BackgroundMetabolic dysfunction-associated steatohepatitis (MASH) is characterized by a lipid overload-induced pathological cascade featuring hepatocyte injury, inflammation, and progressive fibrosis. This study aims to systematically investigate the role of EMMPRIN in MASH progression, and to elucidate its mechanisms in reprogramming the hepatic metabolic microenvironment.MethodsMurine models induced by methionine-choline -deficient diet, hepatocyte-specific EMMPRIN overexpression and knockout mice models were used to evaluate EMMPRIN’ roles in steatohepatitis. Parallel in vitro studies were conducted in corresponding cellular models. Proteomic sequencing, mass spectrometry, co-immunoprecipitation, Western blotting, quantitative PCR, and immunofluorescence were employed to identify downstream targets and characterize ubiquitination modifications.ResultsEMMPRIN overexpression significantly exacerbated MASH phenotypes, including hepatic steatosis, inflammatory infiltration, and collagen deposition. Conversely, EMMPRIN knockout conferred substantial protection against these pathological changes both in vivo and in vitro. Mechanistically, EMMPRIN downregulated UBA52 expression, resulting in reduction in the free ubiquitin pool and subsequent decrease in K63-linked polyubiquitination of monocarboxylate transporter 1 (MCT1). This ubiquitination defect led to destabilization of MCT1 and was associated with a global increase in protein lactylation in EMMPRIN-deficient models. Furthermore, EMMPRIN suppression inhibited several signaling pathways critically involved in MASH pathogenesis, including PPAR signaling, Notch signaling, and TGF-β-mediated fibrotic response.ConclusionOur findings demonstrate that EMMPRIN promotes MASH progression through the UBA52-MCT1 regulatory axis, which modulated ubiquitin-dependent protein stability and induced metabolic reprogramming, thereby driving lipid accumulation, inflammation, and fibrosis. These results position EMMPRIN as a promising therapeutic target for MASH intervention.

As a chronic condition, liver fibrosis is characterized by diverse etiological factors, and the pivotal event to its pathogenesis is the activation of quiescent hepatic stellate cells (HSCs) into myofibroblasts. Mesenchyme homeobox 1 (MEOX1) is a transcription factors central to cellular development and differentiation. However, the role of MEOX1 signaling in hepatic fibrosis still remains largely unknown. In this study, we investigated the potential role and mechanism of MEOX1 in liver fibrosis using different models in vivo and in vitro. The hepatic expression of MEOX1 exhibited a positive correlation with the degree of fibrosis in patients diagnosed with non-alcoholic steatohepatitis (NASH), as determined through bioinformatics analysis. Furthermore, MEOX1 demonstrated high expression levels in activated HSCs and fibrotic liver tissues induced by methionine and choline-deficient diet (MCD), thioacetamide (TAA), or carbon tetrachloride (CCl4) treatment in C57/BL6 mice. Mechanistically, MEOX1 facilitated HSC activation, proliferation, and migration. The comprehensive analysis of transcriptome sequencing and chromatin immunoprecipitation sequencing data revealed that connective tissue growth factor (CTGF) served as a target gene for MEOX1 in HSCs. Specifically, MEOX1 bound to the promoter region of CTGF and enhanced its transcriptional activity, thereby mediating the exacerbating effect of MEOX1 on hepatic fibrosis. In conclusion, our current findings elucidate the role of MEOX1 in exacerbating hepatic fibrosis progression through transcriptional activation of CTGF. Our findings provide valuable insights into the therapeutic potential of targeting MEOX1 for the treatment of hepatic fibrosis.

BackgroundThe mechanisms underlying the occurrence and progression of metabolic dysfunction-associated steatohepatitis (MASH)-related liver fibrosis remains poorly understood. This study aims to identify key transcription factors involved in the development of liver fibrosis in MASH patients, thereby providing potential targets for drug discovery.MethodsMicroarray data were retrieved from liver biopsy specimens of MASH patients exhibiting varying stages of fibrosis via the Gene Expression Omnibus database. Differentially expressed transcription factors (DETFs) were identified through the application of Weighted Gene Co-expression Network Analysis. A set of in vitro and in vivo experiments were conducted to investigate the role of MEOX1 in MASH-related fibrosis. To delineate the potential mechanisms, the transcriptomic RNA sequencing (RNA-seq), Alphafold, and PyMOL were used.ResultsA total of six DETFs (MEOX1, SOX4, LEF1, SOX9, MYC, and CBX2) were identified as being positively correlated with the progression of MASH-related fibrosis. MEOX1 was increased in mouse model of MASH diet-induced liver fibrosis and hepatic stellate cells (HSCs) stimulated by transforming growth factor-β1. Knockdown of the MEOX1 markedly suppressed the activation, proliferation, and migration of HSCs. RNA-Seq analysis identified serine protease inhibitor family E member 1 (SERPINE1) as the critical target of MEOX1 within HSCs. The protein interaction sites of MEOX1 and SERPINE1 were predicted using Alphafold and PyMOL.ConclusionIn summary, as a pivotal transcription factor, MEOX1 activates HSCs via SERPINE1, thereby promoting liver fibrosis associated with MASH. Inhibition of the MEOX1-SERPINE1 pathway could offer a novel therapeutic avenue for treating MASH-related fibrosis.

Background: CD8+ T cells play pivotal roles in antitumor immunity, where infiltration levels often correlate with favorable prognosis. However, the functional heterogeneity of CD8+ T cell subsets within the gastric cancer (GC) tumor microenvironment (TME)-particularly their divergent impacts on tumor progression, immunotherapy response, and clinical outcomes-remains poorly characterized. Methods: We integrated single-cell RNA sequencing (scRNA-seq) data from 23 GC tissues (GEO: GSE150290) with bulk transcriptomic profiles from TCGA-STAD to dissect CD8+ T cell heterogeneity. Analytical pipelines included unsupervised clustering, pseudotime trajectory analysis, and protein-protein interaction (PPI) network construction to identify survival-associated hub genes. Differential gene expression, functional enrichment, and experimental validation were performed to confirm clinical relevance. Results: scRNA-seq resolved CD8+ T cells into five functionally distinct subsets: naïve/memory, exhausted, and three cytotoxic subpopulations. Among these, cytotoxic CD8+ T1 cells exhibited the strongest prognostic relevance, with high infiltration correlating to improved survival and enrichment in G2-grade tumors. Pseudotime analysis revealed differentiation trajectories from naïve to exhausted subsets, accompanied by metabolic and immune checkpoint pathway alterations. PPI network analysis identified SELL, CD79B, and RAMP2 as hub genes, all significantly linked to survival and differentially expressed across tumor grades/stages. Experimental validation confirmed that SELL, CD79B, and RAMP2 knockdown suppressed GC cell proliferation, underscoring their functional roles. Conclusion: Our study unveils the landscape of CD8+ T cell heterogeneity in GC and proposes a three-gene signature (SELL/CD79B/RAMP2) with dual prognostic and therapeutic potential. These findings provide actionable insights for stratifying patients, tailoring immunotherapy regimens, and developing novel targets to enhance antitumor immunity in GC.

Exercise is the main treatment for patients with metabolic-associated fatty liver disease (MAFLD); however, it may be difficult for some patients to adhere to or tolerate an exercise regime. Thus, finding a treatment alternative to exercise is of particular importance. The authors have previously demonstrated that the high expression of microRNA (miRNA/miR)-212 promotes lipogenesis in vitro. The present study aimed to explore the therapeutic potential, as well as the mechanisms of action of miR-212 in MAFLD. The expression of miR-212-3p, but not that of miR-212-5p, was found to be significantly elevated in MAFLD and to be decreased by exercise. Compared with exercise treatment, the inhibition of miR-212-3p expression in a mouse model fed a high-fat diet exerted beneficial effects on MAFLD similar to those of exercise. Conversely, the overexpression of miR-212-3p abolished the ameliorative effects of exercise on MAFLD. Fibroblast growth factor 21 (FGF21) and chromodomain helicase DNA binding protein 1 (CHD1) were identified as target genes of miR-212-3p in lipid metabolism using bioinformatics analysis. Mechanistically, the inhibition of miR-212-3p mimicked the effects of exercise on lipid metabolism by regulating FGF21, but not CHD1. The exercise-related transcription factor, early growth response 1 (EGR1), was identified upstream of miR-212-3p through promoter motif analysis. EGR1 overexpression inhibited miR-212-3p expression. The overexpression of miR-212-3p abolished the effects of exercise on lipid metabolism by exogenously attenuating the transcriptional repression of EGR1. Moreover, the overexpression of miR-212-3p abolished the regulatory effects of EGR1 on FGF21. On the whole, the present study demonstrates that miR-212-3p plays a key role in the effects of exercise on MAFLD. The findings presented herein suggest a potential therapeutic effect of targeting miR-212-3p in MAFLD.

Background: Although the close relationship between nonalcoholic fatty liver disease (NAFLD) and insulin resistance has been clarified and there is a five-fold higher prevalence of NAFLD in patients with diabetes compared to that in patients without diabetes, this is not a reason to focus only on the incidence of NAFLD in people with diabetes because people who are insulin resistant are not necessarily diagnosed with diabetes, which leads to the overlook of NAFLD in non-diabetic population.Actually, we are obligated to pay more attention to the non-diabetic population for early detection and intervention of NAFLD.There is a lack of a convenient tool for predicting NAFLD in non-diabetic adults, and thus we aim to develop and validate a novel clinical nomogram to predict NAFLD among non-diabetic population to save more medical resources and make less missed diagnosis.Methods: Researchers initially enrolled 20,944 patients and excluded those with history of drinking, known medication usage, viral hepatitis, known liver disease, missing covariant data, age <18 years, and impaired fasting blood glucose, leaving 14,251 adults participating in the baseline analysis, who were randomly divided in a ratio of 3:1 into a training dataset with 10,689 participants and a validation dataset with 3,562 participants, using the classification and regression training (caret) package in R software v. 4.0.3.Variables for prediction were selected by multivariable logistic regression analysis, the LASSO method, and clinical experience.Based on these, we constructed a prediction model.Performance of this model was validated by the area under the receiver operator characteristic curve, calibration curve, and decision curve analysis.Results: We used 6 variables to construct the prediction model: body mass index (BMI), aspartate aminotransferase (AST), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), hemoglobin A1c (HbA1c), and diastolic blood pressure (DBP).In the training and validation datasets, the AUROC value of this prediction was 0.891 [95% confidence interval (CI): 0.884 to 0.899] and 0.902 (95% CI: 0.890 to 0.914), respectively.The calibration plots and the decision curve analysis (DCA) demonstrated that the accuracy of this model was good, with high clinical practicability. Conclusions:The nomogram could screen non-diabetic adults for NAFLD and may aid clinical decisionmaking.

Abstract Background: Different patients have different sensitivities to lifestyle interventions (LSI) and thus different outcomes (improved or unchanged). In the present study, we aim to find key markers that can identify patients sensitive to lifestyle interventions. Methods: Raw data were obtained from the Liver Clinic and Obesity Clinic of the Antwerp University Hospital that divided patients into LSI responders and non-responders based on the effectiveness of the intervention at the pathologic level. The limma / voom algorithm was used for difference analysis; Over representation analysis was used for functional enrichment analysis. Functional class scoring was used for gene set enrichment analysis. WGCNA and PPI / MCODE were used to identify valuable modules and genes. Western blot and immunohistochemistry were used for experimental validation.Results: Specific features of LSI responders were extracted based on differential expression and functional enrichment. The CIBERSORT and ESTIMATE algorithm reconfirmed that there were differences in the immune cell composition of LSI responders versus non-responders. Next, the WGCNA algorithm was used to integrate analyses of associations between immune cell phenotypes and genes. PPI and MCODE algorithms were used to screen for gene clusters with higher weights. The test set and validation set data were subjected to correlation analysis of the filtered genes to obtain the hub gene - ANT1. ANT1 was highly expressed in LSI responders, while it was lowly expressed in non-responders. Mechanistically, ANT1 responds to lifestyle intervention by activating Panx1, which is key to lesion improvement in LSI responder populations. Conclusions: In the study, we confirm that LSI responders populations respond to exercise intervention via the ANT1 / Panx1 pathway.

Strengthening science knowledge and interdisciplinary guide can help students with scientific perspective and thinking.A teaching team from the school of medicine and the school of physics science and engineering set up and built a learner-centric course, collides of physics with medicine. The course is composed of several independent and flexible teaching modules. The course assessment including class discussion, module thesis and the final reports, students appraisement and teacher-student discussion is used for teaching evaluation. The results showed that 86.8%(33/38)of the students got excellent scores, the curriculum also got excellent appraisement from 94.7%(36/38) students, indicating the conformed teaching effect. The course makes exploration in the interdisciplinary medical education mode for excellent talents education.

Background: Immune responses are important in the progression of non-alcoholic fatty liver disease (NAFLD). Natural killer T (NKT) cells are main components of the innate immune system that modulate immunity. However, the role of NKT cells in NAFLD remains controversial. Objective: We aimed to investigate the role of NKT cells in non-alcoholic steatohepatitis (NASH)-related fibrosis in fast food diet (FFD)- and methionine choline-deficient (MCD) diet-induced mouse models. Methods Hepatic NKT cells were analysed in wild-type (WT) and CD1d-/- mice fed FFD or MCD diets. Hepatic pathology, cytokine profiles and liver fibrosis were evaluated. Furthermore, the effect of chronic administration of alpha-galactosylceramide (alpha-GalCer) on liver fibrosis was investigated in both FFD- and MCD-treated mice. Results: FFD induced a significant depletion of hepatic NKT cells, thus leading to mild to moderate NASH and early-stage fibrosis, while mice fed MCD diets developed severe liver inflammation and progressive fibrosis without a significant change in hepatic NKT cell abundance. FFD induced a similar liver fibrogenic response in CD1d-/- and WT mice, while MCD induced a higher hepatic mRNA expression of Col1 alpha 1 and TIMP1 as well as relative fibrosis density in CD1d-/- mice than WT mice (31.8 vs. 16.3, p = .039; 40.0 vs. 22.6, p = .019; 2.24 vs. 1.59, p = .036). Chronic administration of alpha-GalCer induced a higher hepatic mRNA expression of TIMP1 in MCD-treated mice than controls (36.7 vs. 14.9, p = .005). Conclusion: NKT cells have protective roles in NAFLD as the disease progresses. During diet-induced steatosis, mild to moderate NASH and the early stage of fibrosis, hepatic NKT cells are relatively depleted, leading to a proinflammatory status. In severe NASH and the advanced stage of liver fibrosis, NKT cells play a role in inhibiting the NASH-related fibrogenic response. Chronic administration of alpha-GalCer induces NKT cell anergy and tolerance, which may play a role in promoting the liver fibrogenic response.

Background Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide that endangers human health. Transcription factors (TFs) have gradually become hot spots for drug development in NAFLD for their impacts on metabolism. However, the specific TFs that regulate immune response in the development of NAFLD is not clear. This study aimed to investigate the TFs involved in the immune response of NAFLD and provide novel targets for drug development. Methods Microarray data were obtained from liver samples from 26 normal volunteers and 109 NAFLD patients using the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were analyzed by limma package. Differentially expressed transcription factors (DETFs) were obtained on DEGs combined with Cistrome Cancer database. Immune signatures and pathways hallmark were identified by ssGSSEA and GSVA. The co-regulation network was constructed by the above results. Further, quantitative Real-time Polymerase Chain Reaction (qRT-PCR), Western blot (WB) and Immunohistochemistry (IHC) were used to validate the relationship between GTF2I and NAFLD. CIBERSORT analysis was performed to identify cell types to explore the relationship between differential expression of GTF2I and immune cell surface markers. Results A total of 617 DEGs and six DETFs (ESR1, CHD2, GTF2I, EGR1, HCFC1, SP2) were obtained by differential analysis. Immune signatures and pathway hallmarks were identified by ssGSSEA and GSVA. GTF2I and CHD2 were screened through the co-regulatory networks of DEGs, DETFs, immune signatures and pathway hallmarks. Furthermore, qRT-PCR, WB and IHC indicated that GTF2I but not CHD2 was significantly upregulated in NAFLD. Finally, in silico, our data confirmed that GTF2I has a wide impact on the immune profile by negatively regulating the expression of the chemokine receptor family (227/261, count of significance). Conclusion GTF2I plays a role in NAFLD by negatively regulating the chemokine receptor family, which affects the immune profile. This study may provide a potential target for the diagnosis or therapy of NAFLD.

BACKGROUND:Diabetes is a metabolic disease which has been confirmed to be involved with abnormal or excessive body fat accumulation. There is still a lack of nationwide research in China to discuss the relationship between adiposity indicators included body mass index (BMI), waist circumference (WC), visceral adiposity index, waist-height ratio, waist-to-hip ratio (WHR) and diabetes. The question of which one is the best indicator of obesity to predict diabetes in China remains to be unclear.METHODS:Data were collected from the China Health and Nutrition Survey (CHNS) in 2009, including 7,930 participants aged over 18 years old for cross-sectional analysis. Information about height, weight, WC, hip circumference, smoking status, alcohol consumption, physical activity, energy intake and blood samples were analyzed. Binary logistic regression models were used to explore the association of WC, BMI, WHR, waist-to-height ration (WHtR) and visceral adipose index (VAI) with the prevalence of diabetes in the 2009 CHNS respectively. Predictive potential of five adiposity indicators was validated by the area under the receiver operator characteristic curve (AUROC). The optimal cut-off points were determined by Youden's index, which was used to estimate the performance of adiposity indicators.RESULTS:The study shows patients in the highest quartile were more likely to have diabetes than those in the lowest quartile of WC (OR: 4.237, 95% CI: 3.265-5.499), BMI (OR: 3.312, 95% CI: 2.601-4.218), WHR (OR: 3.199, 95% CI: 2.493-4.104), WHtR (OR: 3.760, 95% CI: 2.891-4.890), VAI (OR: 4.347, 95% CI: 3.411-5.541). The area under the receiver operator characteristic curve of WC, BMI, WHR, WHtR and VAI for diabetes was 0.700, 0.663, 0.668, and 0.697 and 0.694, respectively. The optimal cut-offs regarding diabetes in Chinese are WHtR ≥0.520 for men and VAI ≥1.878 for women.CONCLUSIONS:Our findings indicate that WC, WHtR, BMI, WHR and VAI are all independent risk factors for diabetes among Chinese adults. WHtR is the most accurate indicator for diabetes in men, while VAI for women.

BackgroundHepatocellular carcinoma (HCC) is a primary malignancy of the liver with high prevalence worldwide and poor prognosis. It has been verified that elongation of very-long-chain fatty acids gene family (ELOVLs), a group of genes that responsible for elongation of saturated and polyunsaturated fatty acids, participate in the pathogenesis and development of multiplex disease including cancers. However, the functions and prognosis of ELOVLs in HCC are still indistinguishable.MethodsFirst, we searched the mRNA expression and survival data of ELOVLs in patients with HCC via the data of The Cancer Genome Atlas (TCGA). The prognosis value of ELOVLs on HCC was assessed by Kaplan–Meier plotter and Cox regression analysis. reverse transcription quantitative- polymerase chain reaction (RT-qPCR), Western blot (WB), and immunohistochemistry were applied to assess the specific mRNA and protein expression of ELOVLs in HCC clinical specimens of our cohort. Then, the functional enrichment of ELOVL1 especially the pathways relating to the immune was conducted utilizing the Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA) analysis. Additionally, TIMER, CIBERSOR, and tumor immune dysfunction and exclusion (TIDE) were employed to evaluate the relationship between ELOVL1 and immune responses. Last, the correlation of ELOVL1 with genome heterogeneity [microsatellite instability (MSI), tumor mutational burden (TMB), mutant-allele tumor heterogeneity (MATH), homologous recombination deficiency (HRD), purity, ploidy, loss of heterozygosity (LOH), and neoantigens] and mutational landscape were also evaluated basing on the date in TCGA.ResultsSignificant expression alteration was observed in ELOVLs family at the pan-cancer level. In liver cancer, ELOVL1 and ELOVL3 were strongly associated with poor prognosis of HCC by survival analysis and differential expression analysis. Immunohistochemistry microarray, WB, and RT-qPCR confirmed that ELOVL1 but not ELOVL3 played an important role in HCC. Mechanistically, functional network analysis revealed that ELOVL1 might be involved in the immune response. ELOVL1 could affect immune cell infiltration and immune checkpoint markers such as PD-1 and CTLA4 in HCC. Meanwhile, high expression of ELOVL1 would be insensitive to immunotherapy. Correlation analysis of immunotherapy markers showed that ELOVL1 has been associated with MSI, TMB, and oncogene mutations such as TP53.ConclusionELOVLs play distinct prognostic value in HCC. ELOVL1 could predict the poor prognosis and might be a potential indicator of immunotherapy efficacy in HCC patients.

非酒精性脂肪性肝病(nonalcoholicfatty liver disease,NAFLD)是我国最为常见的慢性非传染性肝病,是一种与胰岛素抵抗和遗传易感密切相关的代谢应激性肝损伤.目前仍没有被推荐的药物及外科手术用来治疗N A FLD,生活方式的干预如饮食和运动干预仍是NAFLD的一线疗法.本文简述了防治NAFLD的生活方式干预方法.

Hepatic ischemia-reperfusion injury (HIRI) often occurs following surgical procedures such as liver resection and transplantation. However, despite its clinical prominence, to the best of our knowledge, there remain no effective strategies to treat HIRI. Therefore, the aim of present study was to identify therapeutic agents that can exert beneficial effects against HIRI. The present study found that following hepatic IR modeling in mice, gastrodin (Gas) pretreatment improved the IR outcomes in terms of the serum biochemical indexes (alanine transaminase and aspartate transaminase), tissue biochemical indexes (superoxide dismutase, malondialdehyde and reduced glutathione content) and tissue pathology (H&E staining). In addition, compared with those in the IR + vehicle group, the IR + Gas group showed upregulated expression levels of nuclear erythroid 2-related factor 2, heme oxygenase 1 and Bcl-2 as detected by western blotting and reverse transcription-quantitative PCR. The mRNA and protein expression levels of Bax and caspase-3 were downregulated in the IR + Gas group compared with the IR + vehicle group. Concurrently, no significant differences were observed in the parameters between the Sham + vehicle and the Sham + Gas groups, indicating that Gas pretreatment may not cause liver damage. In conclusion, the findings of the present study revealed that Gas pretreatment exerted a protective effect in HIRI through both antioxidant and anti-apoptotic mechanisms.

BACKGROUND:Taspase 1 (TASP1) is a highly conserved protease involved in site-specific proteolysis. Existing researches have revealed a link between TASP1 expression and carcinogenesis. However, limited data are available regarding the prognosis and functions of TASP1 in hepatocellular carcinoma (HCC).METHODS:Western Blotting and qRT-PCR were employed to evaluate the level of TASP1 in HCC cell lines and clinical specimens. TASP1 expression was further calculated in clinical specimens by immunohistochemistry and the mRNA level of TASP1 in HCC was analyzed using Oncomine and UALCAN databases. The TASP1 promoter methylation modification was shown via MEXPRESS and UALCAN. The association between TASP1 expression and postoperative prognosis was evaluated using Kaplan-Meier and Cox regression analysis in clinical patients. The effect of TASP1 on HCC prognosis was analyzed via Kaplan-Meier plotter, GEPIA and UALCAN. Additionally, the regulators, kinases, miRNA and transcription factor targets of TASP1 were identified using LinkedOmics. Moreover, cBioPortal was used to detect the genetic alteration of TASP1. Finally, TIMER was utilized to assess the relation between TASP1 and the immune cell infiltration, whereas the correlation of TASP1 with three immune factors was detected through TISIDB.RESULTS:TASP1 expression was increased in HCC cell lines and HCC tissues. CNV and DNA methylation of TASP1 were changed. Survival analysis revealed that high TASP1 expression was correlated with overall survival (OS). Functional network analysis about TASP1 in HCC showed that the double-strand break repair, peptidyl-threonine modification, spindle organization, peptidyl-lysine modification and microtubule-based movement were modulated. Furthermore, TASP1 expression revealed puissant relation to the infiltration of immune cells and three immune factors in HCC.CONCLUSION:These data indicate that TASP1 may act as a potential prognostic marker in HCC and regulate HCC via multiple mechanisms.

Health system science (HSS) is a science that studies how the health system provides health care for patients, how patients receive and obtain health care, and how health systems promote health. As one of the core innovations of the American Medical Association (AMA) recently, health system science has been implemented in the American medical education since 2013. As the third pillar of medical education, HSS plays an important role in patient and population health and care by cooperating and complementing with basic medicine and clinical medicine. This paper introduces the emergence, knowledge domains and development of HSS in American medical education. Furthermore, combined with the current situation of medical education in China, some ideas and suggestions for developing HSS in Chinese medical schools will be put forward.

Post competency-based medical education complies to the development and philosophy of modern medicine. This paper completely illustrates how to construct a scientific and diversified assessment evaluation system guided by post competency for medical students which combines formative assessment and summative assessment. Through the objective measurement and timely feedback of various abilities of medical students, the closed-loop feedback system of assessment and evaluation can be constructed to guide the exploration and practice of teaching process in reverse.

This article describes characteristics of the humanities and social science curriculum at University of Nebraska Medical Center (UNMC) and Tongji University school of medicine from the perspectives of students and medical education researchers. The background, design, format, teaching content, target population of students are compared and implications are discussed. The major differences are curriculum format and teaching content regarding health system science. Based on the comparison, following motions are proposed to optimize the curriculums of humanities and social science at Tongji University. Multidisciplinary collaboration is needed to design competency-based curriculum, while the learning objectives should address the specific issue of patient-physician relationship in China. Faculty development program and teaching assistants program are potential solutions to the shortage of small group facilitators. Furthermore, projects to improve health-care environment in affiliated teaching hospitals should be encouraged to build a better working and learning culture.