7 steps to become a credentialed paramedic officer

This video describes seven steps credentialing candidates can take in order to become a credentialed paramedic officer by the American College of Paramedic Executives from the National EMS Management Association (NEMSMA).

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Is use of glycine-containing drugs in anesthesia safe?

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Spinal segmental myoclonus resembling “belly dance” in a pregnant woman

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Arens Taga, Irene Florindo, Ariane Kiener, Tiziana Frusca, Giovanni Pavesi




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Fasciculations in nerve and muscle disorders – A prospective study of muscle ultrasound compared to electromyography

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): M.T. Johansson, H.R. Ellegaard, H. Tankisi, A. Fuglsang-Frederiksen, E. Qerama
ObjectivesWe examined the clinical utility of muscle ultrasound (MUS) in detecting fasciculations in patients with nerve and muscle disorders (NMD) and investigated the impact on diagnostic sensitivity when combining electromyography (EMG) and MUS.MethodsWe included 58 consecutive patients suspected to have NMD and 38 healthy subjects (HS). Patients and HS underwent MUS in 14 skeletal and two bulbar muscles and the video recordings of the MUS were anonymised. Only patients underwent EMG.ResultsThe follow-up diagnoses were: 15 Amyotrophic lateral sclerosis (ALS), 15 polyneuropathy, 14 patients had other diagnoses (disease-control group) and 14 patients had no pathological findings.MUS detected more muscles with fasciculations among ALS patients compared to all other groups. In ALS patients, the dominating pattern of fasciculations was continuous (45%). More proximal muscles showed fasciculations among ALS patients compared to all other patient groups. MUS was more sensitive than EMG in detecting fasciculations (58% vs. 48%). When combining the two methods, the sensitivity in detecting fasciculations increased to 65%. Fasciculations in nine muscles could predict the ALS diagnosis with high sensitivity and specificity.ConclusionsMUS is a sensitive tool in detecting fasciculations in patients with NMD and performs well compared to EMG in diagnosing ALS.SignificanceMUS may add valuable information in the clinic, especially in diagnosing ALS.



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Oxidative phosphorylation: regulation and role in cellular and tissue metabolism

Abstract

Oxidative phosphorylation provides most of the ATP that higher animals and plants use to support life and is responsible for setting and maintaining metabolic homeostasis. The pathway incorporates three consecutive near equilibrium steps for moving reducing equivalents between the intramitochondrial [NAD⁺]/[NADH] pool to molecular oxygen, with irreversible reduction of oxygen to bound peroxide at cytochrome c oxidase determining the net flux. Net flux (oxygen consumption rate) is determined by demand for ATP, with feedback by the energy state ([ATP]/[ADP][Pi]) regulating the pathway. This feedback affects the reversible steps equally and independently, resulting in the rate being coupled to ([ATP]/[ADP][Pi])³. With increasing energy state, oxygen consumption decreases rapidly until a threshold is reached, above which there is little further decrease. In most cells, [ATP] and [Pi] are much higher than [ADP] and change in [ADP] is primarily responsible for the change in energy state. As a result, the rate of ATP synthesis, plotted against [ADP], remains low until [ADP] reaches about 30 μm and then increases rapidly with further increase in [ADP]. The dependencies on energy state and [ADP] near the threshold can be fitted by the Hill equation with a Hill coefficients of about −2.6 and 4.2, respectively. The homeostatic set point for metabolism is determined by the threshold, which can be modulated by the pO₂ and intramitochondrial [NAD⁺]/[NADH]. The ability of oxidative phosphorylation to precisely set and maintain metabolic homeostasis is consistent with it being permissive of, and essential to, development of higher plants and animals.

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Do male athletes with already high initial hemoglobin mass benefit from ‘live high–train low’ altitude training?

Abstract

It has been proposed that athletes with high initial values of hemoglobin mass (Hb_mass) will have a lower Hb_mass increase in response to 'live high-train low' (LHTL) altitude training. To verify this assumption, the relationship between initial absolute and relative Hb_mass values and their respective Hb_mass increase following LHTL in male endurance and team-sport athletes was investigated. Overall, 58 male athletes (35 well-trained endurance athletes and 23 elite male field hockey players) undertook an LHTL training camp with similar hypoxic doses (200–230 h). Hb_mass was measured in duplicate pre- and post-LHTL with the carbon monoxide rebreathing method. While there was no relationship (r = 0.02, P = 0.91) between initial absolute Hb_mass (g) and percentage increase in absolute Hb_mass, a moderate relationship (r = −0.31, P = 0.02) between initial relative Hb_mass (g·kg⁻¹) and percentage increase in relative Hb_mass was detected. Mean absolute and relative Hb_mass increased to a similar extent (P ≥ 0.81) in endurance (from 916 ± 88 to 951 ± 96 g, +3.8%, P < 0.001 and from 13.1 ± 1.2 to 13.6 ± 1.1 g·kg⁻¹, +4.1%, P < 0.001) and team-sport (from 920 ± 120 to 957 ± 127 g, +4.0%, P < 0.001 and from 11.9 ± 0.9 to 12.3 ± 0.9 g·kg⁻¹, +4.0%, P < 0.001) athletes following LHTL. The direct comparison study using individual data of male endurance and team-sport athletes and strict methodological control (duplicate Hb_mass-measures, matched-hypoxic dose) indicated that even athletes with higher initial Hb_mass can reasonably expect Hb_mass gain post-LHTL.

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Oceanic dispersion of Fukushima-derived Cs-137 simulated by multiple oceanic general circulation models

Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Hideyuki Kawamura, Akiko Furuno, Takuya Kobayashi, Teiji In, Tomoharu Nakayama, Yoichi Ishikawa, Yasumasa Miyazawa, Norihisa Usui
To understand the concentration and amount of Fukushima-derived Cs-137 in the ocean, this study simulated the oceanic dispersion of Cs-137 by atmospheric and oceanic dispersion simulations. The oceanic dispersion simulations were carried out with an oceanic dispersion model and multiple oceanic general circulation models. The Cs-137 concentrations were sensitive to ocean currents in the coastal, offshore, and open oceans. The mean Cs-137 concentrations of the multiple models relatively well agreed with the observed concentrations in the coastal and offshore oceans during the first few months after the Fukushima disaster, and in the open ocean during the first year after the disaster. The Cs-137 amounts were quantified in the coastal, offshore, and open oceans during the first year after the disaster. It was suggested that Cs-137 actively dispersed from the coastal and offshore oceans to the open ocean, and from the surface layer to the deeper layers in the North Pacific.



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