This study sought to evaluate the expression of previously identified microRNAs known to regulate neuronal differentiation in mesenchymal stem cells (MSCs), including miR-27, miR-125, miR-128, miR-135, miR-140, miR-145, miR-218 and miR-410, among dental pulp stem cells (DPSCs) under conditions demonstrated to induce neuronal differentiation. Using an approved protocol, n = 12 DPSCs were identified from an existing biorepository and treated with basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF), which were previously demonstrated to induce neural differentiation markers including Sox1, Pax6 and NFM among these DPSCs. This study revealed that some microRNAs involved in the neuronal differentiation of MSCs were also differentially expressed among the DPSCs, including miR-27 and miR-145. In addition, this study also revealed that administration of bFGF and EGF was sufficient to modulate miR-27 and miR-145 expression in all of the stimulus-responsive DPSCs but not among all of the non-responsive DPSCs—suggesting that further investigation of the downstream targets of these microRNAs may be needed to fully evaluate and understand these observations.

Introduction Simulation tools are crucial in medical education but current commercial models for ultrasound-guided intravenous (IV) access lack complexity and can be prohibitively expensive. This article proposes a cost-effective gel model system that replicates realistic vein and artery interactions, addressing the limitations of traditional models. An advanced gelatin model was constructed that incorporates intricate vein and artery configurations and enhances medical training by providing a more authentic experience. Patient testing will further validate its efficacy, promising improved accessibility for skill refinement in resource-constrained environments. Methods In a controlled study at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, 12 medical students with limited ultrasound experience participated in a workshop using novel and Blue Phantom™ models for ultrasound-guided IV catheter placement. The advanced gelatin model, created with Ziplock™ Tupperware®, ultrasonography gel-filled balloons, and gelatin, proved more effective, as assessed by participants' post-training comfort levels. The comparison of participants’ pre- and post-training comfort levels with the models was the primary study objective. Participants were asked to complete a confidence survey based on a five-point Likert scale, and after using both models, this survey was re-administered to assess the participant's level of comfort after model use. The statistical analysis comparison of post-training survey data to the pre-training survey data was accomplished using SPSS version 29 (IBM Corp, Armonk, NY), where a paired t-test was set at a significance threshold of p <0.05. Results Analysis of data from both commercially made and advanced ultrasound-guided IV models using a paired t-test revealed a significant advantage for the advanced model. Participants, despite limited ultrasound experience, reported feeling over 4 points higher in skill confidence (p = 0.004) with the advanced model. Its popularity stems from diverse vasculature modeling, proving effective for both experienced practitioners and inexperienced individuals, maintaining value as user skill levels increase. Conclusion This study proposes an advanced model for ultrasound-guided peripheral IV access training, demonstrating a statistically significant increase in confidence levels. Despite limitations such as small sample size and single-site participation, the advanced model's adaptability and cost-effectiveness make it a strong contender for replacing current commercial models, potentially enhancing proficiency and confidence while reducing costs.

Background: Burnout is increasingly recognized as a critical concern in medical education due to its associations with reduced professional performance, decreased empathy, and increased risk of medical errors. With growing evidence that medical students commonly experience burnout and its associated health consequences (eg, depression and suicide), it is essential to explore factors that may protect against its harmful effects on student well-being. Although spirituality is often considered a potential factor supporting mental health and resilience, its role in buffering burnout among medical students has not been comprehensively reviewed. Objective: This scoping review seeks to map the extent, range, and characteristics of the literature examining the relationship between spirituality and burnout and defined forms of stress among medical students. Specifically, the review will (1) describe the nature and direction of reported associations and (2) identify gaps to inform priorities for future research. Methods: This scoping review followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines to ensure a systematic and transparent process. Studies that examined the relationship between spirituality and burnout or related outcomes and correlates, such as anxiety, depression, stress, or suicidality, among undergraduate medical students were eligible. Only studies that focused specifically on medical students rather than other health care professionals or professional students were eligible. Eligible articles were peer-reviewed and published in English. MEDLINE (PubMed), APA PsycInfo, Scopus, and Embase databases were searched. Two reviewers independently screened titles and abstracts, followed by full-text review to determine final inclusion. Discrepancies were resolved through discussion with a third reviewer until consensus was reached. Extracted data were descriptively analyzed and summarized in charts and tables and synthesized narratively according to the review questions. Results: The database searches were completed in July 2025 and yielded 1788 records. Screening was conducted from September 2025 through January 2026. Of the database records 39 (2.2%) peer-reviewed studies met the inclusion criteria. During full-text screening, articles were most frequently excluded because they did not explicitly evaluate the association between spirituality and burnout, represented an ineligible publication type, or included populations beyond undergraduate medical students without reporting separate results for medical students. Data extraction was completed in April 2026. The manuscript reporting results was completed in May 2026 and is under review as of September 2026. Conclusions: This review will provide a comprehensive overview of how spirituality and religious practices have been examined in relation to burnout and stress among undergraduate medical students. By mapping conceptualizations and experiences of spirituality within medical training, as well as varying patterns in how these practices relate to student well-being, this review highlights key gaps in the evidence and directions for future research on factors that may support medical student mental health. Trial Registration: OSF Registries osf.io/tqwsk; https://osf.io/tqwsk International Registered Report Identifier (IRRID): DERR1-10.2196/88915

Introduction: Thoracic outlet syndrome (TOS) is a diagnosis classifying upper extremity symptoms caused by compression of the neurogenic and vascular structures between the clavicle and first rib. It is important to promptly decompress these structures in order to prevent long-term deficits and poor patient outcomes. However, TOS often presents in unique ways with substantial symptom variance, making it difficult to identify, diagnose and promptly treat. Compounding this, common diagnostic tools such as magnetic resonance imaging (MRI) are not independently appropriate for a conclusive diagnosis of TOS. TOS patients can initially present acutely due to symptom exacerbations or emergent situations, which creates an emphasis for the use of multi-modal diagnostic methods and early TOS recognition in order to improve the outcomes for TOS patients, particularly in emergency medical services (EMS) settings. Case Report: A 22-year-old male presented with chronic symptoms of numbness and weakness in his right hand in addition to chest pain that radiated into his right elbow, along with a diminished right radial pulse. The patient also suffered from acute symptomatic exacerbations of total arm asthenia, paresthesia and what the patient described as “an intensely cold hand” during football practice. He was eventually treated with a right first rib resection to decompress the brachial plexus, which resulted in complete symptom resolution and recovery. Conclusion: Due to the serious long-term complications associated with uncorrected brachial plexus compression and the fact that TOS patients can initially present to EMS settings with acute exacerbations, it is important for EMS clinicians to be able to recognize and either treat or appropriately refer patients for treatment. EMS settings are equipped to be able to perform a comprehensive diagnostic assessment because they often have access to the diagnostic modalities necessary for diagnosing TOS.

BACKGROUND Burnout is increasingly recognized as a critical concern in medical education due to its associations with reduced professional performance, decreased empathy, and increased risk of medical errors. With growing evidence that medical students commonly experience burnout and its associated health consequences (eg, depression and suicide), it is essential to explore factors that may protect against its harmful effects on student well-being. Although spirituality is often considered a potential factor supporting mental health and resilience, its role in buffering burnout among medical students has not been comprehensively reviewed. OBJECTIVE This scoping review seeks to map the extent, range, and characteristics of the literature examining the relationship between spirituality and burnout and defined forms of stress among medical students. Specifically, the review will (1) describe the nature and direction of reported associations and (2) identify gaps to inform priorities for future research. METHODS This scoping review followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines to ensure a systematic and transparent process. Studies that examined the relationship between spirituality and burnout or related outcomes and correlates, such as anxiety, depression, stress, or suicidality, among undergraduate medical students were eligible. Only studies that focused specifically on medical students rather than other health care professionals or professional students were eligible. Eligible articles were peer-reviewed and published in English. MEDLINE (PubMed), APA PsycInfo, Scopus, and Embase databases were searched. Two reviewers independently screened titles and abstracts, followed by full-text review to determine final inclusion. Discrepancies were resolved through discussion with a third reviewer until consensus was reached. Extracted data were descriptively analyzed and summarized in charts and tables and synthesized narratively according to the review questions. RESULTS The database searches were completed in July 2025 and yielded 1788 records. Screening was conducted from September 2025 through January 2026. Of the database records 39 (2.2%) peer-reviewed studies met the inclusion criteria. During full-text screening, articles were most frequently excluded because they did not explicitly evaluate the association between spirituality and burnout, represented an ineligible publication type, or included populations beyond undergraduate medical students without reporting separate results for medical students. Data extraction was completed in April 2026. The manuscript reporting results was completed in May 2026 and is under review as of September 2026. CONCLUSIONS This review will provide a comprehensive overview of how spirituality and religious practices have been examined in relation to burnout and stress among undergraduate medical students. By mapping conceptualizations and experiences of spirituality within medical training, as well as varying patterns in how these practices relate to student well-being, this review highlights key gaps in the evidence and directions for future research on factors that may support medical student mental health. CLINICALTRIAL OSF Registries osf.io/tqwsk; https://osf.io/tqwsk INTERNATIONAL REGISTERED REPORT DERR1-10.2196/88915

BACKGROUND Burnout is highly prevalent among undergraduate medical students and is associated with adverse outcomes including depression, anxiety, psychological distress, and suicidal ideation. Spirituality and religiosity are increasingly recognized as potential coping resources that may limit burnout and improve well-being among medical students. However, existing studies vary substantially in how spirituality and burnout are defined and measured. OBJECTIVE The goal of this scoping review was to synthesize evidence on the relationship between spirituality and burnout-related outcomes, including psychological distress and well-being, among undergraduate medical students. METHODS A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Scopus, Web of Science, and PsycINFO were searched. Two independent reviewers screened studies and extracted data, with disagreements resolved by a third reviewer. Extracted data included study characteristics, measurement instruments, and key findings related to spirituality and burnout-related outcomes. RESULTS Thirty-nine studies published from 2007 to 2025 across nineteen countries met inclusion criteria. Most were single site, cross sectional surveys with convenience samples. Sample sizes ranged from about 16 to 1,417. About half used validated spirituality measures (e.g., FACIT-Sp, SWBS, DUREL or Brief COPE); others used single item indicators. Burnout itself was measured less often than stress or mood symptoms. Overall, higher spirituality or intrinsic religiosity was frequently associated with lower burnout stress, anxiety, depressive symptoms, and suicidal ideation, and higher resilience, empathy, life satisfaction, and quality of life. Qualitative work found that spirituality provided meaning, comfort, belonging, and moral grounding during training. A smaller set of studies reported null or mixed findings, often when spirituality was measured with single items or in universities with low religious participation and limited formal support for spiritual practice. CONCLUSIONS Across diverse settings, spirituality is commonly used by medical students and is frequently linked with better mental health. Measurement diversity and the dominance of cross-sectional designs limit causal inference. Future work should use clearer constructs, common validated tools, and prospective or interventional designs. These findings may help inform the development of more holistic and inclusive wellness initiatives within medical education that recognize the potential role of spirituality in supporting student mental health and resilience. CLINICALTRIAL This protocol is registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/TQWSK