The current paradigm regarding sodium handling in animals and humans postulates that total body sodium is regulated predominately via regulation of extracellular volume. Active sodium storage independent of volume retention is thought to be negligible. However, studies in animals, hypertensive patients, and healthy humans suggest water-free storage of sodium in skin. We hypothesized that tissue sodium concentrations ([Na]) found in humans vary and reflect regulation due to variable glycosaminoglycan content due to variable expression of XYLT-1. Twenty seven patients on dialysis and 21 living kidney transplant donors free of clinically detectable edema were studied. During surgery, abdominal skin, muscle, and arteries were biopsied. [Na] was determined by inductively coupled plasma-optical emission spectrometry, semiquantitative glycosaminoglycan content with Alcian stain, and XYLT-1 expression by real-time PCR. [Na] of arteries were ranging between 0.86 and 9.83 g/kg wet wt and were significantly higher in arteries (4.52 ± 1.82 g/kg) than in muscle (2.03 ± 1.41 g/kg; < 0.001) or skin (3.24 ± 2.26 g/kg wet wt; = 0.038). For individual patients [Na] correlated for skin and arterial tissue ( = 0.440, = 0.012). [Na] also correlated significantly with blinded semiquantitative analysis of glycosaminoglycans staining ( = 0.588, = 0.004). In arteries XYLT-1 expression was also correlated with [Na] ( = 0.392, = 0.003). Our data confirm highly variable [Na] in human skin and muscle and extend this observation to [Na] in human arteries. These data support the hypothesis of water-independent sodium storage via regulated glycosaminoglycan synthesis in human tissues, including arteries.

ObjectiveFostering clinical reasoning is a mainstay of medical education. Based on the clinicopathological conferences, we propose a case-based peer teaching approach called clinical case discussions (CCDs) to promote the respective skills in medical students. This study compares the effectiveness of different CCD formats with varying degrees of social interaction in fostering clinical reasoning.Design, setting, participantsA single-centre randomised controlled trial with a parallel design was conducted at a German university. Study participants (N=106) were stratified and tested regarding their clinical reasoning skills right after CCD participation and 2 weeks later.InterventionParticipants worked within a live discussion group (Live-CCD), a group watching recordings of the live discussions (Video-CCD) or a group working with printed cases (Paper-Cases). The presentation of case information followed an admission-discussion-summary sequence.Primary and secondary outcome measuresClinical reasoning skills were measured with a knowledge application test addressing the students’ conceptual, strategic and conditional knowledge. Additionally, subjective learning outcomes were assessed.ResultsWith respect to learning outcomes, the Live-CCD group displayed the best results, followed by Video-CCD and Paper-Cases, F(2,87)=27.07, p<0.001, partial η2=0.384. No difference was found between Live-CCD and Video-CCD groups in the delayed post-test; however, both outperformed the Paper-Cases group, F(2,87)=30.91, p<0.001, partial η2=0.415. Regarding subjective learning outcomes, the Live-CCD received significantly better ratings than the other formats, F(2,85)=13.16, p<0.001, partial η2=0.236.ConclusionsThis study demonstrates that the CCD approach is an effective and sustainable clinical reasoning teaching resource for medical students. Subjective learning outcomes underline the importance of learner (inter)activity in the acquisition of clinical reasoning skills in the context of case-based learning. Higher efficacy of more interactive formats can be attributed to positive effects of collaborative learning. Future research should investigate how the Live-CCD format can further be improved and how video-based CCDs can be enhanced through instructional support.

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Background: This study investigated the feasibility to conduct an educational webinar for improving COVID-19-related knowledge, attitudes, and behaviors in Munich. Methods: A before-after experiment was conducted in Turkish-speaking family physician offices. Turkish-speaking participants (n=245) of a cross-sectional study evaluating COVID-19 knowledge, attitudes, and behaviors were invited to an educational webinar. COVID-19 vaccination intention and knowledge (25 true/false items) were the primary outcomes. Also, attitudes and behaviors to COVID-19 vaccination were asked using Likert scales (min. 1, max. 5). Results: Knowledge (22.8±1.5 vs. 23.1±1.5) and behavior (4.1±0.4 vs. 4.2±0.3) scores did not change after the intervention, nor changed the intention to be vaccinated (p>0.05). However, there was a significant increase in the attitude scores from mean 3.9±0.5 to 4.2±0.5 (p=0.009). The webinar received high scores (mean 4.7±0.2). Conclusion: We suggest educational interventions involving key persons from the Turkish-speaking community as peer trainers to change the negative attitudes towards vaccination.

BackgroundThis study aimed to investigate the knowledge, attitudes, behaviors, and vaccine hesitancy of people with migratory backgrounds among Turkish- and German-speaking patients in Munich regarding the COVID-19 pandemic.MethodsPrimary outcomes were the intention to get vaccinated for COVID-19 and COVID-19 knowledge levels (25 true/false items). Other variables included demographics, attitudes to COVID-19 and vaccination (7 items), and behaviors regarding COVID-19 (7 items). The attitude and behavior questions had 5-point Likert scales. Of the 10 Turkish-speaking family physicians in Munich, 6 agreed to administer Turkish or German questionnaires to consecutive patients during February 2021. Participants with either citizenship, country of origin, native language, or place of birth being non-German were categorized as “Having a migratory background.” Data from 420 respondents were analyzed.ResultsWomen constituted 41.4% (n=174), the mean age was 42.2±15.5 years, 245 (58.3%) preferred the Turkish questionnaire, 348 (82.9%) had a migratory background, and 197 (47.9%) intended to be vaccinated. The mean knowledge, attitude, and behavior scores were 21.5±3.2 (max=25), 3.7±0.8 (max=5), and 4.0±0.5 (max=5). While 42.3% (n=145) of the participants with a migratory background considered getting vaccinated, this proportion was 76.5% (n=52) for non-immigrant Germans (Chi-square=26.818, p<0.001). Non-migratory background (Odds Ratio (OR): 3.082), high attitude scores (OR: 2.877), male sex (OR: 2.185), years of schooling (OR: 1.064), and age (OR: 1.022) were positively associated with vaccination intention.ConclusionsWe suggest initiating or supporting projects run by persons or groups from inside the immigrants targeting to elaborate and change their vaccination attitudes.