Sex differences in obesity-induced hypertension and vascular dysfunction: a protective role for estrogen in adipose tissue inflammation?

Obesity is a potent predictor of cardiovascular disease and associated risk factors, including hypertension. Systemic inflammation has been suggested by a number of studies to be an important link between excess adiposity and hypertension, yet the majority of the studies have been conducted exclusively in males. This is problematic since women represent ~53% of hypertensive cases and are more likely than men to be obese. There is a growing body of literature supporting a central role for immune cell activation in numerous experimental models of hypertension, and both the sex of the subject and the sex of the T cell have been shown to impact blood pressure (BP) responses to hypertensive stimuli. Moreover, sex steroid hormones play an important role in energy homeostasis, as well as in the regulation of immune responses; estrogen, in particular, has a well-known impact on both cardiovascular and metabolic disorders. Therefore, the purpose of this review is to examine whether sex or sex hormones regulate the role of the immune system in the development of hypertension and related vascular dysfunction in response to metabolic changes and stimuli, including a high-fat diet.

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Monteggia fracture-dislocation with intercondylar fracture of the ipsilateral humerus: a new type III Monteggia equivalent

2016-10-06T18-09-02Z
Source: The Southeast Asian Journal of Case Report and Review
Dr.Aakash Mugalur, Dr.Binoti A Sheth.
Monteggia fracture dislocations are rare but complex injuries usually involving a fracture of the ulna and dislocation of the radial head. Monteggia Fracture dislocations are associated with other concomitant injuries in the ipsilateral upper limb. However, ipsilateral distal intercondylar fracture of the humerus and Monteggia fracture dislocation in adults are very rare with only 4 cases described in literature till date. We presented an exceptionally rare case of type III Monteggia fracture dislocation with intercondylar distal humerus fracture with posterior interosseous nerve palsy. The patient was treated with open reduction and internal fixation with post operative physiotherapy. The posterior interosseous nerve palsy recovered without any operative intervention. The patient had good functional outcome with no disability. We consider it to be a type III Monteggia equivalent adding to the expanding list of equivalent lesions.


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Unintentional household poisoning due to rodenticide in a child

2016-10-06T18-09-02Z
Source: The Southeast Asian Journal of Case Report and Review
Nisreen A Rahman, Vinod A Chaudhari, Bhawana A Badhe, Kusa K Shaha.
Introduction: The household poisoning is a major problem in India, and the awareness of these poisons among the people is meager and sometimes they ignorant and careless regarding these poisons. The various types of rat killer or rodenticides used in household, and their improper usage and safety may pose serious health issues. The rat killer poisoning with phosphide, warfarin, and superwarfarin are increasing day by day. Case report: A three years old boy unintentionally consumed rat killer paste, when his mother was out of the house. He had complaints of nausea and vomiting, and he admitted in a primary health care center. Then he was referred to tertiary care center and during the treatment he developed the features of acute renal failure and hepatotoxicity due to the rat killer poison and succumbed on a second day of admission. The features of rat killer poison that is zinc phosphide were evident on thorough autopsy examination, clinical findings, and ancillary examinations. Discussion: There is a need for proper preventive and treatment strategies to reduce the number of exposures, morbidity and mortality due to household poisons including rat killer poisons. In medical practice identifying the rat killer poisoning cases, their proper management, and its medicolegal aspects are very important.


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Subcutaneous zygomycosis presenting as soft-tissue ‘tumour’ over scapula – case report and review of literature

2016-10-06T18-09-02Z
Source: The Southeast Asian Journal of Case Report and Review
Tarun Bali and Malhar N Kumar.
Subcutaneous zygomycosis due to Basidiobolus ranarum is endemic in India, especially in Southern India. This is a case report of animmunocompetent manual labourer who presented with a painless swelling overlying the left scapula. Preoperative imaging studies suggested the possibility of cavernous haemangioma. Excision biopsy was performed and gross as well as histopathological assessment showed it to be a fungal lesion (entomophthoromycosis). Culture of the affected tissue yielded B. ranarum. The patient was treated with potassium iodide and itraconazole and the lesion healed completely in 2 months.


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Adenomyoepithelioma of breast : report of a rare case

2016-10-06T18-09-02Z
Source: The Southeast Asian Journal of Case Report and Review
Dr Reena kouli.
Benign adenomyoepithelioma of the breast is a rare tumor characterized by biphasic proliferation of both an inner layer of epithelial cells and a prominent peripheral layer of myoepithelial cells. This entity may rarely progresses to a more malignant state or gives rise to metastasis. Accurate diagnosis and close follow up is essential for proper treatment of these tumors. We report a 15 year old girl who presented with large lump in the breast which was clinically mistaken for a giant fibroadenoma of breast. No nodes were palpable. On gross examination, a large lump 11x11x8 cm was noted which was well circumscribed, solid on cut section. On histopathologic examination the diagnosis of adenomyoepithelioma was made which was further supported by immunohistochemistry findings.


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Spontaneous neonatal rectal perforation: A case for primary closure

2016-10-06T18-09-02Z
Source: The Southeast Asian Journal of Case Report and Review
Anjali Verma.
Spontaneous perforation of the gastrointestinal tract in the neonate is rare. When it occurs it usually involves the stomach or the ileocaecal region. Perforation of the rectum in the neonate is usually caused by instruments being passed into it. We are hereby reporting a rare case of idiopathic rectal perforation and was successfully managed by primary closure.


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Metabolic acidosis with hemodilution due to massive absorption of normal saline as bladder irrigation fluid following holmium laser enucleation of prostate

Abstract

Holmium laser enucleation of prostate (HoLEP) is being performed with increasing frequency as a minimally invasive alternative to transurethral resection of the prostate (TURP) for the surgical management of benign prostatic hyperplasia (BPH). HoLEP offers the advantage of use of normal saline for irrigation, instead of glycine which is utilized in TURP, decreasing the likelihood of fluid absorption and effects on serum electrolytes. We describe a patient who underwent HoLEP for BPH and subsequently developed non-ion gap metabolic acidosis and hemodilution associated with volume overload.

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A 15-year experience of two hundred and twenty five consecutive right hepatectomies

In case of liver tumor, surgical resection is the therapeutic gold standard to increase patient survival. Among liver resections, right hepatectomy (RH) is defined as a major hepatectomy. The first aim of this study was to analyze the overall morbidity and mortality of patients undergoing RH, the second aim was to assess changes in both patients characteristic and surgical parameters and mortality rates in a single center institution.

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Alpha 1-antitrypsin levels can differentiate allelic phenotypes

Alpha 1 anti-trypsin (A1AT) is a liver protein whose deficiency results in a low A1AT plasma level and is caused by either homozygosity or compound heterozygosity for its mutant Z or S alleles [1]. A1AT heterozygosity has been shown to have a role as a modifier of other chronic liver diseases, however there is lack of data on A1AT plasma levels in such heterozygous phenotypes [2].

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Spontaneous passage of a large common bile duct stone during computed tomography

An asymptomatic 85-year-old man was referred to our hospital for the treatment of a common bile duct (CBD) stone. He had a history of distal gastrectomy and Roux-en-Y reconstruction for gastric cancer. Endoscopic retrograde cholangiopancreatography (ERCP) with a single-balloon enteroscope was performed. The cholangiogram revealed a CBD stone measuring 15mm in diameter (Fig. 1); however, stone extraction failed because of unsuccessful biliary cannulation. Precut sphincterotomy was not performed in this session, and therefore his papilla remained naive.

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Startup Seeks Kickass Paramedic - Dr Drip LLC

Venice Based startup seeking kickass paramedic. Be apart of a growing company from the ground up. Mission / Vision Deliver affordable hydration therapy: Keep people hydrated and feeling good Values Deliver a great product that helps people feel hydrated Be welcoming and dependable Put clients interest at the centre of everything we do Have fun Flexible shifts. Must have CA paramedic licence.

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Quadriparesis due to Lead Poisoning Nine Years After a Gunshot Wound with Retained Bullet Fragments: A Case Report

Lead toxicity in adults is characterized by nonspecific symptoms of abdominal pain, vomiting, constipation, fatigue, and weight loss. We present a case of severe lead toxicity that developed sub-acutely causing quadriparesis nine years after a gun shot wound with retained bullet fragments. The onset of symptoms may have been related to the development of a pseudocyst. The long interval between the gunshot wound and the onset of symptoms contributed to a delay in suspecting that the retained bullet was a source of lead toxicity.

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Differences in scapular orientation between standing and sitting postures at rest and in 120°scaption: A cross sectional study

Scapular orientation may be influenced by static body posture (sitting and standing) and contribute to the development of shoulder pain. Therefore a consistent body posture should be considered when assessing scapular orientation as well as enhancing optimal scapular positioning.

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A Review of Lung Transplantation and its Implications for the Acute Rehabilitation Team

Since the late 1980s, lung transplant has become an option for some individuals (in 2014 4000 lung transplants were performed) with end-stage lung disease aimed to help these individuals restore function and improve survival and quality of life. Individuals living with end-stage lung disease are already deconditioned with poor endurance and limited exercise capacity. There are additional post-transplant factors which can contribute to poor endurance and decreased exercise capacity. While pulmonary rehabilitation in the pre-transplant phase is a crucial component for positive functional outcomes following lung transplant, the incidence of post-transplant complications, coupled with the need for immunosuppression often warrants close monitoring by medical professionals.

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Lumbar muscle cross-sectional areas do not predict clinical outcomes in adults with spinal stenosis: a longitudinal study

Minimal longitudinal data exist regarding the role of lumbar musculature in predicting back pain and function. In cross sectional study designs, there is often atrophy of the segmental multifidus muscle in subjects with low back pain compared with matched controls. However, the cross sectional design of these studies prevents drawing conclusions regarding whether lumbar muscle characteristics predict or modify future back pain or function.

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Obesity, Vascular Disease, and Lumbar Disc Degeneration: Associations of Co-Morbidities in Low Back Pain

Low back pain and obesity are both rising epidemics. This manuscript will examine global trends in obesity, contributory lifestyle and societal factors, and morbidity and mortality associated with cardiovascular disease. Using this background information, the article will explore the complex physiological process of atherosclerosis and association between impaired lumbar perfusion and low back pain. It will also give specific guidance on exercise and nutrition to help treat these potential underlying and contributory mechanisms of spine pathology.

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Poster 401 Optimizing the Process Flow Chart for the Inpatient Management of Osteoporotic Vertebral Compression Fractures (OVCF)

Jonathan Morris: I Have No Relevant Financial Relationships To Disclose

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A 15-year experience of two hundred and twenty five consecutive right hepatectomies

In case of liver tumor, surgical resection is the therapeutic gold standard to increase patient survival. Among liver resections, right hepatectomy (RH) is defined as a major hepatectomy. The first aim of this study was to analyze the overall morbidity and mortality of patients undergoing RH, the second aim was to assess changes in both patients characteristic and surgical parameters and mortality rates in a single center institution.

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Alpha 1-antitrypsin levels can differentiate allelic phenotypes

Alpha 1 anti-trypsin (A1AT) is a liver protein whose deficiency results in a low A1AT plasma level and is caused by either homozygosity or compound heterozygosity for its mutant Z or S alleles [1]. A1AT heterozygosity has been shown to have a role as a modifier of other chronic liver diseases, however there is lack of data on A1AT plasma levels in such heterozygous phenotypes [2].

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Spontaneous passage of a large common bile duct stone during computed tomography

An asymptomatic 85-year-old man was referred to our hospital for the treatment of a common bile duct (CBD) stone. He had a history of distal gastrectomy and Roux-en-Y reconstruction for gastric cancer. Endoscopic retrograde cholangiopancreatography (ERCP) with a single-balloon enteroscope was performed. The cholangiogram revealed a CBD stone measuring 15mm in diameter (Fig. 1); however, stone extraction failed because of unsuccessful biliary cannulation. Precut sphincterotomy was not performed in this session, and therefore his papilla remained naive.

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Inside EMS Podcast: The challenges with pediatric education

Download this podcast on iTunes, SoundCloud or via RSS feed

​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss their recent visit to the Oklahoma University Pediatric Conference. Chris and Kelly discuss the high points of the conference, the challenges with pediatric education and their key takeaways. Kelly also discusses his impressions of the 2016 EMS World Expo that's going on this week in New Orleans.

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Pa. EMS agency receives 3 new ambulances

The ambulances were purchased with a $335,000 grant awarded to the agency in May.

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FDNY EMT squad disarms stabbing suspect

By EMS1 Staff

NEW YORK — Sometimes, being in the right place at the right time can save a life. 

Two FDNY EMTs were responding to a call Wednesday night when they heard loud screams for help nearby. Bruce Fonseca and Ryan Gref found two men in a fight; one was armed with a large knife. 

While Fonseca radioed for assistance, Gref took on the armed man. Fonseca subdued the man after Gref managed to get the knife, reported the NY Daily News. 

The two held onto the attacker while treating the victim until police arrived. 

"This show of professionalism and commitment [is what] show on a day to day basis to the citizens of New York," Israel Miranda, the head of the FDNY EMS union, said. 

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Paramedic - Mercy Medical Center

The Paramedic position supports Mercy's philosophy of patient centered care being a competent, respectful, and compassionate professional who is able to safely, appropriately, accurately, efficiently and independently follow Mercy's standards along with policies and procedures while caring for patients. The Paramedic (Tech Specialist II) assists unit specific team members to identify clinical problems ...

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Genetic basis of hepatitis virus-associated hepatocellular carcinoma: linkage between infection, inflammation, and tumorigenesis

Abstract

Hepatitis virus infection is a leading cause of chronic liver disease, including cirrhosis and hepatocellular carcinoma (HCC). Although anti-viral therapies against hepatitis B virus (HBV) and hepatitis C virus (HCV) have dramatically progressed during the past decade, the estimated number of people chronically infected with HBV and/or HCV is ~370 million, and hepatitis virus-associated hepatocarcinogenesis is a serious health concern worldwide. Understanding the mechanism of virus-associated carcinogenesis is crucial toward both treatment and prevention, and the recently developed whole genome/exome sequencing analysis using next-generation sequencing technologies has contributed to unveiling the landscape of genetic and epigenetic aberrations in not only tumor tissues but also the background liver tissues underlying chronic liver damage caused by hepatitis virus infection. Several major mechanisms underlie the genetic and epigenetic aberrations in the hepatitis virus-infected liver, such as the generation of reactive oxidative stress, ectopic expression of DNA mutator enzymes, and dysfunction of the DNA repair system. In addition, direct oncogenic effects of hepatitis virus, represented by the integration of HBV-DNA, are observed in infected hepatocytes. Elucidating the whole picture of genetic and epigenetic alterations, as well as the mechanisms of tumorigenesis, will facilitate the development of efficient treatment and prevention strategies for hepatitis virus-associated HCC.

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Characterizing cerebral and locomotor muscle oxygenation to incremental ramp exercise in healthy children: relationship with pulmonary gas exchange

Abstract

Aims

To characterize the oxygenation responses at cerebral and locomotor muscle level to incremental exercise in children and to assess the interrelationship with the pulmonary gas exchange responses.

Methods

Eighteen children (9 boys, 9 girls) (mean age 10.9 ± 1.0 years) performed incremental cycle ramp exercise to exhaustion. The concentration of cerebral and muscle oxygenated (O₂Hb) and deoxygenated (HHb) hemoglobin (by means of near-infrared spectroscopy) and pulmonary gas exchange was recorded. Cerebral and muscle O₂Hb and HHb values were expressed as functions of oxygen uptake (VO₂) and breakpoints were detected by means of double linear model analysis. The respiratory compensation point (RCP) was determined. The breakpoints in cerebral and muscle O₂Hb and HHb were compared and correlated to RCP.

Results

The subjects reached peak power output of 105 ± 18 W and VO_2peak of 43.5 ± 7.0 ml min⁻¹ kg⁻¹. Cerebral O₂Hb increased to an intensity of 89.4 ± 5.5 %VO_2peak, where a breakpoint occurred at which cerebral O₂Hb started to decrease. Cerebral HHb increased slightly to 88.1 ± 4.8 %VO_2peak, at which the increase was accelerated. Muscle HHb increased to 90.5 ± 4.8 %VO_2peak where a leveling-off occurred. RCP occurred at 89.3 ± 4.3 %VO_2peak. The breakpoints and RCP did not differ significantly (P = 0.13) and were strongly correlated (r > 0.70, P < 0.05). There were no differences between boys and girls (P = 0.43) and there was no significant correlation with VO_2peak (P > 0.05).

Conclusions

It was shown that cerebral and muscle oxygenation responses undergo significant changes as work rate increases and show breakpoints in the ongoing response at high intensity (85–95 %VO_2peak). These breakpoints are strongly interrelated and associated with changes in pulmonary gas exchange.

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GeoComm to participate in the National Emergency Number Association (NENA) 9-1-1 Standards and Best Practices Conference and Critical Issues Forum

ST. CLOUD, Minn. Next week marks the National Emergency Number Association (NENA) 9-1-1 Standards and Best Practices Conference and Critical Issues Forum. GeoComm's Brooks Shannon and Karl Larsen are excited to participate in both events as attendees and session presenters. The NENA 9-1-1 Standards and Best Practices conference will be held October 9-12 in Columbus, Ohio. This interactive event ...

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Utah paramedics deliver baby during highway closure

By EMS1 Staff

SOUTH JORDAN, Utah — Most people stuck in traffic simply wait for it to pass. But paramedics? They'll deliver a baby.

South Jordan Fire Department paramedics and firefighters were stuck in traffic when they received a call about a woman in labor who was also on the highway.

Crews responded to the call, where paramedic Josh Brown helped deliver the baby in the back of an ambulance. 

The woman and baby were then transported to the hospital. 

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Upper-Limb Recovery After Stroke: A Randomized Controlled Trial Comparing EMG-Triggered, Cyclic, and Sensory Electrical Stimulation

Background and purpose. This study compared the effect of cyclic neuromuscular electrical stimulation (NMES), electromyographically (EMG)-triggered NMES, and sensory stimulation on motor impairment and activity limitations in patients with upper-limb hemiplegia. Methods. This was a multicenter, single-blind, multiarm parallel-group study of nonhospitalized hemiplegic stroke survivors within 6 months of stroke. A total of 122 individuals were randomized to receive either cyclic NMES, EMG-triggered NMES, or sensory stimulation twice every weekday in 40-minute sessions, over an 8 week-period. Patients were followed for 6 months after treatment concluded. Results. There were significant increases in the Fugl-Meyer Assessment [F(1, 111) = 92.6, P < .001], FMA Wrist and Hand [F(1, 111) = 66.7, P < .001], and modified Arm Motor Ability Test [mAMAT; time effect: F(1, 111) = 91.0, P < .001] for all 3 groups. There was no significant difference in the improvement among groups in the FMA [F(2, 384) = 0.2, P = .83], FMA Wrist and Hand [F(2, 384) = 0.4, P = .70], or the mAMAT [F(2, 379) = 1.2, P = .31]. Conclusions. All groups exhibited significant improvement of impairment and functional limitation with electrical stimulation therapy applied within 6 months of stroke. Improvements were likely a result of spontaneous recovery. There was no difference based on the type of electrical stimulation that was administered.

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COMT and ANKK1 Genetics Interact With Depression to Influence Behavior Following Severe TBI: An Initial Assessment

Objective. Genetic variations in the dopamine (DA) system are associated with cortical-striatal behavior in multiple populations. This study assessed associations of functional polymorphisms in the ankyrin repeat and kinase domain (ANKK1; Taq1a) and catechol-O-methyltransferase (COMT; Val158Met) genes with behavioral dysfunction following traumatic brain injury (TBI). Participants. This was a prospective study of 90 survivors of severe TBI recruited from a level 1 trauma center. Main measures. The Frontal Systems Behavior Scale, a self- or family report questionnaire evaluating behavior associated with frontal lobe dysfunction, was completed 6 and 12 months postinjury. Depression was measured concurrently with the Patient Health Questionnaire-9. Study participants were genotyped for Val158Met and Taq1a polymorphisms. Results. No statistically significant behavioral differences were observed by Taq1a or Val158Met genotype alone. At 12 months, among those with depression, Met homozygotes (Val158Met) self-reported worse behavior than Val carriers (P = .015), and A2 homozygotes (Taq1a) self-reported worse behavior than A1 carriers (P = .028) in bivariable analysis. Multivariable models suggest an interaction between depression and genetic variation with behavior at 12 months post-TBI, and descriptive analysis suggests that carriage of both risk alleles may contribute to worse behavioral performance than carriage of either risk allele alone. Conclusion. In the context of depression, Val158Met and Taq1a polymorphisms are individually associated with behavioral dysfunction 12 months following severe TBI, with preliminary evidence suggesting cumulative, or perhaps epistatic, effects of COMT and ANKK1 on behavioral dysfunction.

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The Role of the Frontal Lobe in Complex Walking Among Patients With Parkinsons Disease and Healthy Older Adults: An fNIRS Study

Background. Gait is influenced by higher order cognitive and cortical control mechanisms. Functional near infrared spectroscopy (fNIRS) has been used to examine frontal activation during walking in healthy older adults, reporting increased oxygenated hemoglobin (HbO2) levels during dual task walking (DT), compared with usual walking. Objective. To investigate the role of the frontal lobe during DT and obstacle negotiation, in healthy older adults and patients with Parkinson's disease (PD). Methods. Thirty-eight healthy older adults (mean age 70.4 ± 0.9 years) and 68 patients with PD (mean age 71.7 ± 1.1 years,) performed 3 walking tasks: (a) usual walking, (b) DT walking, and (c) obstacles negotiation, with fNIRS and accelerometers. Linear-mix models were used to detect changes between groups and within tasks. Results. Patients with PD had higher activation during usual walking (P < .030). During DT, HbO2 increased only in healthy older adults (P < .001). During obstacle negotiation, HbO2 increased in patients with PD (P = .001) and tended to increase in healthy older adults (P = .053). Higher DT and obstacle cost (P < .003) and worse cognitive performance were observed in patients with PD (P = .001). Conclusions. A different pattern of frontal activation during walking was observed between groups. The higher activation during usual walking in patients with PD suggests that the prefrontal cortex plays an important role already during simple walking. However, higher activation relative to baseline during obstacle negotiation and not during DT in the patients with PD demonstrates that prefrontal activation depends on the nature of the task. These findings may have important implications for rehabilitation of gait in patients with PD.

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The Effect of Levodopa on Improvements in Protective Stepping in People With Parkinsons Disease

Background. The effect of levodopa on postural motor learning in people with Parkinson's disease is poorly understood. In particular, it is unknown whether levodopa affects improvement in protective postural responses after external perturbations such as a slip or trip, a critical aspect of fall prevention. Objective. Determine the effect of levodopa on postural motor learning in people with Parkinson's disease. Methods. We assessed improvement in protective postural responses in people with Parkinson's disease over short-term (1 day) perturbation training on and off levodopa. We also assessed retention and generalization of improvement. Participants were 22 individuals with Parkinson's disease. The primary outcome was total center of mass (COM) displacement after perturbation. Secondary outcomes assessed first step performance and included margin of stability at first foot contact. Results. People with Parkinson's disease improved COM displacement (P = .011) and margin of stability (P = .016) over training. Improvements in these outcomes were more pronounced after training while on levodopa than off levodopa. Levodopa State x Training interactions were not observed for other step performance variables (eg, step latency, length, total number of steps). Improvements were retained for 24 hours, and for margin of stability, retention was more pronounced while on levodopa than off (P = .018). Conclusions. Individuals with Parkinson's disease are able to improve protective postural responses through short-term perturbation training, and improvements were more pronounced when on levodopa for some variables. Perturbation training may be more effective if completed while optimally medicated with levodopa.

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Handwriting Impairments in People With Parkinsons Disease and Freezing of Gait

Background. Recent studies show that patients with Parkinson's disease (PD) and freezing of gait (FOG) experience motor problems outside their gait freezing episodes. Because handwriting is also a sequential movement, it may be affected in PD patients with FOG relative to those without. Objective. The current study aimed to assess the quality of writing in PD patients with and without FOG in comparison to healthy controls (CTs) during various writing tasks. Methods. Handwriting was assessed by the writing of cursive loops on a touch-sensitive writing tablet and by means of the Systematic Screening of Handwriting Difficulties (SOS) test in 30 PD patients with and without freezing and 15 healthy age-matched CTs. The tablet tests were performed at 2 different sizes, either continuously or alternatingly, as indicated by visual target lines. Results. Patients with freezing showed decreased writing amplitudes and increased variability compared with CTs and patients without freezing on the writing tablet tests. Writing problems were present during both tests but were more pronounced during writing at alternating compared with writing at continuous size. Patients with freezing also had a higher total score on the SOS test than patients without freezing and CTs, reflecting more extensive handwriting problems, particularly with writing fluency. Conclusions. Writing is more severely affected in PD patients with FOG than in those without FOG. These results indicate that deficient movement sequencing and adaptation is a generic problem in patients with FOG.

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Remodeling of Neuronal Circuits After Reach Training in Chronic Capsular Stroke

Background. Subcortical capsular stroke has a poor prognosis, and it is not yet fully understood how and under what circumstances reach training contributes to motor recovery. Objective. This study was performed to investigate changes in neuronal circuits and motor recovery in a chronic capsular stroke model in the presence or absence of reach training. Method. We generated photothrombotic capsular lesions in 42 Sprague-Dawley rats and evaluated motor recovery with or without daily training in a single-pellet reaching task (SPRT). We used 2-deoxy-2-[18F]-fluoro-D-glucose-microPET (positron emission tomography) to assess remodeling of neuronal circuits. Results. SPRT training was selectively beneficial only for the group with incomplete capsular destruction (P < .05), suggesting the relevance of plasticity in the remaining capsular fibers for motor recovery. Groups that did not receive SPRT training showed no motor recovery at all. The microPET analysis demonstrated that motor recovery was correlated with a reduction in cortical diaschisis in ipsilesional motor and sensory cortices and in the contralesional sensory cortex (Pearson's correlation, P < .05). We also observed training-dependent subcortical activation in the contralesional red nucleus, the internal capsule, and the ventral hippocampus (P < .0025; false discovery rate q < 0.05). The groups without reach training did not show the same degree of reduction in diaschisis or activation of the red nucleus. Conclusions. Our results suggest that motor recovery and remodeling of neuronal circuits after capsular stroke depend on the magnitude of the capsular lesion and on the presence or absence of reach training. Task-specific training is strongly indicated only when there is incomplete destruction of the capsular fibers.

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Circadian Melatonin Rhythm Following Traumatic Brain Injury

Background: Sleep-wake disturbances are highly prevalent following traumatic brain injury (TBI), impeding rehabilitaion and quality of life. However, the mechanisms underlying these sleep disturnbances are unclear, and efficacious treatments are lacking. To investigate possible mechanisms underlying sleep disturbance in TBI, we examined characteristics of the circadian rhythm of melatonin, a hormone involved in sleep-wake regulation. We compared TBI patients reporting sleep disturbance with age- and gender-matched healthy volunteers. Methods: We conducted an overnight observational study with salivary melatonin samples collected hourly in 9 patients with severe TBI and 9 controls. Salivary dim light melatonin onset (DLMO) as well as melatonin synthesis onset (SynOn) and offset (SynOff) were used to determine circadian timing. Total overnight salivary melatonin production was calculated as the area under the curve from melatonin synthesis onset to offset. Results: Compared with healthy individuals, TBI patients showed 42% less melatonin production overnight (d = 0.87; P = .034). The timing of DLMO was delayed by approximately 1.5 hours in patients with TBI compared with controls (d = 1.23; P = .003). Conclusions: In patients with TBI, melatonin production was attenuated overnight, and the timing of melatonin secretion was delayed. We suggest that disruption to the circadian regulation of melatonin synthesis is a feature of severe TBI, possibly contributing to the sleep difficulties that are commonly reported in this population.

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Engaging Cervical Spinal Cord Networks to Reenable Volitional Control of Hand Function in Tetraplegic Patients

Background. Paralysis of the upper limbs from spinal cord injury results in an enormous loss of independence in an individual's daily life. Meaningful improvement in hand function is rare after 1 year of tetraparesis. Therapeutic developments that result in even modest gains in hand volitional function will significantly affect the quality of life for patients afflicted with high cervical injury. The ability to neuromodulate the lumbosacral spinal circuitry via epidural stimulation in regaining postural function and volitional control of the legs has been recently shown. A key question is whether a similar neuromodulatory strategy can be used to improve volitional motor control of the upper limbs, that is, performance of motor tasks considered to be less "automatic" than posture and locomotion. In this study, the effects of cervical epidural stimulation on hand function are characterized in subjects with chronic cervical cord injury. Objective. Herein we show that epidural stimulation can be applied to the chronic injured human cervical spinal cord to promote volitional hand function. Methods and Results. Two subjects implanted with a cervical epidural electrode array demonstrated improved hand strength (approximately 3-fold) and volitional hand control in the presence of epidural stimulation. Conclusions. The present data are sufficient to suggest that hand motor function in individuals with chronic tetraplegia can be improved with cervical cord neuromodulation and thus should be comprehensively explored as a possible clinical intervention.

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Same Intervention-Different Reorganization: The Impact of Lesion Location on Training-Facilitated Somatosensory Recovery After Stroke

Background. The brain may reorganize to optimize stroke recovery. Yet relatively little is known about neural correlates of training-facilitated recovery, particularly after loss of body sensations. Objective. Our aim was to characterize changes in brain activation following clinically effective touch discrimination training in stroke patients with somatosensory loss after lesions of primary/secondary somatosensory cortices or thalamic/capsular somatosensory regions using functional magnetic resonance imaging (fMRI). Methods. Eleven stroke patients with somatosensory loss, 7 with lesions involving primary (S1) and/or secondary (S2) somatosensory cortex (4 male, 58.7 ± 13.3 years) and 4 with lesions primarily involving somatosensory thalamus and/or capsular/white matter regions (2 male, 58 ± 8.6 years) were studied. Clinical and MRI testing occurred at 6 months poststroke (preintervention), and following 15 sessions of clinically effective touch discrimination training (postintervention). Results. Improved touch discrimination of a magnitude similar to previous clinical studies and approaching normal range was found. Patients with thalamic/capsular somatosensory lesions activated preintervention in left ipsilesional supramarginal gyrus, and postintervention in ipsilesional insula and supramarginal gyrus. In contrast, those with S1/S2 lesions did not show common activation preintervention, only deactivation in contralesional superior parietal lobe, including S1, and cingulate cortex postintervention. The S1/S2 group did, however, show significant change over time involving ipsilesional precuneus. This change was greater than for the thalamic/capsular group (P = .012; d = –2.43; CI = –0.67 to –3.76). Conclusion. Different patterns of change in activation are evident following touch discrimination training with thalamic/capsular lesions compared with S1/S2 cortical somatosensory lesions, despite common training and similar improvement.

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Evidence-based hiring practices for EMS organizations

NEW ORLEANS — Millennials, already the largest generational cohort in the workforce, have different needs and expectations for employment than previous generations. The growth of the workforce and how to apply evidence-based hiring practices to EMS organizations were explained in a presentation by Lt. Joel Lavender (ret.) and Kurt Steward, Ph.D. at the EMS World Expo.

The traditional public safety hiring approach solicits applicants, conducts testing, ranks applicants and selects top candidate for interviews. The focus on knowledge, skills and abilities doesn't assess the applicant's potential to fit within the organization. In addition, this traditional approach is slow, paper-based and creates lots of opportunity for bias.

After describing the growing influence of millennials in the workforce, Steward introduced a behavior-based approach using science and big data to find applicants. The approach starts with an internal assessment of top performers and the internally gathered data on behaviors is used to predict success. In the hiring process, candidates are compared to the behaviors of the success profile from existing personnel. The variation between the applicant and the success profile is used to determine if additional screening is needed in the interview process.

Memorable quotes on hiring and retaining millennials
Steward started his career as a police officer, worked in city management and then spent 10 years as the Dallas Fire-Rescue CFO. Lavender held a variety of positions as a firefighter, paramedic, instructor, bomb squad technician, officer and PIO with Dallas Fire-Rescue from 1982 to 2015. Here are memorable quotes from Steward and Lavender on evidence-based hiring.

"Sit down. Shut up. Stay shutted up."
— Lavender describing the advice he received as a new firefighter in 1982

"All types of organizations are struggling with how do we get people in the door and keep them (in the organization)."
— Steward commenting on the breadth of the hiring and retention problem

"Social media matters. Millennials learn about your organization from its website. They are going to make decisions about joining your organization based on the website."
— Steward discussing the importance of social media for recruitment

"Millennials are like a piece in puzzle and looking for a place to fit in."
— Lavender encouraging the audience to understand millennials

Key takeaways on evidence-based hiring
Here are the key takeaways from the presentation.

Generations in EMS workforce
Millennials are the largest generation, across all occupations, in the workforce. The total workforce is composed of the silent generation, baby boomers, generation X, millennials and post millennials. In the public sector, millennials make up a smaller percentage (24 percent) of the workforce than in the general workforce (34 percent).

EMS workforce growth
The EMS workforce in the United States is expected to grow based on Department of Labor projections from 235,000 to 290,000 providers between now and 2022. EMS leaders need to grow the workforce by more than 23 percent while also replacing paramedics retiring from the workforce. Finding candidates with the specific technical skills, dedication and ability to fit or become part of an organization's culture is a significant challenge for fire and EMS leaders.

Millennials desires for a career
Pay is not the top driver for millennials in the workforce. Research on millennials shows a strong desire for training (45 percent) and opportunities for advancement (27 percent). Encouragement (13 percent) and pay incentives (10 percent) are less desired by millennials.

What millennials want — training, mentoring and new responsibilities — is disconnected from what many employers are offering. Fire departments and EMS agencies need to provide more opportunities for millennials to train, especially on duty, and advance in the career field.

Behavior assessment
The behaviors EMS providers bring to the workforce change very little over time. We are who we are. Behavior-based assessment, which compares a profile of current successful members of the workforce with applicants, has the potential to improve EMS applicant hiring and retention.

Learn more:

• Money still talks, but it whispers to millennial medics
• Much of what EMS leaders believe about millennials is wrong
• 5 ways EMS leaders can better understand medics

Top Tweet:

Learning how to adapt to hiring millenials. #EMSWorldExpo http://pic.twitter.com/MQP810hnrG

— Lloyd Ayers (@LloydAyers4) October 5, 2016

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Copyright

Publication date: November 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 6





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Contributors

Publication date: November 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 6





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Contents

Publication date: November 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 6





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CME Accreditation Page

Publication date: November 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 6





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Forthcoming Issues

Publication date: November 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 6





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Diffuse Lung Disease

Publication date: November 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 6
Author(s): Jeffrey P. Kanne




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Imaging of Idiopathic Pulmonary Fibrosis

Publication date: November 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 6
Author(s): Joanna E. Kusmirek, Maria Daniela Martin, Jeffrey P. Kanne

Teaser

Idiopathic interstitial pneumonias are a heterogeneous group of diffuse lung diseases characterized by distinct clinicopathologic entities with the usual interstitial pneumonia (UIP) being the most common. The pattern of UIP can be seen in idiopathic pulmonary fibrosis (IPF) as well as in secondary causes, most commonly in connective tissue diseases. IPF is usually progressive and associated with a very poor prognosis, and newer therapies pose a risk of serious complications; therefore, diagnostic certainty is crucial. This article reviews the radiologic findings in UIP with clinical correlation and histopathologic features along with its significance for prognosis and patients monitoring.


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Index

Publication date: November 2016
Source:Radiologic Clinics of North America, Volume 54, Issue 6





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How technology is transforming EMS

Usability of electronic patient care reports, mobile technology applications and model for improvement discussed at EMS World Expo.

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Clarius Mobile Health demonstrates wireless, handheld ultrasound scanners

The scanners pair with iOS and Android devices for point-of-care assessments to help diagnose critically ill patients.

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HIC1 epigenetically represses CIITA transcription in B lymphocytes

Publication date: Available online 6 October 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Sheng Zeng, Yuyu Yang, Xian Cheng, Bisheng Zhou, Ping Li, Yuhao Zhao, Xiaocen Kong, Yong Xu
Differentiation of B lymphocytes into isotope-specific plasma cells represents a hallmark event in adaptive immunity. During B cell maturation, expression of class II transactivator (CIITA) gene is down-regulated although the underlying epigenetic mechanism is not completely defined. Here we report that hypermethylated in cancer 1 (HIC1) was up-regulated in differentiating B lymphocytes paralleling CIITA repression. Over-expression of HIC1 directly repressed endogenous CIITA transcription in B cells. Reporter assay and chromatin immunoprecipitation (ChIP) assay confirmed that HIC1 bound to the proximal CIITA type III promoter (−545/−113); mutation of a conserved HIC1 site within this region abrogated CIITA trans-repression. More important, depletion of HIC1 with small interfering RNA (siRNA) restored CIITA expression in differentiating B cells. Mechanistically, HIC1 preferentially interacted with and recruited DNMT1 and DNMT3b to the CIITA promoter to synergistically repress CIITA transcription. On the contrary, silencing of DNMT1/DNMT3b or inhibition of DNMT activity with 5-aza-dC attenuated CIITA trans-repression. Therefore, our data identify HIC1 as a novel factor involved in B cell differentiation acting as an epigenetic repressor of CIITA transcription.



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Cancer Screening Among Patients Who Self-Identify as Muslim: Combining Self-Reported Data with Medical Records in a Family Practice Setting

Abstract

Cancer screening is a core component of family medicine but screening inequalities are well documented in Canada for foreign-born persons. Although people of Muslim faith and culture are the fastest growing immigrant population in Canada, there is little information in the literature about their cancer screening practices. Determining screening gaps could inform practice-based quality improvement initiatives. We conducted a retrospective chart review combining patient-level medical record data with self-reported religious affiliation to examine the relationship between religion and cancer screening in a large multi-site urban family practice. Religious affiliation was classified as Muslim, other affiliation, or atheist/no religious affiliation. 5311 patients were included in the study sample. Muslim patients were significantly less likely to prefer English for spoken communication than the other two groups, less likely to be Canadian-born, more likely to have a female family physician, and were over-represented in the lowest income quintile. Muslim women were most likely to be up-to-date on breast cancer screening (85.2 vs. 77.5 % for those with other religions vs. 69.5 % for those with no religious affiliation). There were no significant differences in cancer screening by physician sex. In this pilot study conducted within a primary care practice, we used self-reported data on religious affiliation to examine possible inequities in cancer screening and observed intriguing variations in screening by self-identified religious affiliation. Future efforts to collect and use similar patient-level data should incorporate non-official languages and intensively outreach to patients with less health system contact. Regardless, the family medicine context may be the ideal setting to collect and act on patient-level sociodemographic data such as religious affiliation.

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