypertrophy, dysfunction, and ultimately failure, as observed in morbid obesity and uncontrolled diabetes. Due to its anatomical and functional vicinity to the myocardium, EAT can affect the morphology and function of all of the heart chambers. Increased epicardial fat has been largely associated with increased left ventricular mass, abnormal geometry, enlarged atria, and diastolic dysfunction. Multifactorial physical and biomolecular mechanisms can explain the effects of excessive EAT on the heart

Efficient communication dynamics on macro-connectome, and the propagation speed

Global communication dynamics in the brain can be captured using fMRI, MEG, or electrocorticography (ECoG), and the global slow dynamics often represent anatomical constraints. Complementary single-/multi-unit recordings have described local fast temporal dynamics. However, global fast temporal dynamics remain incompletely understood with considering of anatomical constraints. Therefore, we compared temporal aspects of cross-area propagations of single-unit recordings and ECoG, and investigated their anatomical bases. First, we demonstrated how both evoked and spontaneous ECoGs can accurately predict latencies of single-unit recordings. Next, we estimated the propagation velocity (1.0–1.5 m/s) from brain-wide data and found that it was fairly stable among different conscious levels. We also found that the shortest paths in anatomical topology strongly predicted the latencies. Finally, we demonstrated that Communicability, a novel graph-theoretic measure, is able to quantify that more than 90% of paths should use shortest paths and the remaining are non-shortest walks. These results revealed that macro-connectome is efficiently wired for detailed communication dynamics in the brain