The evaluation of ventilatory functional restrictions during a maximal exercise tolerance test in patients with Scheuermann disease has never been described.
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Δευτέρα 16 Ιουλίου 2018
Severe Hyperkyphosis Reduces the Aerobic Capacity and Maximal Exercise Tolerance in Patients with Scheuermann Disease
The Reliability of Motor Evoked Potentials to Predict Dorsiflexion Injuries During Lumbosacral Deformity Surgery: Importance of Multiple Myotomal Monitoring
Case-control analysis of transcranial motor evoked potential (MEP) responses and clinical outcome.
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Evaluation of N-Succinimidyl S-Acetylthioacetate Ligand for Radiolabeling of Humanized Antibodies with 188Rhenium
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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Evaluation of N-Succinimidyl S-Acetylthioacetate Ligand for Radiolabeling of Humanized Antibodies with 188Rhenium
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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Maternal Proteins That Are Phosphoregulated upon Egg Activation Include Crucial Factors for Oogenesis, Egg Activation and Embryogenesis in Drosophila melanogaster
Egg activation is essential for the successful transition from a mature oocyte to a developmentally competent egg. It consists of a series of events including the resumption and completion of meiosis, initiation of translation of some maternal mRNAs and destruction of others, and changes to the vitelline envelope. This major change of cell state is accompanied by large scale alteration in the oocyte's phosphoproteome. We hypothesize that the cohort of proteins that are subject to phosphoregulation during egg activation are functionally important for processes before, during, or soon after this transition, potentially uniquely or as proteins carrying out essential cellular functions like those they do in other (somatic) cells. In this study, we used germline-specific RNAi to examine the function of 189 maternal proteins that are phosphoregulated during egg activation in Drosophila melanogaster. We identified 53 genes whose knockdown reduced or abolished egg production and caused a range of defects in ovarian morphology, as well as 51 genes whose knockdown led to significant impairment or abolishment of the egg hatchability. We observed different stages of developmental arrest in the embryos and various defects in spindle morphology and aberrant centrosome activities in the early arrested embryos. Our results, validated by the detection of multiple genes with previously-documented maternal effect phenotypes among the proteins we tested, revealed 15 genes with newly discovered roles in egg activation and early embryogenesis in Drosophila. Given that protein phosphoregulation is a conserved characteristic of this developmental transition, we suggest that the phosphoregulated proteins may provide a rich pool of candidates for the identification of important players in the egg-to-embryo transition.
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An EMS-induced new sequence variant, TEMS5032, in the coding region of SRS3 gene leads to shorter grain length in rice ( Oryza sativa L.)
Abstract
Grain shape and size influence yield and consumer preferences in rice. In the present study, we characterized and mapped a short and bold grained mutant and named it as TEMS5032, as the mutant is a result of EMS-induced transition from C to T at the 5032nd bp of SRS3 gene, which is known to affect grain size in rice. The substitution led to creation of a stop codon in the motor domain of SRS3, a kinesin 13 family gene, translating into a truncated protein product. However, transcription of this gene remained unaffected in TEMS5032 compared to the wild type, N22. Further, the mutation was found to affect 13 of the 25 cell cycle-related genes as they showed differential expression with respect to N22. Based on rate of grain filling, dry matter accumulation in the endosperm and histological studies, the effect of mutation in TEMS5032 was found to be similar to a known variant, TCM758, but less severe than sar1 mutant. Sequencing of 88 rice germplasm lines in the kinesin motor domain region did not reveal the presence of this mutation, establishing it as a new variant of SRS3 gene.
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RapidDeploy hires leading public safety GIS expert
RapidDeploy, a leader in cloud-based Computer-Aided Dispatch (CAD) technology, announced the hiring of Brooks Shannon as Vice President of Product Management. Shannon is a national subject matter expert in public safety Geographic Information Systems (GIS), and has been involved in numerous efforts to increase and enhance location accuracy for 911 systems. "Our CAD technology is already...
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Laboratory for Advanced Medicine commercializes non-invasive, artificial intelligence-based IvyGene Blood Test for early cancer detection
Company Expands Headquarters and National Workforce to Accommodate Rapid Growth IRVINE, Calif.—Laboratory for Advanced Medicine (LAM), a clinical-stage medical technology company developing innovative technologies for the early diagnosis and intervention of cancers, today announced the commercialization of its revolutionary, non-invasive and highly accurate IvyGene test. IvyGene is designed...
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Annual First Responder Caring Award for 2018
ORANGEBURG, N.Y. – Dynarex, a leading medical products brand and provider of disposable medical supplies, is pleased to launch the 2nd Annual "First Responder Caring Award." The FRCA is to honor EMS/EMT first responders or first responder units who have gone above and beyond the call of duty. This year Dynarex will award one Grand Prize Winner with $2500 in Dynarex product and...
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EMTs help disabled pilot visit former airport
Two EMTs volunteered to help a former patient visit the airport where he was a pilot before suffering an aneurysm
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The Interprofessional/Family-Centered-Care Observation Rubric (I-FOR): Results of a Multicenter Study of a New Measure of Educational Outcomes
Abstract
Introduction The ability to provide family-centered care (FCC) and the ability to work in interprofessional care teams (IPC) are essential educational outcomes in graduate training programs. Lack of standardized measures leave programs to rely on idiosyncratic methods to monitor outcomes. We developed a faculty observation tool as part of an effort to create a national quality improvement database. We present evidence for the feasibility and validity of the faculty observation tool. Methods Trainees and faculty at four independent training programs participated. Nineteen maternal and child health disciplines were represented. Faculty supervisors rated trainees using the new measure (I-FOR), and trainees completed related subscales of a previously developed self-report measure, the core competency measure (CCM). Faculty provided qualitative feedback regarding the I-FOR in a separate questionnaire. Results Faculty (n = 78) completed the I-FOR on 86 trainees (86/92 = 93%) and reported satisfaction with completing the measures. The I-FOR demonstrated good internal consistency (Cronbach's alpha > 0.930) and test–retest reliability (IPC r = 0.862, FCC r = 0.823, p < 0.001). Greater than 95% of participants reported that the I-FOR accurately addressed the relevant skills for each practice domain. The I-FOR showed no correlation with the CCM. Significant improvements over time in the I-FOR ratings were demonstrated in three out of four programs. Discussion The I-FOR demonstrated good internal consistency and test–retest reliability. Faculty responses provide evidence for the feasibility and validity of the instrument. Self-report and faculty-observation measures both increased with training but were not correlated with each other.
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Investigation of Predictors of Newborn Screening Refusal in a Large Birth Cohort in North Dakota, USA
Abstract
Objectives The objective of this study was to identify maternal and provider predictors of newborn screening (NBS) refusal in North Dakota between 2011 and 2014. Methods Records of 40,440 live resident births occurring in North Dakota between 2011 and 2014 were obtained from the North Dakota Department of Health and included in the study. Factor-specific percentages of NBS refusals and 95% confidence intervals were computed for each predictor. Since the outcome is rare, multivariable Firth logistic regression was used to investigate maternal and provider predictors of NBS refusal. Model goodness-of-fit test was evaluated using the Hosmer–Lemeshow test. All analyses were conducted in SAS 9.4. Results Of the 40,440 live births, 135 (0.33%) were NBS refusals. 97% of the refusals were to white women, 94% were homebirths, and 93% utilized state non-credentialed birth attendants. The odds of NBS refusals were significantly higher among non-credentialed birth attendants (p < 0.0001), homebirths (p < 0.0001), and among those that refused Hepatitis B vaccination (HBV) at birth (p = 0.047). On the other hand, odds of NBS refusals were significantly (p < 0.0001) lower among women that had more prenatal visits. Conclusions for Practice This study provides preliminary evidence of association between NBS refusal and provider type, home births, and HBV refusal. Additional studies of obstetric providers, home births and women are needed to improve our understanding of the reasons for NBS refusal to better deliver preventive services to newborns.
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City paramedic helps foil robbery in Queens
Tomblin Nihjee, 20, was charged with assault of an EMT, petit larceny, and misdemeanor assault and harassment
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Correction to: Barriers Faced by the Health Workers to Deliver Maternal Care Services and Their Perceptions of the Factors Preventing Their Clients from Receiving the Services: A Qualitative Study in South Sudan
The original version of this article unfortunately contained a mistake in the funding statement.
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Ledipasvir/Sofosbuvir Effectively Treats Hepatitis C Virus Infections in an Underserved Population
Abstract
Background
Underserved populations have an unequal burden of HCV infections and poor outcomes with interferon-based treatments. Direct-acting antivirals have the potential to reduce these inequalities.
Aims
We aimed to estimate sustained virologic response (SVR) following treatment with sofosbuvir-based regimens for HCV infections among underserved individuals and summarize the frequency of SVR across published studies of underserved populations.
Methods
We used data from a clinical cohort of patients aged ≥ 18 years who initiated sofosbuvir-based regimens for HCV infection between February 2014 and June 2016 at an urban public hospital network that serves as the healthcare safety-net for Tarrant County, Texas. We estimated SVR with corresponding 95% confidence limits (CL). In addition, we systematically reviewed the evidence to identify other studies of direct-acting antivirals among underserved populations.
Results
Our study population comprised 435 patients. The majority of patients were aged ≥ 50 years (76%), male (52%), non-Hispanic White (54%), HCV genotype 1 (79%) and treated with ledipasvir/sofosbuvir (69%). Overall SVR was 89% (95% CL 86, 92%) and highest for ledipasvir/sofosbuvir (SVR = 95%, 95% CL 92, 97%). The reported SVR following direct-acting antivirals among 837 underserved patients from three other studies ranged between 90 and 99%.
Conclusions
Our results suggest that direct-acting antivirals, particularly ledipasvir/sofosbuvir, are generally effective for achieving SVR among underserved patients with HCV infections and may help reduce inequalities in HCV prevalence and outcomes for this vulnerable population.
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Fourth annual Hooley Awards finalists announced
LAKEVILLE, Minn. — ImageTrend, Inc. announced the nine finalists for this year's Hooley™ Awards. The Hooley Awards recognize innovators and thought leaders, honoring their involvement, creativity and passion in three categories: Innovation, Service and New Frontier. The winners will be announced at the 10th annual ImageTrend Connect Conference on July 18, 2018. "The Hooley...
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Concentrating on intrinsic disorder
Concentrating on intrinsic disorder
Concentrating on intrinsic disorder, Published online: 16 July 2018; doi:10.1038/s41576-018-0037-7
Many eukaryotic proteins, including key transcription regulators, contain intrinsically disordered regions (IDRs), which serve as flexible interaction platforms. The molecular understanding of IDR-based interactions is now emerging, providing new insights into how IDRs promote protein compartmentalization and/or phase separation and how these processes regulate gene expression.from Genetics via xlomafota13 on Inoreader https://ift.tt/2Lcmei1
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Evaluation of Community Programs for Early Childhood Development: Parental Perspectives and Recommendations
Abstract
Objectives Optimal early childhood development is crucial for promoting positive child health outcomes. Community programs supporting child development are available throughout the United States but general parental perceptions of such programs are not well understood. This study aimed to examine parental perceptions of community programs for early childhood development in a semi-urban city of the US. Methods Data were collected from focus groups (n = 4) composed of English-fluent parents from the local community with at least one child aged 0–5 years. After generation of verbatim transcripts, data were analyzed by two independent coders in order to identify themes. Results Parental perceptions were categorized into four areas: (1) Utilization of community services, (2) Helpful aspects of community services, (3) Negative aspects of community services and (4) Parental recommendations for improved resource utilization. Helpful aspects identified included social and economic support, provision of parental education, and developmental screening and medical support. Negative aspects included utilization of standardized assessment tools, awareness of agencies and resources, and access to services. In order to improve resource utilization, parents suggested improved communication with parents and the child's medical home, transparency, and translation of program information into other languages. Conclusions For Practice Overall, participants felt that community programs that support early childhood development and parenting were helpful. However, community agencies can improve on communication with parents and medical providers as well as translation of program information.
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Patient-, Hospital-, and Neighborhood-Level Factors Associated with Severe Maternal Morbidity During Childbirth: A Cross-Sectional Study in New York State 2013–2014
Abstract
Background The incidence of severe maternal morbidity (SMM) during childbirth is increasing in the United States. A better characterization of risk factors for SMM may identify targets for improving maternal outcomes. This study aims to characterize patient-, hospital-, and neighborhood-level factors associated with SMM during childbirth. Methods SMM during childbirth was identified in the 2013–2014 State Inpatients Database for New York. Hospital and neighborhood characteristics were abstracted from the American Hospital Association and the Area Health Resources files. Multilevel modeling was used to identify factors associated with SMM, with and without blood transfusion, and its between-hospital variation. Results 403,116 delivery-related discharges from 139 hospitals were analyzed; 1557 (0.39%) recorded SMM without blood transfusion. In the final multilevel model, 7 patient-level factors were associated with a greater than fourfold increase in the risk of SMM: pulmonary hypertension, postpartum hemorrhage, placenta accreta, chronic kidney disease, cardiac conduction disorders, emergent cesarean delivery, and preeclampsia. Three hospital-level factors were associated with SMM: proportion of non-White patients, proportion of Medicaid beneficiaries, and coding intensity. No neighborhood-level factors were predictive of SMM. The proportion of variation in SMM explained by the model was 23.5 with 23.2% related to patient-level factors. The model explained 55% of the between-hospital variation, primarily related to patient-level factors. Similar results were observed for SMM with blood transfusion. Conclusions This study confirms the association between patient-level factors and SMM. It identifies patient-level factors as the major driver of between-hospital variation in SMM. Efforts to improve maternal outcomes should target patient-level factors.
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Bacteremia in patients with liver cirrhosis: Prevalence and predictors of multidrug resistant organisms
Journal of Clinical Gastroenterology
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High incidence of autoimmune gastritis in patients misdiagnosed with two or more failures of H. pylori eradication
Alimentary Pharmacology and Therapeutics
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Indistinguishable T2/T3-N0 rectal cancer on rectal magnetic resonance imaging: Comparison of surgery-first and neoadjuvant chemoradiation therapy-first strategies
International Journal of Colorectal Disease
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Hepatocellular carcinoma as a leading cause of cancer-related deaths in Japanese type 2 diabetes mellitus patients
Journal of Gastroenterology
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Risk factors for 30-day hospital readmission after radical gastrectomy: A single-center retrospective study
Gastric Cancer
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Relationship Between Meal Frequency and Gastroesophageal Reflux Disease (GERD) in Iranian Adults
Abstract
Background
The association between frequency of meals and snacks and gastroesophageal reflux disease (GERD) is less studied in Middle-Eastern countries.
Aim
We aimed to determine the relationship between meal and snack frequency with GERD symptoms in a large sample of Iranian adults.
Methods
In this cross-sectional study, 4669 individuals filled out a questionnaire about their number of meals and snacks. Frequency of total meals was defined by summing up the frequency of main meals and snacks, and participants were categorized into four categories: < 3, 3–5, 6–7 and ≥ 8 meals/day. GERD was defined as having heartburn sometimes or more during the last 3 months. The severity of disease was assessed.
Results
The prevalence of GERD in the study population was 23.7%. There was no significant association between meal or snack frequency and GERD symptoms in the whole population. However, after adjustment of all potential confounders, we found that women who consumed 1–2 or 3–5 snacks per day, compared with those who never had snacks, had a 41% (OR 0.59; 95% CI 0.42–0.84) and 51% (OR 0.49; 95% CI 0.32–0.75) reduced risk of having GERD, respectively. Women who consumed 6–7 or ≥ 8 snacks and meals per day had a 38% (OR 0.62; 95% CI 0.41–0.96) and 43% (OR 0.57; 95% CI 0.34–0.95) risk reduction for GERD compared with those who ate < 3 snacks and meals per day.
Conclusion
We found no significant association between meal frequency and GERD symptoms in the whole population. Gender-specific analysis revealed inverse associations between meal and snack frequency and GERD in Iranian women. Further prospective studies are required to confirm these associations.
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Quality Improvement in Gastroenterology: A Systematic Review of Practical Interventions for Clinicians
Abstract
Background
Quality improvement (QI) identifies practical methods to improve patient care; however, it is not always widely known which QI methods are successful. We sought to create a primer of QI in gastroenterology for the practicing clinician.
Methods
We performed a systematic review of QI literature in gastroenterology. We included search terms for inflammatory bowel disease, irritable bowel syndrome, celiac disease, gastroesophageal reflux disease, pancreatitis, liver disease, colorectal cancer screening, endoscopy, and gastrointestinal bleeding. We used general search terms for QI as well as specific terms to capture established quality metrics for each GI disease area.
Results
We found 33 studies that met our definitions for QI. There were 17 studies of endoscopy including screening colonoscopy, six on liver disease, four on IBD, two on GERD, three on GI bleeding, and one on celiac disease. Education was the most common intervention, although most successful studies combined education with another intervention. Other effective interventions included retraining sessions to reach ADR goals in colonoscopy, nursing protocols to increase HCC screening, and EMR decision support tools to prompt reassessment of PPI therapy. Many studies showed improved compliance to metrics, but few were able to show differences in length of stay, readmissions, or mortality.
Conclusions
Our review of quality improvement literature in gastroenterology revealed common themes of successful programs: Education was frequently used but often insufficient, the EMR may be underutilized in guiding decision making, and patient-reported outcomes were infrequently assessed. Further research may be needed to compare QI strategies directly.
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Differences Between the Intestinal Lumen Microbiota of Aberrant Crypt Foci (ACF)-Bearing and Non-bearing Rats
Abstract
Background
Multiple factors including host–microbiota interaction could contribute to the conversion of healthy mucosa to sporadic precancerous lesions. An imbalance of the gut microbiota may be a cause or consequence of this process.
Aim
The goal was to investigate and analyze the composition of gut microbiota during the genesis of precancerous lesions of colorectal cancer.
Methods
To analyze the composition of gut microbiota in the genesis of precancerous lesions, a rat model of 1, 2-dimethylhydrazine (DMH)-induced aberrant crypt foci (ACF) was established. The feces of these rats and healthy rats were collected for 16S rRNA sequencing.
Results
The diversity and density of the rat intestinal microbiota were significantly different between ACF-bearing and non-bearing group. ACF were induced in rats treated with DMH and showed increased expression of the inflammatory cytokines IL-6, IL-8, and TNF-α. Firmicutes was the most predominant phylum in both ACF-bearing and non-bearing group, followed by Bacteroidetes. Interestingly, although the density of Bacteroidetes decreased from the fifth week to the 17th week in both groups, it was significantly reduced in ACF-bearing group at the 13th week (P < 0.01). At the genus level, no significant difference was observed in the most predominant genus, Lactobacillus. Instead, Bacteroides and Prevotella were significantly less abundant (P < 0.01), while Akkermansia was significantly more abundant (P < 0.05) in ACF-bearing group at the 13th week.
Conclusion
Imbalance of the intestinal microbiota existed between ACF-bearing and non-bearing rats, which could be used as biomarker to predict the genesis of precancerous lesions in the gut.
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Genomic data sharing in Canada: flying under the regulatory radar?
Abstract
Canada's regulatory frameworks governing privacy and research are generally permissive of genomic data sharing, though they may soon be tightened in response to public concerns over commercial data handling practices and the strengthening of influential European privacy laws. Regulation can seem complex and uncertain, in part because of the constitutional division of power between federal and provincial governments over both privacy and health care. Broad consent is commonly practiced in genomic research, but without explicit regulatory recognition, it is often scrutinized by research or privacy oversight bodies. Secondary use of health-care data is legally permissible under limited circumstances. A new federal law prohibits genetic discrimination, but is subject to a constitutional challenge. Privacy laws require security safeguards proportionate to the data sensitivity, including breach notification. Special categories of data are not defined a priori. With some exceptions, Canadian researchers are permitted to share personal information internationally but are held accountable for safeguarding the privacy and security of these data. Cloud computing to store and share large scale data sets is permitted, if shared responsibilities for access, responsible use, and security are carefully articulated. For the moment, Canada's commercial sector is recognized as "adequate" by Europe, facilitating import of European data. Maintaining adequacy status under the new European General Data Protection Regulation (GDPR) is a concern because of Canada's weaker individual rights, privacy protections, and regulatory enforcement. Researchers must stay attuned to shifting international and national regulations to ensure a sustainable future for responsible genomic data sharing.
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China: concurring regulation of cross-border genomic data sharing for statist control and individual protection
Abstract
This paper reviews the major legal instruments and self-regulations that bear heavily on the cross-border sharing of genomic data in China. It first maps out three overlapping frameworks on genomic data and analyzes their underpinning policy goals. Subsequent sections examine the regulatory approaches with respect to five aspects of responsible use and sharing of genomic data, namely, consent, privacy, security, compatible processing, and oversight. It argues that substantial centralised control exerted by the state is, and would probably remain, the dominant feature of genomic data governance in China, though concerns of individual protection are gaining momentum. Rather than revolving around a simplistic antinomy between privacy preservation and open science, the regulatory landscape is mainly shaped by the tension between government desires for national security, state competitiveness, and public health benefits.
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The effects of breathing at a frequency of 0.1 Hz on affective state, the cardiovascular system, and adequacy of ventilation
Psychophysiology, EarlyView.
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Biochemically diagnosed hypothyroidism and postoperative complications after cardiac surgery: a retrospective cohort analysis
Abstract
Purpose
To determine whether hypothyroidism is associated with cardiovascular complications and surgical wound infections after cardiac surgery.
Methods
Patients were categorized as: (1) hypothyroid [patients with increased TSH concentrations (≧ 5.5 mIU/L) within 6 months prior to surgery]; (2) corrected hypothyroid [diagnosis of hypothyroidism any time before surgery or on preoperative thyroid supplementation and normal TSH concentration (0.4 \(\le\) TSH \(\le\) 5.5 mIU/L]; and (3) euthyroid [no hypothyroid diagnosis and not on preoperative thyroid supplementation and normal TSH concentrations (0.4–5.5 mIU/L)]. We conducted pairwise comparisons among the three groups using inverse probability of treatment weighting. We compared the groups on postoperative myocardial infarction, cardiac arrest, atrial fibrillation, and a composite of surgical wound infections and postoperative vasopressor use using multivariable logistic regression models. We compared the groups on ICU and hospital length of stay using Cox proportional hazards regression.
Results
Hypothyroidism was associated with a lower risk of atrial fibrillation than euthyroidism, with an estimated relative risk (99.4% CI) of 0.71 (0.56, 0.89); P < 0.001. However, none of the other pairwise comparisons on myocardial infarction, cardiac arrest, and atrial fibrillation were significant. Corrected hypothyroid patients were slightly more likely to be discharged from hospital at any given time than euthyroid patients (hazard ratios (99.6% CI), 1.18 (1.07, 1.30); P < 0.001), but no other pairwise comparisons for secondary outcomes were significant.
Conclusions
Hypothyroidism was associated with lower risk of atrial fibrillation than euthyroidism, and corrected hypothyroidism was associated with a shorter length of stay than euthyroidism.
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End-tidal carbon dioxide monitoring improves patient safety during propofol-based sedation for breast lumpectomy: A randomised controlled trial
BACKGROUND The use of sedation is becoming more commonplace. Although pulse oximetry is a standard monitoring procedure during sedation, it cannot accurately detect early hypoventilation. End-tidal carbon dioxide (EtCO2) monitoring can be an earlier indicator of airway compromise; however, the existing literature is limited to a few studies with varying outcomes. OBJECTIVES To evaluate whether EtCO2 monitoring decreases the incidences of CO2 retention and apnoeic events in propofol-based sedation. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Two hundred women (aged 18 to 65 years, ASA physical status 1 or 2) who were scheduled for breast lumpectomy between June 2017 and August 2017. INTERVENTIONS Patients were allocated randomly to receive either standard monitoring or standard monitoring and EtCO2 monitoring. MAIN OUTCOME MEASURES The primary outcome was the incidence of CO2 retention. The secondary outcomes were the number of actions taken to restore ventilation, variations in PaCO2 and pH, the frequency of apnoea and the recovery time. RESULTS CO2 retention occurred significantly less often in the EtCO2 monitoring group (10 vs. 87%; P
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Is Abortion Included in Maternal and Child Health Curricula in the United States?
Abstract
Purpose The purpose of this study is to assess whether Maternal and Child Health (MCH) graduate programs address abortion content in their programs' foundational courses, elective courses, and general curricula. Description Between January and March 2017, we conducted a descriptive study with faculty from the 13 Centers of Excellence in Maternal and Child Health Education, Science and Practice (COEs). We reviewed syllabi and discussed foundational and elective course content via email and key informant interviews with COE faculty. We categorized abortion coverage in foundational courses as "transparent" or "tangential" depending on inclusion of the word "abortion" in course syllabi. We identified electives addressing abortion as "electives including abortion" and courses that focus on abortion as "abortion-specific electives." Assessment Evidence demonstrated that most programs do not transparently address abortion in required course curricula. Only one of 13 COEs transparently addresses abortion in the foundational course(s); seven COEs tangentially include abortion in foundational courses; and all programs address abortion in some capacity though no standard exists to ensure its inclusion. Despite barriers, including avoidance of controversy and fear of losing funding, COEs could address abortion by establishing shared curricular standards, facilitating values clarification and attitude transformation activities, utilizing information-sharing networks, strengthening relationships between MCH programs and abortion-related organizations, and using professional societies. The scope of our study does not allow us to conclude why abortion content is lacking nor the quality of current content. Conclusion MCH programs should transparently incorporate abortion content in foundational and electives courses to educate students on how to engage with complex and sometimes stigmatized public health issues.
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Fluid management concepts for severe neurological illness: an overview
Purpose of review The acute care of a patient with severe neurological injury is organized around one relatively straightforward goal: avoid brain ischemia. A coherent strategy for fluid management in these patients has been particularly elusive, and a well considered fluid management strategy is essential for patients with critical neurological illness. Recent findings In this review, several gaps in our collective knowledge are summarized, including a rigorous definition of volume status that can be practically measured; an understanding of how electrolyte derangements interact with therapy; a measurable endpoint against which we can titrate our patients' fluid balance; and agreement on the composition of fluid we should give in various clinical contexts. Summary As the possibility grows closer that we can monitor the physiological parameters with direct relevance for neurological outcomes and the various complications associated with neurocritical illness, we may finally move away from static therapy recommendations, and toward individualized, precise therapy. Although we believe therapy should ultimately be individualized rather than standardized, it is clear that the monitoring tools and analytical methods used ought to be standardized to facilitate appropriately powered, prospective clinical outcome trials. Correspondence to Boris D. Heifets, MD, PhD, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive Rm H3580, Stanford, CA 94305, USA. Tel: +1 650 497 8057; fax: +1 650 725 8544; e-mail: bheifets@stanford.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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In Response
No abstract available
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Special Cardiac Arrest Situations in the Perioperative Period
No abstract available
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Experience of Airway Management Training Program for Low- and Middle-Income Countries
No abstract available
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Intestinal Bacterial Flora and Alzheimer’s Disease
Despite the huge economic burden of Alzheimer's disease (AD), effective treatments of this pathology have still not found. As is mostly believed, the pathogenesis of AD is multifactorial. The intestinal microbial flora is the most complex microecosystem in mammals; there are reasons to believe that this flora is in significant symbiont relations with the human organism. The gut microbiome diversity can be considerably impaired by different types of diets, various chemical agents, and by the action of stress. As was found, disturbances of the gut microbial composition may be a factor responsible for some psychiatric diseases. Emerging evidence from recent studies indicates that neurodegenerative diseases might be directly associated with the impairment of the gut microbial flora. Thus, fecal microbiota therapy (FMT) might be a promising approach to suppress neurodegenerative disorders and, maybe, AD in particular.
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Physiological/Neurophysiological Mechanisms Involved in the Formation of Stress Responses
Physiological mechanisms involved in the generation of the stress reaction were the topic of great number of research and review papers published in the 20th Century and in the recent period. Nonetheless, mostly separate specific aspects of this problem have been discussed in a great majority of the respective communications. In the proposed review, we tried to fill this "gap" and to concentrate our attention on generalization and systematization of the existing information related to different aspects of the problem of stress mechanisms.
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Anodal Transcranial Direct Current Stimulation of the Motor Cortex in Healthy Volunteers
Effects of anodal transcranial direct current stimulation (tDCS) of the motor cortex on heart rate variability (HRV) indices in healthy volunteers were examined. Baseline HRVs of 16 healthy subjects were recorded, and the HRV changes during anodal and sham tDCS stimulation over the vertex were observed. RM-ANOVA showed significant changes in the means of the high-frequency (HF) band, lowfrequency (LF) band, and LF/HF ratio (P < 0.0001, P = 0.012, and P = 0.01, respectively). A significant decrease in the LF/HF ratio was found during tDCS as compared to baseline (P = 0.033); this effect was mainly due to an increase in the HF band during active stimulation (P = 0.002 in active vs. baseline, and P = 0.007 in active vs. sham). A slight statistically insignificant decrease in the LF band and increase in the HF band induced a significance in comparison of the LF/HF ratio during sham stimulation. The increase in the HF HRV component reflects intensification of parasympathetic activity during anodal stimulation of the motor cortex. Possible explanations are activation of the motor cortex or a dominancy of the left hemisphere due to lateralized current flow. According to our results, neuromodulation of the motor cortex can be an adjuvant to maintain the autonomic balance in some neurological diseases.
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Neurotoxicity of Cuprizone in Female and Male Rats: Electrophysiological Observations
Cuprizone induces massive demyelination in the CNS; however, the effects of cuprizone on the functions of the peripheral nervous system, as well as differential effects it may exert on males and females, have not yet been studied. Thus, we aimed to examine changes in the electromyographic characteristics of female and male Sprague-Dawley rats with cuprizone-induced demyelination. The body mass, food intake, nerve conduction velocity (NCV) along the sciatic nerve, latency, amplitude, and integral intensity (area) of the compound muscle action potential (CMAP; m. gastrocnemius) were measured weekly throughout a 4-week demyelination period, and histological sections of the brain and sciatic nerve were examined. Cuprizone led to a reduction in the NCV, CMAP amplitude and area, body mass, and food intake; simultaneously, it led to an increase in the CMAP latency. Notably, electrophysiological observations reveal that cuprizone affects both female and male rats, but males are more sensitive. This is the first study showing gender differences for the peripheral neurotoxicity of cuprizone.
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Respiratory Rhythm in a Simplified Respiratory Network Model
The regulatory mechanism of the respiratory system is always a hot topic in the neurobiology field. Many researchers proposed multitudinous respiratory network models and explored their internal connections. For further understanding the effect of the respiratory system in breathing, we have built a simplified respiratory network model and studied the relations between each neuron in this network. We, firstly, removed the pre-I neuron from the network and found that there are abundant bifurcation phenomena with respect for the interspike intervals (ISIs). In addition, a large number of unusual firing patterns were observed in the network under conditions of AC stimulation. After adjusting the potassium conductance in the pre-I neuron by a different tonic drive from the d1 input, we show the transition from bursting patterns to analogous single spiking and, subsequently, convert-bursting patterns. Moreover, when sodium ion channels were removed or synaptic connections and tonic drives in the network were excluded, the network activity showed relevant variations. This may help to explain some functions of ion channels or certain neurons of the network. Finally, the biparametric screening plane with the excitatory synaptic conductance and persistent sodium conductance has been drawn. Graduations in this plane reflected different firing patterns, such as tonic spiking, bursting, and aperiodic bursting. Our results provide important insights for understanding the regulatory mechanisms of the respiratory network and the surrounding structures.
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Effects of Prenatal Combined Stress on Passive Avoidance Learning and Memory in Rats
The effects of combined prenatal stress (including the action of electromagnetic fields, zoo social stress, and immobility on pregnant females) on the learning and memory of offsprings of rats were investigated. Two groups of male and female rats (n = 16 in each) were studied. The animals received prenatally (from 8 to 18 days of gestation) three different stresses as follows: immobilization of pregnant mothers (0.5 h, twice a day by placing in a restrainer), social stress (6 rats kept in a small cage), and exposure to electromagnetic waves (4 h, 0.5 MT, 50 Hz). The learning and memory of rats were assessed two months after birth (2, 6, 24, 48 h and 1- and 2-week-long intervals after training) by using a conditioning avoidance method. Also, expression of the APP gene was investigated in rats using RT-PCR. The prenatal stress suppressed visits of male offsprings to the dark compartment in comparison with the control group, and the difference was significant 2 h after the shock (P < 0.05). These parameters were also reduced in female offsprings of the stressed group, but this difference was insignificant (P > 0.05).The relative expression of the APP gene was also higher in both male and female offsprings (P < 0.05 and 0.01, respectively). Thus, the implemented combined prenatal stress impaired the acquisition process and long-term memory in male offsprings and long-term memory in female offsprings. Also, it may promote deposition of β-amyloid plaques.
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Combined Effects of Donepezil and Lovastatin on Cognition Deficit Induced by Bilateral Lesion of the Nucl. Basalis Magnocellularis in a Rat Model of Alzheimer’s Disease
Donepezil is the common standard symptomatic treatment for mild-to-moderate Alzheimer's disease (AD) patients, but it showed only moderate efficacy and also emergence tolerance. To conquer this shortcoming, combinations of several drugs are widely used. Statins, competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, are commonly prescribed drugs for the treatment of hypercholesterolemia. Growing evidence demonstrated that this class of medicines exerts neuroprotective effects in neurological disorders, including AD. We have examined whether co-administration of lovastatin with donepezil provides a synergistic cognition-improving effect in an animal model of AD. In rats with the bilaterally lesioned nucl. basalis magnocellularis (NBM), lovastatin (20 mg/kg) and donepezil (10 mg/kg), when administered separately, noticeably improved working and reference memory tests in the radial maze, compared to the NBM lesioned group with no treatment but not with lower doses. Combined administration of subtherapeutic doses of lovastatin (1.0 mg/kg) and donepezil (0.1 mg/kg), which exerted no discernible effects on performance when given alone, significantly improved working and reference memory, indicating a synergistic cognitionimproving effect. This result suggests that a low dose of lovastatin potentiates the effect of an inactivedose of donepezil on cognitive impairment, and that the synergistic effect may be mediated through increases in the choline acetyltransferase activity and ACh level to compensate the cholinergic deficit in the rat model of Alzheimer's disease.
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Expression of Neuronal NO Synthase and the Hyperglycemic Reflex to Anoxic Stimulation of the Carotid Body in Normoglycemic and Hyperglycemic Rats
Blood glucose levels are detected by glucoreceptors located in the central nervous system (CNS) and peripheral tissues, in particular in the pancreatic beta cells and carotid bodies (CBs). Nitric oxide (NO) modulates the chemosensory discharge in the CBs by temporarily inhibiting oxygen (O2) consumption through the blockade of mitochondrial cytochrome-c-oxidase (Cit-c). It has been reported that the NO synthase (NOS) level is higher in hyperglycemic rats. Therefore, there is a possibility that acute anoxia affects the gene expression of neuronal NOS (nNOS) in the CBs, and this is mediated by the glucose level. Male Sprague-Dawley rats (250 to 300 g) anesthetized with sodium pentobarbital (30 mg/kg) and artificially ventilated were used in our experiments. The rats were divided in four groups: i) control 1, normoglycemic rats (C1); ii) experimental 1, normoglycemic rats (E1) with anoxic CB stimulation with cyanide; iii) control 2, hyperglycemic rats (C2) treated as in the C1 group, and iv) experimental 2, hyperglycemic rats (E2) treated as in the E1 group. At the end of the experiment, the blood glucose levels were measured, and the CBs were extirpated to determine nNOS expression through qPCR testing. Anoxic stimulation of the CBs induced a significant increase in the glucose level when the E1 vs. E2 groups were compared, whereas nNOS mRNA expression in E2 rats was smaller when compared to E1. It is concluded that hyperglycemia induced by streptozotocin reduces nNOS mRNA expression in the CBs and hyperglycemic reflex after anoxic stimulation of the CBs in rats.
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