Systemic aging influences various physiological processes and contributes to structural and functional decline in cardiac tissue. These alterations include an increased incidence of left ventricular hypertrophy, a decline in left ventricular diastolic function, left atrial dilation, atrial fibrillation, myocardial fibrosis and cardiac amyloidosis, elevating susceptibility to chronic heart failure (HF) in the elderly. Age-related cardiac dysfunction stems from prolonged exposure to genomic, epigenetic, oxidative, autophagic, inflammatory and regenerative stresses, along with the accumulation of senescent cells. Concurrently, age-related structural and functional changes in the vascular system, attributed to endothelial dysfunction, arterial stiffness, impaired angiogenesis, oxidative stress and inflammation, impose additional strain on the heart. Dysregulated mechanosignalling and impaired nitric oxide signalling play critical roles in the age-related vascular dysfunction associated with HF. Metabolic aging drives intricate shifts in glucose and lipid metabolism, leading to insulin resistance, mitochondrial dysfunction and lipid accumulation within cardiomyocytes. These alterations contribute to cardiac hypertrophy, fibrosis and impaired contractility, ultimately propelling HF. Systemic low-grade chronic inflammation, in conjunction with the senescence-associated secretory phenotype, aggravates cardiac dysfunction with age by promoting immune cell infiltration into the myocardium, fostering HF. This is further exacerbated by age-related comorbidities like coronary artery disease (CAD), atherosclerosis, hypertension, obesity, diabetes and chronic kidney disease (CKD). CAD and atherosclerosis induce myocardial ischaemia and adverse remodelling, while hypertension contributes to cardiac hypertrophy and fibrosis. Obesity-associated insulin resistance, inflammation and dyslipidaemia create a profibrotic cardiac environment, whereas diabetes-related metabolic disturbances further impair cardiac function. CKD-related fluid overload, electrolyte imbalances and uraemic toxins exacerbate HF through systemic inflammation and neurohormonal renin-angiotensin-aldosterone system (RAAS) activation. Recognizing aging as a modifiable process has opened avenues to target systemic aging in HF through both lifestyle interventions and therapeutics. Exercise, known for its antioxidant effects, can partly reverse pathological cardiac remodelling in the elderly by countering processes linked to age-related chronic HF, such as mitochondrial dysfunction, inflammation, senescence and declining cardiomyocyte regeneration. Dietary interventions such as plant-based and ketogenic diets, caloric restriction and macronutrient supplementation are instrumental in maintaining energy balance, reducing adiposity and addressing micronutrient and macronutrient imbalances associated with age-related HF. Therapeutic advancements targeting systemic aging in HF are underway. Key approaches include senomorphics and senolytics to limit senescence, antioxidants targeting mitochondrial stress, anti-inflammatory drugs like interleukin (IL)-1β inhibitors, metabolic rejuvenators such as nicotinamide riboside, resveratrol and sirtuin (SIRT) activators and autophagy enhancers like metformin and sodium-glucose cotransporter 2 (SGLT2) inhibitors, all of which offer potential for preserving cardiac function and alleviating the age-related HF burden.

Background: With the increasing recognition of the importance of simulation-based teaching in medical education, research in this field has developed rapidly. To comprehensively understand the research dynamics and trends in this area, we conducted an analysis of knowledge mapping and global trends. Objective: This study aims to reveal the research hotspots and development trends in the field of simulation-based teaching in medical education from 2004 to 2024 through bibliometric and visualization analyses. Methods: Using CiteSpace and VOSviewer, we conducted bibliometric and visualization analyses of 6743 articles related to simulation-based teaching in medical education, published in core journals from 2004 to 2024. The analysis included publication trends, contributions by countries and institutions, author contributions, keyword co-occurrence and clustering, and keyword bursts. Results: From 2004 to 2008, the number of articles published annually did not exceed 100. However, starting from 2009, the number increased year by year, reaching a peak of 850 articles in 2024, indicating rapid development in this research field. The United States, Canada, the United Kingdom, Australia, and China published the most articles. Harvard University emerged as a research hub with 1799 collaborative links, although the overall collaboration density was low. Among the 6743 core journal articles, a total of 858 authors were involved, with Lars Konge and Adam Dubrowski being the most prolific. However, collaboration density was low, and the collaboration network was relatively dispersed. A total of 812 common keywords were identified, forming 4189 links. The keywords “medical education,” “education,” and “simulation” had the highest frequency of occurrence. Cluster analysis indicated that “cardiopulmonary resuscitation” and “surgical education” were major research hotspots. From 2004 to 2024, a total of 20 burst keywords were identified, among which “patient simulation,” “randomized controlled trial,” “clinical competence,” and “deliberate practice” had high burst strength. In recent years, “application of simulation in medical education,” “3D printing,” “augmented reality,” and “simulation training” have become research frontiers. Conclusions: Research on the application of simulation-based teaching in medical education has become a hotspot, with expanding research areas and hotspots. Future research should strengthen interinstitutional collaboration and focus on the application of emerging technologies in simulation-based teaching.

Background: The Objective Structured Clinical Examination (OSCE) is a pivotal tool for assessing health care professionals and plays an integral role in medical education. Objective: This study aims to map the bibliometric landscape of OSCE research, highlighting trends and key influencers. Methods: A comprehensive literature search was conducted for materials related to OSCE from January 2004 to December 2023, using the Web of Science Core Collection database. Bibliometric analysis and visualization were performed with VOSviewer and CiteSpace software tools. Results: Our analysis indicates a consistent increase in OSCE-related publications over the study period, with a notable surge after 2019, culminating in a peak of activity in 2021. The United States emerged as a significant contributor, responsible for 30.86% (1626/5268) of total publications and amassing 44,051 citations. Coauthorship network analysis highlighted robust collaborations, particularly between the United States and the United Kingdom. Leading journals in this domain—BMC Medical Education, Medical Education, Academic Medicine, and Medical Teacher—featured the highest volume of papers, while The Lancet garnered substantial citations, reflecting its high impact factor (to be verified for accuracy). Prominent authors in the field include Sondra Zabar, Debra Pugh, Timothy J Wood, and Susan Humphrey-Murto, with Ronaldo M Harden, Brian D Hodges, and George E Miller being the most cited. The analysis of key research terms revealed a focus on “education,” “performance,” “competence,” and “skills,” indicating these are central themes in OSCE research. Conclusions: The study underscores a dynamic expansion in OSCE research and international collaboration, spotlighting influential countries, institutions, authors, and journals. These elements are instrumental in steering the evolution of medical education assessment practices and suggest a trajectory for future research endeavors. Future work should consider the implications of these findings for medical education and the potential areas for further investigation, particularly in underrepresented regions or emerging competencies in health care training.

Background: Problem-Based Learning (PBL) is an engaging, student-centered teaching approach that has become increasingly popular in the field of medical education. Particularly during clinical rotations, PBL is thought to enhance students’ clinical reasoning and skills. However, the impact of PBL in pediatric clerkships has not been fully explored. Objective: This study aimed to assess the influence of PBL on the clinical skills of medical interns during pediatric rotations, comparing the outcomes between PBL and traditional teaching methods. Methods: A randomized controlled trial was conducted with 72 medical interns (38 male, 34 female) participating in pediatric rotations at our hospital between November 2023 and September 2024. The interns were assigned at random to either the PBL group (36 students) or the traditional teaching group (36 students), with stratification based on baseline clinical examination scores. Both groups participated in a two-week pediatric internship, encountering identical clinical cases. The PBL group received instruction supplemented with PBL, while the traditional group received bedside teaching. The outcomes were evaluated using a theoretical knowledge exam, Mini-CEX assessments, and a PBL group satisfaction survey. Results: The results of the theoretical knowledge exam showed no significant difference between the groups (PBL group: 90.25 ± 2.15, traditional group: 89.78 ± 2.14, p > 0.05), indicating similar support for theoretical learning. Mini-CEX evaluations demonstrated that the PBL group showed significant improvements in history taking, medical decision-making, physician-patient interactions, and comprehensive clinical skills compared to the traditional group. Feedback from the PBL group was overwhelmingly positive, with students highlighting significant improvements in clinical reasoning and diagnostic skills. Conclusion: PBL significantly enhanced clinical skills in pediatric clerkships, particularly in clinical reasoning, diagnosis, and communication. Although both teaching methods supported theoretical learning equally, PBL fostered greater student engagement and deeper learning, suggesting that it could be a valuable model for future medical education.

Case Presentation: A 3-year-and-6-month-old child was reported to have recurrent high fever with generalized lymph node enlargement and significant elevation of inflammatory markers such as C-reactive protein and procalcitonin in tests. Later, whole exome sequencing determined that the child's disease was haploinsufficiency of A20 (HA20).Results: After immunosuppressive therapy, the child's symptoms improved significantly, and the inflammatory markers dropped to the normal range.Conclusion: Because of the characteristics of HA20, this disease is often underdiagnosed and misdiagnosed in clinical practice. By reporting this case of HA20 in a child, we hope to increase the awareness of this disease in the clinic.

Background: Situational simulation teaching enhances students’ practical skills and clinical decision-making by replicating real-world scenarios. Pediatric practice often involves complex, dynamic situations, making it crucial for students to gain experience in a controlled environment where repeated practice can develop clinical expertise. Objective: This study aims to evaluate the effectiveness of situational simulation in pediatric clinical practice by comparing its impact on trainees’ skills with that of conventional teaching methods. Methods: A total of 52 pediatric trainees were randomly assigned to two groups: one participating in situational simulation training and the other receiving traditional instruction over a six-week period. A mixed-method approach, including formal assessments and Mini-Clinical Evaluation Exercises (Mini-CEX), was used to assess knowledge, clinical abilities, and overall competencies. A feedback survey was also administered to the simulation group to evaluate the impact of simulation-based training on their learning outcomes. Results: Theoretical exam performance was comparable between both groups, with no significant difference (p > 0.05). However, the situational simulation group showed significant improvements in key skills compared to the traditional group: medical history taking (26.92% vs 69.23%, p = 0.005), clinical judgment (19.23% vs 46.15%, p = 0.011), doctor-patient communication (26.92% vs 61.54%, p = 0.025), and overall clinical competence (19.23% vs 57.69%, p = 0.009). The simulation group also reported higher satisfaction and demonstrated superior competency in practical assessments. Conclusion: This study confirms that situational simulation effectively improves pediatric clinical skills, especially in practical competence and patient communication. The findings support further integration of simulation-based teaching into pediatric training programs to enhance clinical readiness and confidence.