Bronchial blockers under pressure: in vitro model and ex vivo model

Background

Pressures (P_e) exerted by bronchial blockers on the inner wall of the bronchi may cause mucosal ischaemia. Our aims were as follows: (i) to compare the intracuff pressure (P_i) and P_e exerted by commercially available bronchial blockers in an in vitro and an ex vivo model; (ii) to investigate the influence of both the inflated intracuff volume and cuff diameter on P_e; and (iii) to estimate the minimal sealing volume (V_Smin) and the corresponding P_e for each bronchial blocker studied.

Methods

The P_e exerted by seven commercial bronchial blockers was measured at different inflation volumes using a custom-designed system using in vitro and ex vivo animal models with two internal diameters (12 and 15 mm).

Results

In the same conditions, P_i was significantly lower than P_e (P<0.05), and P_e was higher in the in vitro model than in the ex vivo model. The P_e increased with the inflated volume, with use of the small-diameter model (P<0.05). Ex vivo models needed a higher minimal sealing volume than the in vitro models, and this volume increased with the diameter (e.g. the V_Smin at a positive pressure of 25 cm H₂O required a P_e ranging from 12 to 78 mm Hg on the 15 mm ex vivo model and from 66 to 110 mm Hg on the 12 mm ex vivo model).

Conclusions

The P_i cannot be used to approximate P_e. The diameter of the model, the inflated volume, and the bronchial blocker design all influence P_e. A pressure higher than the critical ischaemic threshold (i.e. 25 mm Hg) was needed to prevent air leak around the cuff in the in vitro and ex vivo models.

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Phorbol-12-myristate-13-acetate induces nociceptin in human Mono Mac 6 cells via multiple transduction signalling pathways

Background

Nociceptin in the peripheral circulation has been proposed to have an immunoregulatory role with regards to inflammation and pain. However, the mechanisms involved in its regulation are still not clear. The aim of this study was to investigate signalling pathways contributing to the regulation of the expression of nociceptin under inflammatory conditions.

Methods

Mono Mac 6 cells (MM6) were cultured with or without phorbol-12-myristate-13-acetate (PMA). Prepronociceptin (ppNOC) mRNA was detected by RT-qPCR and extracellular nociceptin by fluorescent-enzyme immunoassay. Intracellular nociceptin and phosphorylated kinases were measured using flow cytometry. To evaluate the contribution of various signalling pathways to the regulation of ppNOC mRNA and nociceptin protein, cells were pre-treated with specific kinase inhibitors before co-culturing with PMA.

Results

ppNOC mRNA was expressed in untreated MM6 at low concentrations. Exposure of cells to PMA upregulated ppNOC after nine h compared with controls without PMA (median normalized ratio with IQR: 0.18 (0.15–0.26) vs. 0 (0–0.02), P<0.01). Inhibition of mitogen-activated protein kinases specific for signal transduction reversed the PMA effects (all P<0.001). Induction of nociceptin protein concentrations in PMA stimulated MM6 was prevented predominantly by identity of ERK inhibitor (P<0.05).

Conclusions

Upregulation of nociceptin expression by PMA in MM6 cells involves several pathways. Underlying mechanisms involved in nociceptin expression may lead to new insights in the treatment of pain and inflammatory diseases.

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Gain-of-function mutations in SMAD4 cause a distinctive repertoire of cardiovascular phenotypes in patients with Myhre syndrome

Myhre syndrome is a rare, distinctive syndrome due to specific gain-of-function mutations in SMAD4. The characteristic phenotype includes short stature, dysmorphic facial features, hearing loss, laryngotracheal anomalies, arthropathy, radiographic defects, intellectual disability, and a more recently appreciated spectrum of cardiovascular defects with a striking fibroproliferative response to surgical intervention. We report four newly described patients with typical features of Myhre syndrome who had (i) a mildly narrow descending aorta and restrictive cardiomyopathy; (ii) recurrent pericardial and pleural effusions; (iii) a large persistent ductus arteriosus with juxtaductal aortic coarctation; and (iv) restrictive pericardial disease requiring pericardiectomy. Additional information is provided about a fifth previously reported patient with fatal pericardial disease. A literature review of the cardiovascular features of Myhre syndrome was performed on 54 total patients, all with a SMAD4 mutation. Seventy percent had a cardiovascular abnormality including congenital heart defects (63%), pericardial disease (17%), restrictive cardiomyopathy (9%), and systemic hypertension (15%). Pericarditis and restrictive cardiomyopathy are associated with high mortality (three patients each among 10 deaths); one patient with restrictive cardiomyopathy also had epicarditis. Cardiomyopathy and pericardial abnormalities distinguish Myhre syndrome from other disorders caused by mutations in the TGF-β signaling cascade (Marfan, Loeys–Dietz, or Shprintzen–Goldberg syndromes). We hypothesize that the expanded spectrum of cardiovascular abnormalities relates to the ability of the SMAD4 protein to integrate diverse signaling pathways, including canonical TGF-β, BMP, and Activin signaling. The co-occurrence of congenital and acquired phenotypes demonstrates that the gene product of SMAD4 is required for both developmental and postnatal cardiovascular homeostasis. © 2016 Wiley Periodicals, Inc.

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DNM1L-related encephalopathy in infancy with Leigh syndrome-like phenotype and suppression-burst

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Network burst activity in hippocampal neuronal cultures: the role of synaptic and intrinsic currents

The goal of this work was to define the contributions of intrinsic and synaptic mechanisms toward spontaneous network-wide bursting activity, observed in dissociated rat hippocampal cell cultures. This network behavior is typically characterized by short-duration bursts, separated by order of magnitude longer interburst intervals. We hypothesize that while short-timescale synaptic processes modulate spectro-temporal intraburst properties and network-wide burst propagation, much longer timescales of intrinsic membrane properties such as persistent sodium (Na_p) currents govern burst onset during interburst intervals. To test this, we used synaptic receptor antagonists picrotoxin, 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), and 3-(2-carboxypiperazine-4-yl)propyl-1-phosphonate (CPP) to selectively block GABA_A, AMPA, and NMDA receptors and riluzole to selectively block Na_p channels. We systematically compared intracellular activity (recorded with patch clamp) and network activity (recorded with multielectrode arrays) in eight different synaptic connectivity conditions: GABA_A + NMDA + AMPA, NMDA + AMPA, GABA_A + AMPA, GABA_A + NMDA, AMPA, NMDA, GABA_A, and all receptors blocked. Furthermore, we used mixed-effects modeling to quantify the aforementioned independent and interactive synaptic receptor contributions toward spectro-temporal burst properties including intraburst spike rate, burst activity index, burst duration, power in the local field potential, network connectivity, and transmission delays. We found that blocking intrinsic Na_p currents completely abolished bursting activity, demonstrating their critical role in burst onset within the network. On the other hand, blocking different combinations of synaptic receptors revealed that spectro-temporal burst properties are uniquely associated with synaptic functionality and that excitatory connectivity is necessary for the presence of network-wide bursting. In addition to confirming the critical contribution of direct excitatory effects, mixed-effects modeling also revealed distinct combined (nonlinear) contributions of excitatory and inhibitory synaptic activity to network bursting properties.

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Receptive field size, chemical and thermal responses, and fiber conduction velocity of rat chorda tympani geniculate ganglion neurons

Afferent chorda tympani (CT) fibers innervating taste and somatosensory receptors in fungiform papillae have neuron cell bodies in the geniculate ganglion (GG). The GG/CT fibers branch in the tongue to innervate taste buds in several fungiform papillae. To investigate receptive field characteristics of GG/CT neurons, we recorded extracellular responses from GG cells to application of chemical and thermal stimuli. Receptive field size was mapped by electrical stimulation of individual fungiform papillae. Response latency to electrical stimulation was used to determine fiber conduction velocity. Responses of GG neurons to lingual application of stimuli representing four taste qualities, and water at 4°C, were used to classify neuron response properties. Neurons classified as SALT, responding only to NaCl and NH₄Cl, had a mean receptive field size of six papillae. Neurons classified as OTHER responded to salts and other chemical stimuli and had smaller mean receptive fields of four papillae. Neurons that responded to salts and cold stimuli, classified as SALT/THERMAL, and neurons responding to salts, other chemical stimuli and cold, classified as OTHER/THERMAL, had mean receptive field sizes of six and five papillae, respectively. Neurons responding only to cold stimuli, categorized as THERMAL, had receptive fields of one to two papillae located at the tongue tip. Based on conduction velocity most of the neurons were classified as C fibers. Neurons with large receptive fields had higher conduction velocities than neurons with small receptive fields. These results demonstrate that GG neurons can be distinguished by receptive field size, response properties and afferent fiber conduction velocity derived from convergent input of multiple taste organs.

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Beta modulation reflects name retrieval in the human anterior temporal lobe: an intracranial recording study

Naming people, places, and things is a fundamental human ability that is often impaired in patients with language-dominant anterior temporal lobe (ATL) dysfunction or ATL resection as part of epilepsy treatment. Convergent lines of evidence point to the importance of the ATL in name retrieval. The physiologic mechanisms that mediate name retrieval in the ATL, however, are not well understood. The purpose of this study was to characterize the electrophysiologic responses of the human ATL during overt cued naming of famous people and objects. Eight neurosurgical patients with suspected temporal lobe epilepsy who underwent implantation of intracranial electrodes for seizure focus localization were the subjects of this study. Specialized coverage of the ATL was achieved in each subject. The subjects named pictures of U.S. presidents and images of common hand-held tools. Event-related band power was measured for each ATL recording site. Both the left and right ATL demonstrated robust and focal increases in beta-band (14–30 Hz) power during person and tool naming. The onset of this response typically occurred at 400 ms but sometimes as early as 200 ms. Visual naming of famous people and tools is associated with robust and localized modulation of the beta band in both the left and right ATL. Measurement of visual naming responses may provide the groundwork for future mapping modalities to localize eloquent cortex in the ATL.

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Issue Information

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Measuring cerebral auto-variability

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Exercise and muscle protein synthesis: not all roads lead to mTORC1

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Integration of vasodilatory stimuli in skeletal muscle vasculature: subtraction by addition?

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Prehospital Care Coordinator Receives EMS Champion Award

PITTSBURGH, PA –Ten plus years into her career and working with a variety of EMS agencies in Allegheny County, Pennsylvania & beyond, Kate Lambert has never lost sight of why she was driven to become a paramedic. For love and caring of others, regardless of their situation or where life has led them, her hallmark is the compassion and empathy that she exhibits whether taking care of a patient ...

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Prevent EMS medication errors with checklists and job aids

Most EMS providers have witnessed or been involved with a medication error attributable to poor system design and lack of safety behaviors

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Last Call: Paramedic, educator Richard Beebe

Paramedic, educator, author and EMS advocate Richaed Beebe was remembered at a memorial service on Saturday, June 11. This is Beebe's last call.

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Effect of alternate nostril breathing on acute stress-induced changes in cardiovascular parameters in obese young adults

2016-06-14T10-31-39Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Sharad Jain.
Background: Obesity is a major problem in young adults. They are more prone to develop hypertension. Cold pressor test (CPT) is an autonomic function test which produces acute stress. Alternate nostril breathing (ANB) exercise may be helpful in reducing the elevated sympathetic activity in obese and may be helpful in coping up the stress in obese subjects. Aims and Objectives: The aim of the present study was to find out the effect of ANB on acute stress-induced changes in cardiovascular parameters in obese young adults. Materials and Methods: A total of 60 obese male subjects (body mass index > 30) participated in the present study. CPT was performed to induce acute stress. Cardiovascular parameters were recorded using impedance cardiovasograph and mercury sphygmomanometer before CPT and in recovery phase in Step 1 and were repeated in Step 2 with ANB exercise. Statistical analysis was done by one-way ANOVA and Tukey post-hoc tests. Results: The study results showed that all the cardiovascular parameters were significantly higher (P

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Last Call: Paramedic, educator Richard Beebe

Paramedic, educator, author and EMS advocate Richaed Beebe was remembered at a memorial service on Saturday, June 11. This is Beebe's last call.

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Erratum to: Heritability and genome-wide analyses of problematic peer relationships during childhood and adolescence

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Distribution of Candida albicans and non-albicans Candida in clinical samples and their intrinsic biofilm production status

2016-06-14T09-55-56Z
Source: International Journal of Medical Science and Public Health
Kanishka Hrishi Das, Muhammad I Getso, Azeez-Akande O.
Background: Candida species, mainly Candida albicans are traditionally associated with severe and debilitating diseases especially in immunocompromised hosts. Biofilm is emerging virulence factor in fungi and has been correlated with pathogenicity among Candida species. The emergence of C. albicans and non-albicans Candida (NAC) species producing biofilms and severe or recurrent infections in hospitalized patients with its attendant treatment failure and poor prognosis has become a great concern globally. Objective: To determine the species distribution of Candida organisms (C. albicans and NAC) from clinical samples and their pathogenic ability to produce biofilms; and to highlight the clinical implications of these extracellular substances to aid preventive measures, chemotherapy, and prognosis. Materials and Methods: This was a descriptive, cross-sectional study, and was carried out at SRM MCH & SR, Tamil Nadu, India. Between February 2014 and January 2015, a total of 90 Candida fungal isolates recovered from clinical samples including urine, pus, vaginal swab, skin scrapping, sputum, and blood were analyzed. Samples were cultured on Sabouraud Dextrose Agar with gentamycin. Candida organisms were identified by standard methods. Germ tube rapid test was used to differentiate C. albicans and Candida dublinieses from other Candida species. Further speciation of the isolates was carried out by culture on CHROM agar and Corn meal-Tween 80 agar, including sugar fermentation and assimilation tests. Biofilm production was detected using Congo red method. Results were analyzed statistically. Result: A total of 90 Candida organisms were recovered from clinical specimens of which 33 (36.7%) were C. albicans and 57(63.3%) were NAC species. Majority of the isolates were recovered from urine (42, 46.7%), vaginal swab (20, 22.2%), and pus (11, 12.2%) samples. Among NAC species, the most common isolate was C. tropicalis (23, 25.6%) followed by C. parapsilosis (15, 16.7%). Of the 90 Candida species analyzed, 26 (28.9%) gave positive results for biofilm production. Overall, biofilm formation was detected more frequently among NAC species (16, 61.5%) than in C. albicans (10, 38.5%). Among NAC species, C. tropicalis (12, 46.2%) produced biofilm most frequently than other members of the group. Although, most of the Candida isolates strongly producing biofilms were members of NAC species particularly C. tropicalis (3, 50%), nonetheless, majority of the weakly biofilm producers were also detected among the strains of C. tropicalis (9, 45%). Conclusion: The outcome of this study shows a notable shift in the pathogenic incidence of Candida species from C. albicans to NAC species with significant rate of pathogenic biofilm production. Biofilm production was most common in C. tropicalis than other members of NAC species whereas slime formation was not detected in C. glabrata species. There is need to create awareness among the populace and stakeholders on healthcare system management about this emerging scenario in Candida species pathogenicity, biofilm production, and clinical repercussions for appropriate measures to checkmate the trend.


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Awareness of health insurance in a rural population of Bangalore, India

2016-06-14T09-55-56Z
Source: International Journal of Medical Science and Public Health
Indumathi K, Hajira Saba I, Arun Gopi, Mangala Subramanian.
Background: Health insurance is a rapidly emerging social security instrument for the rural poor, for whom, chronic health problems, arising due to prevalence of diseases and inaccessibility to an affordable health care system is a major threat to their income earning capacity. Insurance is one of the risk management strategies. The need for an insurance system that works on the basic principle of pooling of risks of unexpected costs of persons falling ill and needing hospitalization by charging premium from a wider population base of the same community. There is a need to increase the awareness of health insurance among rural population therefore this study was undertaken. Objective: (1) To study the socioeconomic and demographic characteristics of study population; and (2) to analyze the awareness of health insurance of study population. Materials and Methods: A pretested semi-structured questionnaire was used for collecting data on sociodemographic and economic characteristics of the study population and their awareness of the benefits and purpose of taking health insurance. Study was from October 2015 to December 2015. The data were analyzed using percentages and proportion. A total of 1084 sample houses were visited and among them 399 were interviewed. Result: Of the 399 respondents, 302 (75.7%) of them were aware of health insurance. Among 302 only 202 (66.9%) had procured health insurance. Of these, 187(95.5%) had government insurance and 15(7.5%) of them had private health insurance. Awareness of health insurance was associated with socioeconomic status and education (p

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