Abstract Background Empathy is a core competence in medical practice that contributes to patient outcomes and physician well-being. Although widely studied, the developmental trajectory of empathy during medical education remains unclear, particularly in China. To date, no long-term longitudinal studies have examined empathy development among Chinese medical students. Methods We conducted a five-year prospective longitudinal study among medical students at Fudan University. Both the Jefferson Scale of Empathy–Student version (JSE-S), which assesses context-specific clinical empathy in medical settings, and the Interpersonal Reactivity Index (IRI), which measures dispositional (trait) empathy in general social contexts, were administered annually from 2019 to 2023. Mixed-effects models were used to analyze changes in empathy and their predictors, with fixed effects including academic year, age, career aspiration, and entry year. Results A total of 104 students contributed 266 valid responses across multiple measurement waves. JSE-S scores significantly decreased over time, with fifth-year scores markedly lower than first-year scores (B = − 11.57, p < .001). Older students and those with stronger medical career aspirations reported higher JSE-S scores. IRI scores positively predicted JSE-S scores (B = 0.40, p < .001) but remained stable across academic years, suggesting that trait empathy was largely unaffected by medical training. Conclusions Clinical empathy among Chinese medical students significantly decreased over five years, whereas trait empathy remained stable. These findings highlight the distinct developmental trajectories of clinical and trait empathy and emphasize the value of longitudinal dual-scale assessment. Educational interventions are needed to sustain empathy as a professional competence throughout medical training, particularly in the face of increasing clinical demands and contextual pressures during the later stages of education.

Reinforcement fine-tuning (RFT) has shown promise for training LLM agents to perform multi-turn decision-making based on environment feedback. However, most existing evaluations remain largely in-domain—training and testing are conducted in the same environment or even on the same tasks. In real-worlddeployment, agents may operate in unseen environments with different background knowledge, observation spaces, and action interfaces. To characterize the generalization profile of RFT under such shifts, we conduct a systematic study along three axes: (1) within-environment generalization across task difficulty, (2) cross-environment transfer to unseen environments, and (3) sequential multi-environment training to quantify transfer and forgetting. Our results show that RFT generalizes well across task difficulty within an environment, but exhibits unstable transfer to unseen environments, which correlates with shifts in both semantic priors and observation/action interfaces. In contrast, sequential training yields promising downstream gains with minimal upstream forgetting, and mixture training across environments improves the overall balance. We further provide detailed analyses and deeper insights, and hope our work helps the community develop and deploy generalizable LLM agents.

Global knowledge production and dissemination through academic publishing plays a critical role in achieving epistemic inclusion for peripheral scholars. This paper reports on an autoethnographic study of the 15 years of academic publishing efforts by the first author, Jiaqi Liu (JL). We used the theoretical lens of epistemic agency to explore how JL navigates the challenges posed by the structural constraints of academic publishing. We adopted the framework of "researching multilingually" (RM-ly) as an analytical framework to examine the specifics of how JL exercises her epistemic agency. The findings indicate that linguistic injustice was associated with epistemic exclusion, but JL developed her epistemic agency by drawing on the intentionality, spatiality, and relationality dimensions of RM-ly practices. She took responsibility for the advancement of her own knowledge, and generated new insights and practices in order to enhance her epistemic participation between English-, Japanese-, and Chinese-mediated research worlds. The paper suggests that instead of perceiving epistemic exclusion as an insurmountable difficulty, peripheral multilingual scholars can foster epistemic agency through the alternative approach of RM-ly and engage in multi-directional knowledge production and dissemination.

The rise of globalization of higher education has brought unprecedented challenges to the training of international students in Japan’s graduate schools. It is particularly important to investigate their multilingual practices in the context and to study how to play a role in the development od academic literacy. This study recruited 13 Chinese students enrolled in the English-medium-instruction Degree Program（EMI） of Japanese universities. Data were collected from semi-structured interviews and the reading/lecture notes of participants. We used NVivo 12 to analyze the data and interpreted international students’ multilingual practices drawing on the concept of academic socialization as well as the three dimensions（awareness,spatiality, and relationality） of the Research Multilingually（RM-ly） framework. Qualitative analysis revealed a reconstructive and covariant system where individual students constantly interacted with their learning environment in the context of academic socialization. We also revealed the impact of the system on the development of individual students’ academic literacies. Especially, we found that increased language awareness of students as multilingual researchers helps to enhance their academic reflexivity; the constraints of multilingual space cultivate multilingual habitus in students and develop their academic autonomy; academic communities established in formal or informal multilingual networks promote the academic cooperation among students.

Drawing on neoliberal ideology as a theoretical lens, this study critically examines how neoliberal ideological assumptions shape the interpretation and implementation of TGUP (Top Global University Project) as an English-medium instruction (EMI) policy in the Japanese context at multiple levels of government, universities, and multilingual international students. We examined documents describing TGUP policies published both by the government and TGUP universities, and then contrasted these policies with interview data drawn from conversations with three key stakeholder groups (international students, EMI faculty, and administrative staff) in four focal universities. The findings reveal the conflicts of policy making at different levels and challenge the English-only ideology in EMI practices. By taking a critical language policy approach, the study offers a nuanced understanding of how neoliberal ideology constitutes a policy-to-practice gap in language policy and planning. We argue that EMI should not be reduced to English-only medium of instruction, but rather treated as an alternative approach to the internationalization and globalization of education, and understood as a learning space where multilingual students enhance their learning by relying on their shared language repertoires.

Background The overwhelming interest in economically cost-effective treatments had led to an increase in the development of cosmetic facial injections. Concomitantly, complications have been also on the increasing trend. This article aimed to investigate the social-economic impact caused by infection after cosmetic facial injection. Methods A retrospective study was conducted between January 2014 and December 2019. Information including demographics, location of the original injection site, treatments, economic loss, and time away from work associated with complications was documented. Patients were asked to complete 2 FACE-Q domains 4 weeks after the first presentation, including quality of life and patient experience. Results Complete data were available for 12 patients. All patients were female; the mean age was 32.66 years (range, 26-49 years). The mean therapeutic cost of atypical mycobacterium was 18170.58 USD. The mean time away from work was 51.25 days (range, 21-103 days). The mean cost of time away from work was 400.80 USD (range, 164.23-805.50 USD). From FACE-Q, patients reported a decreased quality of social life, including social function (38.83 +/- 12.10), psychological distress (48.67 +/- 11.01), and early-life impact (39.92 +/- 10.15). Patients also reported low satisfaction with their decision to undergo the cosmetic facial injection. Conclusions Infection after cosmetic facial injection comes at a considerable social-economic impact on patients. Patients who responded in this study were extremely unsatisfied with the quality of life following the infection.

本研究对19名L1汉语普通话、L2英语、L3俄语初级学习者开展塞音生成实验.我们运用定量方法分析学习者的L2英语和L3俄语的词首塞音声学参数—嗓音起始时间,旨在调查L3语音生成习得特征以及先前语言的影响,讨论L3感知与生成习得的界面关系,并在此基础上探讨跨语言视域下的多外语语音教学方案.实证研究发现:(1)语言间存在的显著声学差异性会造成L3清浊塞音生成的混淆,L3俄语学习者很难运用发音器官完成浊塞音的调音过程;(2)L3清塞音的感知与生成之间存在正相关关系,而L3浊塞音的感知与生成之间不存在显著相关性.研究结果表明:我们在讨论多外语语音习得问题时,不仅要考察语言习得顺序及水平,更应比较语言组合的类型特征,才能更全面地描摹跨多语语音感知和生成习得的全貌.

《第三语言语音习得调查的进展》作为第三语言语音习得研究的专著,内容涉及英语、德语、法语、西班牙语、波兰语、日语等的多语音体系习得研究成果.文章首先介绍了该书的内容,其次围绕研究方法、研究问题和理论模型进行了评价.该书不仅理据充分地论述了研究一语、二语以外的三语或多语习得特征和过程的必要性,更为重要的是在现有研究基础上有了较大突破.该书用实证研究案例说明了第三语言语音习得研究的复杂性及可能性,对我国从事多外语语音习得或民族语言语音习得及教学研究的学者,在理论构建和实验方法范式方面都有重要的参考价值.同时,该书的研究成果对完善多语及民族语教学体系,制定社会、机构及家庭教育语言规划也有借鉴意义.

This article reports on a cross-linguistic study of 58 Chinese students’ perception of voiced and voiceless stops in their third language (L3). The participants were Japanese, Russian, or Spanish major students in a Chinese university, who were beginner learners of these languages but who had all learned English as their second language (L2) for over 10 years. The purpose of this study was to investigate the L3 learners’ perceptual differences in the stop categories, and analyze the effects of the learners’ multi-language background on their perception of L3 stops. Results from the perception experiment showed that: 1) the value and range of voice onset time (VOT) play an essential role in Chinese students’ perception of voiceless stops; and 2) the pre-voicing during closure is the key to Chinese students’ perception of voiced stops. We attribute their difficulty in perceiving L3 voiceless stops to the similarity in the phonemic range of voiceless stops between the learners’ L3 and their L1 and L2, as this leads to confusion in perception. On the other hand, the dissimilarity between L3 voiced stops and those of L1 and L2 is conducive to the students’ perception of L3 voiced stops. Findings from this study provide empirical evidence for the effect of similarity and dissimilarity in speech sounds as proposed in earlier phonology acquisition theories, and they can also inform the pedagogy of multi-language education.

Objective: To investigate the relationships between the constitutions of Traditional Chinese Medicine (TCM) and patients with cerebral infarction (CI) in a Chinese sample. Methods: A total of 3748 participants with complete data were available for data analysis. All study subjects underwent complete clinical baseline characteristics' evaluation, including a physical examination and response to a structured, nurse-assisted, self-administrated questionnaire. A population of 2010 neutral participants were used as the control group. Multiple variable regression (MLR) were employed to estimate the relationship between constitutions of TCM and the outcome. Design: A cross-sectional study was conducted to evaluate the association of body constitution of TCM and CI. Settings/Location: Communications and healthcare centers in Shanghai. Subjects: A total of 3748 participants with complete data were available for data analysis. Outcome measures: All study subjects underwent complete clinical baseline characteristics' evaluation, including a physical examination and response to a structured, nurse-assisted, self-administrated questionnaire. A population of 2010 neutral participants were used as the control group. MLR were employed to estimate the relationship between constitutions of TCM and the outcome. Result: The prevalence of CI was 2.84% and 4.66% in neutral participants and yang-deficient participants (p=0.012), respectively. Univariate analysis demonstrated a positive correlation between yang deficiency and CI. After adjustment for relevant potential confounding factors, the MLR detected significant associations between yang deficiency and CI (odds ratio=1.44, p=0.093). Conclusion: A yang-deficient constitution was significantly and independently associated with CI. A higher prevalence of CI was found in yang-deficient participants as compared with neutral participants.

In the wake of call for retractions of papers from Harvard University heart stem cell research lab, the public concerns had been raised about stem cell researches, including adipose-derived stem cells (ADSCs).

本研究通过实证性方法,旨在验证日语语音习得临界期假说,并探讨成年人日语学习者达到母语者发音水平的可能性.本研究针对日语学习者和日语母语者进行了语音实验.实验数据显示:(1)发音习得水平与年龄因素之间存在相关关系,越早开始学习日语,发音习得水平越高;(2)被试中有7名日语学习者虽学习起始年龄都已过语言习得临界期,但其发音习得水平仍达到了日语母语者水平.本研究结果否定了“超过一定年龄才开始学习外语的学习者几乎不可能达到完全习得”这一严格的语言习得临界期假说,同时也证明了即使成年人学习外语,发音也有可能达到母语者发音水平的可能性.

Objective To assess clinical features and treatment of angiosarcoma.Methods A retrospective study was carried out among seven patients hospitalized for angiosarcoma in the Department of Plastic Surgery,Zhongshan Hospital of Fudan University from January 2004 to March 2012.Clinical behaviors,therapeutic strategies and outcomes of angiosarcoma were analyzed in these patients.Results Of the seven patients,four were male,and three were female,with a median age of 67 years (range,37-77 years).Clinical presentations were various,including irregular ulcerous nodular masses in four patients,localized ulcer in one patient,and irregular erythematous nodules in two patients.All the patients were treated surgically with or without postoperative adjuvant therapy.Pathological examination revealed various degrees of differentiation and atypia of tumor cells,as well as obvious proliferation of endothelial cells,and all of these patients were diagnosed as angiosarcoma.Immunohistochemical analysis revealed a positive staining for CD31 and CD34.After surgical treatment,angiosarcoma recurred in four patients with the median time to the first recurrence being 3.5 months (range,1-6 months),cerebral metastasis occurred in one patient 5 months later,and two patients died.Conclusions Angiosarcoma is a rare and heterogeneous sarcoma with diverse clinical presentations.Local wide resection is the cornerstone of angiosarcoma treatment,and adjuvant therapy may improve its prognosis.

1 Nanhang Lu, MD Zihao Feng, MD Jiaqi Liu, MD Yong Zhang, MD Fazhi Qi, MD, PhD Department of Plastic and Reconstructive Surgery Zhongshan Hospital Fudan University Shanghai, China Sir: D sternal wound infection (DSWI) after cardiac operation remains a challenging problem for surgeons, and there is still a lack of consensus on its optimal surgical management. In recent years, the technique of sternum refixation by using titanium plate system in DSWI treatment has been reported in a few case reports,1,2 and the results seemed to be quite encouraging. We present a retrospective case-controlled study to identify whether the titanium plate refixation would improve the outcome of patients with DSWI. Between August 2006 and February 2012, 72 patients with DSWI were admitted into our department. We performed transverse titanium plate refixation of the sternum in combination with muscle flap reconstruction in 32 patients, and the other 40 patients received the conventional muscle flap reconstruction operations. Patients in both groups received the same pattern of antibiotic strategy and were comparable in sex distribution, recurrent DSWI cases, and DSWI risk factors (combined valve/CABG surgery, aortic surgery, left ventricular ejection fraction ≤ 30%, arterial hypertension, diabetes mellitus, current smoker, chronic obstructive pulmonary disease, renal insufficiency, and obesity). The only difference between the 2 groups was that patients in conventional treatment group were significantly younger than those in plate refixation group. All the patients were followed up for at least 18 months. Postoperative DSWI rate was significantly lower in plate refixation group (8.9% vs 40%, P < 0.05). Among patients who did not develop postoperative DSWI, the mean length of hospital stay was 12.4 ± 3.1 days in plate refixation group, significantly lower than 15.6 ± 3.1 days in conventional treatment group (P < 0.05). No significant difference was found between the 2 groups in mortality, major organ dysfunction, intensive care unit stay rate, or transfusion rate (Table 1). Sternal dehiscence had been demonstrated to have a direct relation with the development of sternal wound infection.3 Good fixation and immobilization of the sternum could lead to an optimal bone healing, which might prevent sternal dehiscence after the operation, and would be able to decrease Copyright © 2013 The Authors. Published by Lippincott Williams & Wilkins on behalf of The American Society of Plastic Surgeons. PRS Global Open is a publication of the American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Plast Reconstr Surg Glob Open 2013;1:e80; doi:10.1097/ GOX.0000000000000028; Published online 6 December 2013. Application of Transverse Titanium Plate Refixation in Deep Sternal Wound Infection: A Retrospective Analysis