Burnout and motivation to study medicine among students during the COVID-19 pandemic

AimTo investigate medical students’ burnout and motivation levels in each of the six years of their studies during the COVID-19 pandemic and identify independent predictors of burnout and motivation.MethodsAn anonymous cross-sectional survey was sent to the students of all six years within our school. Burnout was measured with the adapted Oldenburg Burnout Inventory questionnaire (OLBI-S) and motivation with the updated Strength of Motivation for Medical School (SMMS-R) questionnaire. Univariate analysis was performed with the Kruskal–Wallis test and Spearman’s correlation, while multivariable analysis with linear regression models.ResultsA total of 333 medical students (52% of student body) responded. Higher burnout levels correlated with lower motivation to study medicine (rho = −0.30, p < 0.001). Burnout levels differed between the six years of medical studies, peaking in years two and four whereas being the lowest in year one (p = 0.01). Motivation levels differed significantly as well, peaking in years one and four whereas being the lowest in years five and six (p = 0.012). In the multivariable linear regression models, being a female (b = 2.22, p = 0.016), studying in the fourth year vs. first year (b = 2.54, p = 0.049), having a perceived beginner/intermediate vs. advanced/expert technology level (b = 2.05, p = 0.032) and a perceived poor school support system (b = 6.35, p < 0.001) were independently associated with higher burnout levels. Furthermore, studying in the fifth year vs. first year (b = −5.17, p = 0.019) and a perceived poor school support system (b = −3.09, p = 0.01) were independently associated with a reduced motivation to study medicine.ConclusionOur study highlighted potential areas for intervention to decrease the rate of burnout and low motivation among medical students. However, further research is needed to unravel the full effect of the pandemic on medical students

Cytoarchitectonics of human hypothalamus and the distribution of orexin receptors

The human hypothalamus is a compact area at the base of human brain which occupies volume of four cubic centimeters. Despite its small size, the human hypothalamus demonstrates a remarkable complexity in terms of cell morphology and cell populations. Thus, in this small area there are about fifteen cell groups with enormous morphological and functional differences between them. Despite the numerous works dealing with various neurotransmitters and neuropeptides in the hypothalamus, both in animal and human level, there are no experimental data on the morphological characteristics of neurons. For that reason in the first part of this work we performed a thorough study of the morphological and quantitative characteristics of neurons in every nucleus of the hypothalamus. In the second part of this work, we studied the distribution of Orexin A receptors in the human hypothalamus and the results correlated with the morphological data of the first section so as to produce an accurate allocation, at the cellular level, of this distribution. We applied the Golgi method in fifteen post-mortem hypothalamic specimens from individuals of both sexes, different ages, not suffering from any neurological or psychiatric illness. For the quantitative study we analyzed the neurons with ImageJ software and NeuronJ plugin. For immunohistochemical study, a protocol for immunohistochemical detection of receptors Orexin A was implemented. The study revealed the following conclusions: A) The quantitative analysis of neurons in the human hypothalamus, showed that neurons in the lateral hypothalamic area, the supraoptic nucleus, the suprachiasmatic nucleus, the ventro-medial nucleus and the ventral lateral tuberal nucleus, displayed morphological uniformity with statistically secure values of dendritic parameters. B) The suprachiasmatic nucleus of the hypothalamus demonstrated the neurons with the longer dendrites and axons. This property allows him to act as a regulator in other nuclei of the hypothalamus and alter their functionality based on circadian rhythms. C) Orexin A might play a special role in plasticity of neurons and neuronal networks of the human hypothalamus mediated of course by other neurotransmitters. D) The ventro-medial nucleus and the dorso-medial nucleus of human hypothalamus were detected for the first time receptors Orexin A. This fact gives a first explanation of the involvement of these two nuclei in the functions of sleep regulation, food intake and metabolism.Ο ανθρώπινος υποθάλαμος είναι μια μικρή σε μέγεθος περιοχή της βάσης του εγκεφάλου που καταλαμβάνει όγκο μόλις τέσσερα κυβικά εκατοστά. Παρά το μικρό του μέγεθος, ο υποθάλαμος παρουσιάζει μια αξιοπρόσεχτη πολυπλοκότητα από άποψη κυτταρικής μορφολογίας και κυτταρικών πληθυσμών. Έτσι, στη μικρή αυτή περιοχή υπάρχουν περί τις δεκαπέντε κυτταρικές ομάδες με τεράστιες μορφολογικές αλλά και λειτουργικές διαφορές μεταξύ τους. Παρά την πληθώρα εργασιών που ασχολούνται με τους νευροδιαβιβαστές και τα διάφορα νευροπεπτίδια του υποθαλάμου, τόσο σε επίπεδο πειραματοζώων όσο και σε επίπεδο ανθρώπου, δεν υπάρχουν πειραματικά δεδομένα για τα μορφολογικά χαρακτηριστικά των νευρώνων. Για το λόγο αυτό στο πρώτο τμήμα της παρούσας εργασίας γίνεται μια ενδελεχής μελέτη των μορφολογικών και μορφομετρικών χαρακτηριστικών των νευρικών κυττάρων των πυρήνων του υποθαλάμου. Στο δεύτερο τμήμα της εργασίας, μελετήσαμε την κατανομή των υποδοχέων της ορεξίνης Α στον ανθρώπινο υποθάλαμο και συσχετίσαμε τα αποτελέσματα με τα μορφολογικά δεδομένα του πρώτου τμήματος. Συγκεντρώθηκαν νεκροτομικά παρασκευάσματα υποθαλάμου από δεκαπέντε άτομα και των δύο φύλλων, διαφόρων ηλικιών, που δεν έπασχαν από κάποια νευρολογική ή ψυχιατρική πάθηση. Για την μορφολογική και μορφομετρική μελέτη χρησιμοποιήθηκε η μέθοδος Golgi και ένα λογισμικό ανάλυσης εικόνας. Για την ανοσοϊστοχημική μελέτη, εφαρμόστηκε ένα πρωτόκολλο ανοσοϊστοχημείας για την ανίχνευση των υποδοχέων της ορεξίνης Α. Από τη μελέτη προέκυψαν τα εξής συμπεράσματα: Α) Η μορφομετρική ανάλυση των νευρώνων στον ανθρώπινο υποθάλαμο, απέδειξε ότι οι νευρώνες στην πλάγια υποθαλαμική περιοχή, στον υπεροπτικό πυρήνα, στον υπερχιασματικό πυρήνα, στον έσω κοιλιακό πυρήνα και στον πλάγιο φυματικό πυρήνα, παρουσιάζουν μορφολογική ομοιομορφία με στατιστικά ασφαλείς τιμές δενδριτικών παραμέτρων. Β) Ο υπερχιασματικός πυρήνας του υποθαλάμου παρουσίασε τους νευρώνες με το μεγαλύτερο μήκος δενδριτών και νευράξονα γεγονός που του επιτρέπει να ασκεί ένα γενικότερο ρυθμιστικό ρόλο στους υπόλοιπους πυρήνες του υποθαλάμου και να τροποποιεί τη λειτουργικότητά τους με βάση τους κιρκάδιους ρυθμούς. Γ) Η ορεξίνη Α, πιθανώς να διαδραματίζει κάποιο ιδιαίτερο ρόλο στην πλαστικότητα των νευρώνων και των νευρωνικών δικτύων του ανθρωπίνου υποθαλάμου με τη διαμεσολάβηση φυσικά και άλλων νευροδιαβιβαστών. Δ) Στον έσω κοιλιακό και στον έσω ραχιαίο πυρήνα του ανθρώπινου υποθαλάμου ανιχνεύθηκαν για πρώτη φορά υποδοχείς της ορεξίνης Α και η ύπαρξη αυτή εξηγεί σε ένα πρώτο επίπεδο τη συμμετοχή των δύο αυτών πυρήνων στις διαδικασίες της λήψης τροφής, του μεταβολισμού και της ρύθμισης του κύκλου ύπνου-εγρήγορσης

Treatment of Acquired Transthyretin Amyloidosis in Domino Liver Transplantation

BACKGROUND: Domino liver transplantation (DLT) has been commonly used during the last two decades to partly meet the high need for liver transplants. However, the recipients of grafts from patients with noncirrhotic inherited metabolic disorders may ultimately develop metabolic syndrome, and management is usually intricate, being complicated by the underlying initial disorder, other comorbidities, and post-transplantation conditions. CASE: We report here the management and the outcome in a patient with acquired transthyretin amyloidosis after DLT and significant comorbidities. Final treatment with a transthyretin gene silencing agent, patisiran, was well tolerated and resulted in remission of the aggravating neurological deficits in a follow-up period of two years. CONCLUSIONS: The case presented here supports the concept that patisiran can target the hepatocytes producing the mutated transthyretin in acquired transthyretin amyloidosis, as efficiently as in hereditary transthyretin amyloidosis, and can be used to treat patients with transthyretin amyloidosis after DLT. This article is protected by copyright. All rights reserved

Cellular Localization of Orexin 1 Receptor in Human Hypothalamus and Morphological Analysis of Neurons Expressing the Receptor

The orexin system is related to food behavior, energy balance, wakefulness and the reward system. It consists of the neuropeptides orexin A and B, and their receptors, orexin 1 receptor (OX1R) and orexin 2 receptor (OX2R). OX1R has selective affinity for orexin A, and is implicated in multiple functions, such as reward, emotions, and autonomic regulation. This study provides information about the OX1R distribution in human hypothalamus. The human hypothalamus, despite its small size, demonstrates a remarkable complexity in terms of cell populations and cellular morphology. Numerous studies have focused on various neurotransmitters and neuropeptides in the hypothalamus, both in animals and humans, however, there is limited experimental data on the morphological characteristics of neurons. The immunohistochemical analysis of the human hypothalamus revealed that OX1R is mainly found in the lateral hypothalamic area, the lateral preoptic nucleus, the supraoptic nucleus, the dorsomedial nucleus, the ventromedial nucleus, and the paraventricular nucleus. The rest of the hypothalamic nuclei do not express the receptor, except for a very low number of neurons in the mammillary bodies. After identifying the nuclei and neuronal groups that were immunopositive for OX1R, a morphological and morphometric analysis of those neurons was conducted using the Golgi method. The analysis revealed that the neurons in the lateral hypothalamic area were uniform in terms of their morphological characteristics, often forming small groups of three to four neurons. A high proportion of neurons in this area (over 80%) expressed the OX1R, with particularly high expression in the lateral tuberal nucleus (over 95% of neurons). These results were analyzed, and shown to represent, at the cellular level, the distribution of OX1R, and we discuss the regulatory role of orexin A in the intra-hypothalamic areas, such as its special role in the plasticity of neurons, as well as in neuronal networks of the human hypothalamus

Kenhub Atlas of Human Anatomy

<p>This atlas represents a collection of clear, comprehensible and didactically valuable images from Kenhub.com, intuitively organized to aid you in your mastery of the organization of the human body. The features of this modern print atlas were formulated by direct input from students of anatomy and experienced educators. This print atlas was designed by the preferences of anatomy students to assist in the challenges of identifying structures in the anatomy laboratory and to assist in studying for written exams.</p&gt