Same provider, different location: Variation in patient satisfaction scores between freestanding and hospital-based emergency departments
Simon Erin L; Shakya Sunita; Smalley Courtney M; Muir McKinsey; Podolsky Seth R; Fertel Baruch
The American Journal of Emergency Medicine
2020
2020-01
Journal Article
<a href="http://doi.org/10.1016/j.ajem.2020.01.002" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2020.01.002</a>
Pharmacological inhibition of CSF1R by GW2580 reduces microglial proliferation and is protective against neuroinflammation and dopaminergic neurodegeneration.
microglia; neuroprotection; Parkinson's disease; proliferation
Increased pro‐inflammatory cytokine levels and proliferation of activated microglia have been found in Parkinson's disease (PD) patients and animal models of PD, suggesting that targeting of the microglial inflammatory response may result in neuroprotection in PD. Microglial proliferation is regulated by many factors, but colony stimulating factor‐1 receptor (CSF1R) has emerged as a primary factor. Using data mining techniques on existing microarray data, we found that mRNA expression of the CSF1R ligand, CSF‐1, is increased in the brain of PD patients compared to controls. In two different neurotoxic mouse models of PD, acute MPTP and sub‐chronic LPS treatment, mRNA and protein levels of CSF1R and CSF‐1 were significantly increased. Treatment with the CSF1R inhibitor GW2580 significantly attenuated MPTP‐induced CSF1R activation and Iba1‐positive cell proliferation, without a reduction of the basal Iba1‐positive population in the substantia nigra. GW2580 treatment also significantly decreased mRNA levels of pro‐inflammatory factors, without alteration of anti‐inflammatory mediators, and significantly attenuated the MPTP‐induced loss of dopamine neurons and motor behavioral deficits. Importantly, these effects were observed in the absence of overt microglial depletion, suggesting that targeting CSF1R signaling may be a viable neuroprotective strategy in PD that disrupts pro‐inflammatory signaling, but maintains the beneficial effects of microglia. [ABSTRACT FROM AUTHOR]
Neal Matthew L; Fleming Sheila M; Budge Kevin M; Boyle Alexa M; Kim Chunki; Alam Gelareh; Beier Eric E; Wu Long‐Jun; Richardson Jason R
FASEB Journal
2020
2020-01
Journal Article
<a href="http://doi.org/10.1096/fj.201900567RR" target="_blank" rel="noreferrer noopener">10.1096/fj.201900567RR</a>
Social Media for Doctors: Taking Professional and Patient Engagement to the Next Level.
American Recovery and Reinvestment Act; Consumer Participation; Education Continuing (Credit); Goals and Objectives; Health Education; Health Insurance Portability and Accountability Act; Physicians Family -- Psychosocial Factors; Professional Practice; Professional-Patient Relations; Screen Time; Social Media
The article explores some best practices and challenges that have emerged as more physicians and patients use social media platforms for health information. Topics mentioned include the importance of a strong social media presence to promote practice, ways to use social media for advocacy, and assessment of medical condition in generalities or use of fictionalized accounts to protect patient identity.
NGUYEN BICH-MAY; LU EMILY; BHUYAN NATASHA; LIN KENNY; SEVILLA MIKE
Family Practice Management
2020
2020-02-01
Journal Article
n/a
FIXED: True Stories of OUD.
Gardner-Buckshaw Stacey
Family Medicine
2020
2020-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.22454/FamMed.2020.716294" target="_blank" rel="noreferrer noopener">10.22454/FamMed.2020.716294</a>
Using the Constructivist/Active Learning Theoretical Framework to develop and test a simulation-based interprofessional geriatric training curriculum
Education; Simulation; Geriatrics; Healthcare; Interprofessional
The literature is lacking in theoretically grounded techniques to design interprofessional educational experiences that prepare students to function effectively in interprofessional teams dedicated to the management of complex geriatric patients. We describe the use of the Constructivist/Active Learning theoretical framework to develop an interprofessional simulation-based educational program for students in healthcare fields that combines didactics, skills practice, simulation, volunteer or simulated caregiver interaction, and team care planning into a scaffolded learning experience. Results of post-education surveys show high satisfaction with the education and growth in students’ interprofessional competencies. Our application of this theoretical framework provides a low-tech, yet highly effective method to teach interprofessional team skills in the management of complex geriatric syndromes.
Niederriter Joan; Hovland Cynthia; Hazelett Susan; Whitford Maureen; Drost Jen; Brown Diane; Morgan Abby; Kropp Denise; Sanders Margy; Gareri Michele; Fosnight Sue; Radwany Steven; McQuown Colleen; Ahmed Rami
Journal of Interprofessional Education & Practice
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.xjep.2020.100322" target="_blank" rel="noreferrer noopener">10.1016/j.xjep.2020.100322</a>
A Rare Case of Simultaneous Evans Syndrome and Primary Antiphospholipid Syndrome.
thrombocytopenia; antiphospholipid syndrome; evans syndrome
Evans Syndrome (ES) is a rare autoimmune disorder that presents with simultaneous or sequential development of autoimmune hemolytic anemia (AIHA), thrombocytopenia, and/or neutropenia. This disease may occur in conjunction with other autoimmune disorders. Primary antiphospholipid syndrome (APS) is a disorder characterized by thrombosis, which can cause life-threatening complications such as fetal demise, strokes, or deep vein thrombosis. A 67-year-old male with type 2 diabetes mellitus, hypertension, and renal insufficiency presented with concomitant ES and APS. His hematological abnormalities began in 2013 after a deep vein thrombosis of the left lower extremity led to a diagnosis of APS and was started on chronic warfarin. In 2014, he was found to have immune thrombocytopenia (ITP) with relapses the following year. Several months later, he was hospitalized and diagnosed with AIHA. In the setting of his previous episodes of ITP and current AIHA, the diagnosis of ES was made. The initial treatment was 100 mg prednisone taper, but rituximab was required to make complete platelet recovery. The severe deterioration and rapid recovery with proper treatment of the patient highlights the importance of a timely diagnosis of ES. Mild thrombocytopenia can be associated with APS; however; severe thrombocytopenia may warrant further investigation for other possible causes. Maintaining ES on the differential diagnosis of patients with APS and thrombocytopenia could enhance health outcomes.
Patel Bhamini P; Jakob John
Cureus
2020
2020-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.7759/cureus.6845" target="_blank" rel="noreferrer noopener">10.7759/cureus.6845</a>
Simulation-based Training Curriculum for the Management of Vaginal Cuff Dehiscence and Evisceration.
medical education; Simulation; obstetrics and gynecology; bowel evisceration; vaginal cuff dehiscence
Objective Vaginal cuff dehiscence with evisceration (VCDE) is a serious, life-threatening complication of hysterectomy. Due to the high volume of hysterectomies performed in the U.S each year, it is likely that a practitioner will encounter VCDE during their career. Due to its infrequent occurrence, residents receive little exposure to it during training. Delayed diagnosis of VCDE can impede proper management and lead to severe, long-term complications or death. Our goal was to provide an opportunity for resident physicians to identify VCDE and practice performing a reduction of prolapsed bowel and vaginal cuff repair through hands-on simulation in hopes that the simulation would improve the residents' confidence and knowledge in recognizing and managing future VCDE cases. Methods Obstetrics and Gynecology residents postgraduate year (PGY) 1-4 participated in this study (n=13). Before and after the simulated case, a knowledge test covering VCDE recognition and management and a confidence survey were given to the participants. A gynecologic mannequin was modified by placing simulated bowel into the abdominal cavity with a portion extending through a vaginal cuff and protruding from the vaginal introitus. For the simulation, a hemodynamically unstable patient presented with findings consistent with a VCDE. Once the decision to proceed to surgery was made, participants were transferred to a simulated operating room where they performed a reduction of prolapsed bowel and vaginal cuff closure either laparoscopically or vaginally on the mannequin. A debriefing session was held post-simulation to discuss management and thought processes, as well as reflect on their performance and discuss improvement strategies for future cases. Finally, the residents participated in a brief didactic lecture on education about the incidence, presentation, and management of VCDE. Results Analysis of the knowledge questionnaires showed the median score and interquartile range (IQR) pre- and post-simulation was 15(12-28) and 20(19-22) respectively, with a median score increase (and IQR) of 5(3.5-8.5) (p=0.001). The confidence score had pre- and post-simulation median scores (and IQRs) of 28(20-34.5) and 40(37.5-46) respectively, with a median score increase (and IQR) of 15(8-20.5) (p=0.001). Conclusions Our intervention improved residents' knowledge and confidence in recognizing VCDE, identifying the need for surgical management, and performing a reduction of prolapsed bowel and vaginal cuff repair.
Chapman Amelia D; Bashour Marla; Sagaria Lauren; Gothard David; Ballas Derek A
Cureus
2020
2020-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.7759/cureus.6752" target="_blank" rel="noreferrer noopener">10.7759/cureus.6752</a>
Current Advances in the Treatment of BRAF-Mutant Melanoma.
immunotherapy; resistance; BRAF; melanoma; metastatic
Melanoma is the most lethal form of skin cancer. Melanoma is usually curable with surgery if detected early, however, treatment options for patients with metastatic melanoma are limited and the five-year survival rate for metastatic melanoma had been 15-20% before the advent of immunotherapy. Treatment with immune checkpoint inhibitors has increased long-term survival outcomes in patients with advanced melanoma to as high as 50% although individual response can vary greatly. A mutation within the MAPK pathway leads to uncontrollable growth and ultimately develops into cancer. The most common driver mutation that leads to this characteristic overactivation in the MAPK pathway is the B-RAF mutation. Current combinations of BRAF and MEK inhibitors that have demonstrated improved patient outcomes include dabrafenib with trametinib, vemurafenib with cobimetinib or encorafenib with binimetinib. Treatment with BRAF and MEK inhibitors has met challenges as patient responses began to drop due to the development of resistance to these inhibitors which paved the way for development of immunotherapies and other small molecule inhibitor approaches to address this. Resistance to these inhibitors continues to push the need to expand our understanding of novel mechanisms of resistance associated with treatment therapies. This review focuses on the current landscape of how resistance occurs with the chronic use of BRAF and MEK inhibitors in BRAF-mutant melanoma and progress made in the fields of immunotherapies and other small molecules when used alone or in combination with BRAF and MEK inhibitors to delay or circumvent the onset of resistance for patients with stage III/IV BRAF mutant melanoma.
Hima Patel; Yacoub Nour; Mishra Rosalin; White Aaron; Long Yuan; Alanazi Samar; Garrett Joan T
Cancers
2020
2020-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.3390/cancers12020482" target="_blank" rel="noreferrer noopener">10.3390/cancers12020482</a>
The Density of Perineuronal Nets Increases With Age in the Inferior Colliculus in the Fischer Brown Norway Rat.
aging; inferior colliculus; GABAergic; perineuronal nets; Wisteria floribunda agglutinin
Age-related hearing loss, one of the most frequently diagnosed disabilities in industrialized countries, may result from declining levels of GABA in the aging inferior colliculus (IC). However, the mechanisms of aging and subsequent disruptions of temporal processing in elderly hearing abilities are still being investigated. Perineuronal nets (PNs) are a specialized form of the extracellular matrix and have been linked to GABAergic neurotransmission and to the regulation of structural and synaptic plasticity. We sought to determine whether the density of PNs in the IC changes with age. We combined Wisteria floribunda agglutinin (WFA) staining with immunohistochemistry to glutamic acid decarboxylase in three age groups of Fischer Brown Norway (FBN) rats. The density of PNs on GABAergic and non-GABAergic cells in the three major subdivisions of the IC was quantified. Results first demonstrate that the density of PNs in the FBN IC increase with age. The greatest increases of PN density from young to old age occurred in the central IC (67% increase) and dorsal IC (117% increase). Second, in the young IC, PNs surround non-GABAergic and GABAergic cells with the majority of PNs surrounding the former. The increase of PNs with age in the IC occurred on both non-GABAergic and GABAergic populations. The average density of PN-surrounded non-GABAergic cells increased from 84.9 PNs/mm(2) in the young to 134.2 PNs/mm(2) in the old. While the density of PN-surrounded GABAergic cells increased from 26 PNs/mm(2) in the young to 40.6 PNs/mm(2) in the old. The causality is unclear, but increases in PN density in old age may play a role in altered auditory processing in the elderly, or may lead to further changes in IC plasticity.
Mafi Amir M; Hofer Lindsay N; Russ Matthew G; Young Jesse W; Mellott Jeffrey G
Frontiers in aging neuroscience
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.3389/fnagi.2020.00027" target="_blank" rel="noreferrer noopener">10.3389/fnagi.2020.00027</a>
Intravital Microscopy of the Beating Murine Heart to Understand Cardiac Leukocyte Dynamics.
HEART; cardiovascular; leukocyte; intravital microscopy; multiphoton microscopy
Cardiovascular disease is the leading cause of worldwide mortality. Intravital microscopy has provided unprecedented insight into leukocyte biology by enabling the visualization of dynamic responses within living organ systems at the cell-scale. The heart presents a uniquely dynamic microenvironment driven by periodic, synchronous electrical conduction leading to rhythmic contractions of cardiomyocytes, and phasic coronary blood flow. In addition to functions shared throughout the body, immune cells have specific functions in the heart including tissue-resident macrophage-facilitated electrical conduction and rapid monocyte infiltration upon injury. Leukocyte responses to cardiac pathologies, including myocardial infarction and heart failure, have been well-studied using standard techniques, however, certain questions related to spatiotemporal relationships remain unanswered. Intravital imaging techniques could greatly benefit our understanding of the complexities of in vivo leukocyte behavior within cardiac tissue, but these techniques have been challenging to apply. Different approaches have been developed including high frame rate imaging of the beating heart, explantation models, micro-endoscopy, and mechanical stabilization coupled with various acquisition schemes to overcome challenges specific to the heart. The field of cardiac science has only begun to benefit from intravital microscopy techniques. The current focused review presents an overview of leukocyte responses in the heart, recent developments in intravital microscopy for the murine heart, and a discussion of future developments and applications for cardiovascular immunology.
Allan-Rahill Nathaniel H; Lamont Michael R E; Chilian William M; Nishimura Nozomi; Small David M
Frontiers in immunology
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.3389/fimmu.2020.00092" target="_blank" rel="noreferrer noopener">10.3389/fimmu.2020.00092</a>
Is CYP2C70 the key to new mouse models to understand bile acids in humans?
Guo Grace L; Chiang John Y L
Journal of lipid research
2020
2020-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1194/jlr.C120000621" target="_blank" rel="noreferrer noopener">10.1194/jlr.C120000621</a>
Sternoclavicular joint septic arthritis presenting as cervical abscess and subcutaneous emphysema: A case report.
septic arthritis; sternoclavicular joint; cervical subcutaneous emphysema; Neck abscess
Sternoclavicular joint septic arthritis results from hematogenous spread of a bacterial infection, usually in the immunocompromised. It commonly presents as a chest wall abscess. Cervical abscess resulting from sternoclavicular joint septic arthritis is a rare complication with only one reported case in the English literature. We describe a case of sternoclavicular joint septic arthritis in an elderly diabetic adult with cervical abscess as initial presentation.
Fornwalt Brandon E; Goosmann Madeline; Reynolds Stephen; Bunevich Jared D
SAGE open medical case reports
2020
1905-07
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Journal Article
<a href="http://doi.org/10.1177/2050313X20902874" target="_blank" rel="noreferrer noopener">10.1177/2050313X20902874</a>
A Qualitative Analysis of the Delivery of Person-Centered Nutrition to Asian Americans With Dementia in the Adult Day Health Care Setting.
dementia; nutrition; qualitative methods; immigrants; adult day care
Adult day service centers (ADSCs) provide community-based long-term care, including meals, to racially diverse older adults, 47% of whom have dementia and consequently experience elevated nutritional risk. We examine nutritional behaviors for Chinese and Vietnamese persons living with dementia (PLWD) in ADSCs and evaluate the extent to which ADSCs provide person-centered nutritional care. Multi-stakeholder interviews were conducted. Data were coded using Dedoose and analyzed using Braun and Clarke's six-step method. The Model for the Provision of Good Nutritional Care in Dementia guided analysis. Barriers to food intake included distracting meal environment, rigid mealtimes, and excessively restrictive diets. Conversely, peer relationships, culturally tailored meals and celebrations, and consistent staff assisting with feeding benefited PLWD. ADSCs can support healthy nutritional behaviors and quality of life among PLWD through person-centered nutritional care. To optimize nutritional services, further exploration is needed with respect to the ADSC environment, users' culture and ethnicity, and liberalized diets for PLWD.
Sadarangani Tina; Chong Stella; Park Susie; Missaelides Lydia; Johnson Jordan; Trinh-Shevrin Chau; Brody Abraham
Journal of applied gerontology : the official journal of the Southern Gerontological Society
2020
2020-03
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Journal Article
<a href="http://doi.org/10.1177/0733464820910030" target="_blank" rel="noreferrer noopener">10.1177/0733464820910030</a>
Black Robe/White Coat: Mental Health Providers Must Reclaim the Role of Caring Clinician.
Public policy issues; Community psychiatry
Munetz Mark R
Psychiatric services (Washington, D.C.)
2020
2020-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1176/appi.ps.201900366" target="_blank" rel="noreferrer noopener">10.1176/appi.ps.201900366</a>
Step by Step: Advancing the Understanding of Local Vascular Control.
Editorials; vasodilation; hypoxia; dilation; endothelium; arterial pressure
Chilian William M; Yin Liya; Ohanyan Vahagn
Arteriosclerosis, thrombosis, and vascular biology
2020
2020-03
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Journal Article
<a href="http://doi.org/10.1161/ATVBAHA.120.313811" target="_blank" rel="noreferrer noopener">10.1161/ATVBAHA.120.313811</a>
Extracorporeal Therapies in the Treatment of Focal Segmental Glomerulosclerosis.
Focal segmental glomerulosclerosis; Low-density lipoprotein apheresis; Extracorporeal therapy; Immunoadsorption; Plasma exchange
Focal segmental glomerulosclerosis (FSGS) is one of the most frequent and severe glomerular kidney disease with frequent progression to end-stage renal disease and a high rate of recurrence in renal transplantations. Due to intolerance or resistance to the current immunomodulatory treatments, the management of FSGS is a therapeutic challenge. Over the last few years, development in extracorporeal therapies has shown potential beneficial outcomes in drug-resistant and recurrent FSGS patients. Thus, this study reviews the current literature on the use of extracorporeal therapies, such as plasma exchange therapy, immunoadsorption, and low-density lipoprotein apheresis, for the treatment of FSGS in the pediatric population.
Raina Rupesh; Wang Joseph; Sharma Aditya; Chakraborty Ronith
Blood purification
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1159/000506277" target="_blank" rel="noreferrer noopener">10.1159/000506277</a>
The Role of Endothelin and Endothelin Antagonists in Chronic Kidney Disease.
Focal segmental glomerulosclerosis; Diabetic nephropathy; Endothelin; Endothelin antagonists; Hypertensive nephropathy
Background: Endothelins (ET) are a family of peptides that act as potent vasoconstrictors and pro-fibrotic growth factors. ET-1 is integral to renal and cardiovascular pathophysiology and exerts effects via autocrine, paracrine and endocrine signaling pathways tied to regulation of aldosterone, catecholamines, and angiotensin. In the kidney, ET-1 is critical to maintaining renal perfusion and controls glomerular arteriole tone and hemodynamics. It is hypothesized that
Raina Rupesh; Chauvin Abigail; Chakraborty Ronith; Nair Nikhil; Shah Haikoo; Krishnappa Vinod; Kusumi Kirsten
Kidney diseases (Basel, Switzerland)
2020
2020-01
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Journal Article
<a href="http://doi.org/10.1159/000504623" target="_blank" rel="noreferrer noopener">10.1159/000504623</a>
Bile acid receptors FXR and TGR5 signaling in fatty liver diseases and therapy.
bile acid metabolism; liver diseases; farnesoid X receptor; alcoholic and nonalcoholic fatty; bile acid therapies; Takeda G protein-coupled receptor 5
Bile acid synthesis is the most significant pathway for catabolism of cholesterol and for maintenance of whole body cholesterol homeostasis. Bile acids are physiological detergents that absorb, distribute, metabolize, and excrete nutrients, drugs, and xenobiotics. Bile acids also are signal molecules and metabolic integrators that activate nuclear farnesoid X receptor (FXR) and membrane Takeda G protein-coupled receptor 5 (TGR5; i.e., G protein-coupled bile acid receptor 1) to regulate glucose, lipid, and energy metabolism. The gut-to-liver axis plays a critical role in the transformation of primary bile acids to secondary bile acids, in the regulation of bile acid synthesis to maintain composition within the bile acid pool, and in the regulation of metabolic homeostasis to prevent hyperglycemia, dyslipidemia, obesity, and diabetes. High-fat and high-calorie diets, dysbiosis, alcohol, drugs, and disruption of sleep and circadian rhythms cause metabolic diseases, including alcoholic and nonalcoholic fatty liver diseases, obesity, diabetes, and cardiovascular disease. Bile acid-based drugs that target bile acid receptors are being developed for the treatment of metabolic diseases of the liver.
Chiang John Y L; Ferrell Jessica M
American journal of physiology. Gastrointestinal and liver physiology
2020
2020-03
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Journal Article
<a href="http://doi.org/10.1152/ajpgi.00223.2019" target="_blank" rel="noreferrer noopener">10.1152/ajpgi.00223.2019</a>
New Year's.
Jouriles Nicholas
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2020
2020-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/acem.13929" target="_blank" rel="noreferrer noopener">10.1111/acem.13929</a>
What Is That? Innumerable Mysterious Densities Identified on Abdominal Imaging.
Radiopaque densities can be observed on imaging after the ingestion of either foreign bodies or some medications. Our case report discusses an 11-year-old boy with autism spectrum disorder and attention deficient disorder who presented to the emergency department because of concerns for constipation and dehydration. Incidentally, an abdominal x-ray showed numerous radiopaque densities throughout his intestines in addition to his constipation. He was admitted, and his home regimen was reviewed to attempt to identify a potential source for these radiopaque densities. This case presented an interesting teaching opportunity in the identification of the radiopaque densities and review of pharmacokinetics.
Kaiser Nicole; Blackford Martha G
Pediatric emergency care
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1097/PEC.0000000000002046" target="_blank" rel="noreferrer noopener">10.1097/PEC.0000000000002046</a>
Early Termination of Cardiac Rehabilitation Is More Common With Heart Failure With Reduced Ejection Fraction Than With Ischemic Heart Disease.
PURPOSE: Despite known benefits of cardiac rehabilitation (CR), early termination (failure to complete >1 mo of CR) attenuates these benefits. We analyzed whether early termination varied by referral indication in the context of recent growth in patients referred for heart failure with reduced ejection fraction (HFrEF). METHODS: We reviewed records from 1111 consecutive patients enrolled in the NYU Langone Health Rusk CR program (2013-2017). Sessions attended, demographics, and comorbidities were abstracted, as well as primary referral indication: HFrEF or ischemic heart disease (IHD; including post-coronary revascularization, post-acute myocardial infarction, or chronic stable angina). We compared rates of early termination between HFrEF and IHD, and used multivariable logistic regression to determine whether differences persisted after adjusting for relevant characteristics (age, race, ethnicity, body mass index, smoking, hypertension, chronic obstructive pulmonary disease, and depression). RESULTS: Mean patient age was 64 yr, 31% were female, and 28% were nonwhite. Most referrals (85%) were for IHD; 15% were for HFrEF. Early termination occurred in 206 patients (18%) and was more common in HFrEF (26%) than in IHD (17%) (P < .01). After multivariable adjustment, patients with HFrEF remained at higher risk of early termination than patients with IHD (unadjusted OR = 1.73, 95% CI, 1.17-2.54; adjusted OR = 1.53, 95% CI, 1.01-2.31). CONCLUSIONS: Nearly 1 in 5 patients in our program terminated CR within 1 mo, with HFrEF patients at higher risk than IHD patients. While broad efforts at preventing early termination are warranted, particular attention may be required in patients with HFrEF.
Bostrom John; Searcy Ryan; Walia Ahana; Rzucidlo Justyna; Banco Darcy; Quien Mary; Sweeney Greg; Pierre Alicia; Tang Ying; Mola Ana; Xia Yuhe; Whiteson Jonathan; Dodson John A
Journal of cardiopulmonary rehabilitation and prevention
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1097/HCR.0000000000000495" target="_blank" rel="noreferrer noopener">10.1097/HCR.0000000000000495</a>
Exploring the Networking of Academic Health Science Leaders: How and Why Do They Do It?
PURPOSE: Networking is essential to leadership effectiveness in the business context. Yet little is known about leadership networking within the academic health science context. If we are going to train academic leaders, we must first understand the relational, network-based activities of their work. The purpose of this study was to explore how academic health science leaders engage in networking activities in the academic health science context. METHOD: A constructivist grounded theory approach guided our study. The authors interviewed 24 academic health science leaders who were enrolled in the New and Evolving Academic Leadership program at the University of Toronto and used social network mapping as an elicitation method. Interviews, which were conducted between September 2014 and June 2015, explored participants' networks and networking activities. Constant comparative analysis was used to analyze the interviews, with attention paid to identifying key networking activities. RESULTS: Academic health science leaders were found to engage in 4 types of networking activities: role bound, project based, goal/vision informed, and opportunity driven. These 4 types were influenced by participants' conception of their role and their perceived leadership work context, which in turn influenced their sense of agency. CONCLUSIONS: The networking activities identified in this study of academic health science leaders resonate with effective networking activities found in other fields. The findings highlight that these activities can be facilitated by focusing on leaders' perceptions about role and work context. Leadership development should thus attend to these perceptions to encourage effective networking skills.
Lieff Susan J; Baker Lindsay; Poost-Foroosh Laya; Castellani Brian; Hafferty Fred W; Ng Stella L
Academic medicine : journal of the Association of American Medical Colleges
2020
2020-01
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Journal Article
<a href="http://doi.org/10.1097/ACM.0000000000003177" target="_blank" rel="noreferrer noopener">10.1097/ACM.0000000000003177</a>
Mechanisms underlying auditory processing deficits in Fragile X syndrome.
auditory system; autism spectrum disorders; synaptic transmission; Fragile X syndrome; circuit development; hyperacusis
Autism spectrum disorders (ASD) are strongly associated with auditory hypersensitivity or hyperacusis (difficulty tolerating sounds). Fragile X syndrome (FXS), the most common monogenetic cause of ASD, has emerged as a powerful gateway for exploring underlying mechanisms of hyperacusis and auditory dysfunction in ASD. This review discusses examples of disruption of the auditory pathways in FXS at molecular, synaptic, and circuit levels in animal models as well as in FXS individuals. These examples highlight the involvement of multiple mechanisms, from aberrant synaptic development and ion channel deregulation of auditory brainstem circuits, to impaired neuronal plasticity and network hyperexcitability in the auditory cortex. Though a relatively new area of research, recent discoveries have increased interest in auditory dysfunction and mechanisms underlying hyperacusis in this disorder. This rapidly growing body of data has yielded novel research directions addressing critical questions regarding the timing and possible outcomes of human therapies for auditory dysfunction in ASD.
McCullagh Elizabeth A; Rotschafer Sarah E; Auerbach Benjamin D; Klug Achim; Kaczmarek Leonard K; Cramer Karina S; Kulesza Randy J Jr; Razak Khaleel A; Lovelace Jonathan W; Lu Yong; Koch Ursula; Wang Yuan
FASEB journal : official publication of the Federation of American Societies for Experimental Biology
2020
2020-03
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Journal Article
<a href="http://doi.org/10.1096/fj.201902435R" target="_blank" rel="noreferrer noopener">10.1096/fj.201902435R</a>
Experimental animal models of coronary microvascular dysfunction.
Coronary microvascular dysfunction (CMD) is commonly present in patients with metabolic derangements and is increasingly recognized as an important contributor to myocardial ischemia, both in the presence and absence of epicardial coronary atherosclerosis. The latter condition is termed 'ischemia with non-obstructive coronary arteries' (INOCA). Notwithstanding the high prevalence of INOCA, effective treatment remains elusive. Although to date there is no animal model for INOCA, animal models of CMD, one of the hallmarks of INOCA, offer excellent test models for enhancing our understanding of the pathophysiology of CMD and for investigating novel therapies. This article presents an overview of currently available experimental models of CMD - with an emphasis on metabolic derangements as risk factors - in dogs, swine, rabbits, rats and mice. In all the available animal models, metabolic derangements are most often induced by a high fat diet and/or diabetes mellitus via injection of alloxan or streptozotocin, but there is also a wide variety of spontaneous as well as transgenic animal models which develop metabolic derangements. Depending on number, severity and duration of exposure to risk factors - all these animal models show perturbations in coronary microvascular (endothelial) function and structure, similar to what has been observed in patients with INOCA and co-morbid conditions. The use of these animal models will be instrumental in identifying novel therapeutic targets and for the subsequent development and testing of novel therapeutic interventions to combat ischemic heart disease, the number one cause of death worldwide.
Sorop Oana; van de Wouw Jens; Chandler Selena; Ohanyan Vahagn; Tune Johnathan D; Chilian William M; Merkus Daphne; Bender Shawn B; Duncker Dirk J
Cardiovascular research
2020
2020-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/cvr/cvaa002" target="_blank" rel="noreferrer noopener">10.1093/cvr/cvaa002</a>
Fostering change within the pharmacy school curriculum.
curriculum; student; INTERPROFESSIONAL relations; CURRICULUM planning; QUALITY assurance; school; curriculum; PHARMACEUTICAL education; COURSE evaluation (Education); TEAMS in the workplace; OUTCOME-based education; AFFINITY groups; NONPRESCRIPTION drugs; change; nonprescription medication; over-the-counter; school; student; change; CHANGE management; nonprescription medication; over-the-counter
Lloyd Mackenzie
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1093/ajhp/zxz317" target="_blank" rel="noreferrer noopener">10.1093/ajhp/zxz317</a>
Operative Technique for Laparoscopic Placement of Continuous Ambulatory Peritoneal Dialysis Catheter.
peritoneal dialysis; CAPD catheter placement; laparoscopic catheter placement; PD catheter placement
Background: Peritoneal dialysis (PD) is an increasingly utilized treatment modality for renal replacement therapy that affords medical and lifestyle benefits to the patient and financial savings to the health care system. Successful long-term use of PD is reliant upon an optimally functioning catheter. Many potential catheter-related complications can be avoided through utilizing optimal placement technique. As widespread use of PD as a renal replacement modality continues to increase, the need for a safe, standardized, catheter placement technique has become more evident. Objectives: To present a succinct synopsis of the rationale and elements of our current surgical management strategy for patients undergoing evaluation for PD and to provide a detailed stepwise description of our operative technique for PD catheter placement. This review describes potential pitfalls that may prevent optimal catheter function and describes each step taken to prevent potential complications. This description is combined with intraoperative photographs to highlight key steps. Conclusion: Following a defined reproducible stepwise approach, laparoscopic placement of continuous ambulatory peritoneal dialysis catheters can be performed safely and known potential complications hindering optimal catheter function can be addressed prophylactically.
Smith Brandon M; Dan Adrian G
Journal of laparoendoscopic & advanced surgical techniques. Part A
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1089/lap.2019.0750" target="_blank" rel="noreferrer noopener">10.1089/lap.2019.0750</a>
Betaine restores epigenetic control and supports neuronal mitochondria in the cuprizone mouse model of multiple sclerosis.
Methionine metabolism is dysregulated in multiple sclerosis (MS). The methyl donor betaine is depleted in the MS brain where it is linked to changes in levels of histone H3 trimethylated on lysine 4 (H3K4me3) and mitochondrial impairment. We investigated the effects of replacing this depleted betaine in the cuprizone mouse model of MS. Supplementation with betaine restored epigenetic control and alleviated neurological disability in cuprizone mice. Betaine increased the methylation potential (SAM/SAH ratio), levels of H3K4me3, enhanced neuronal respiration, and prevented axonal damage. We show that the methyl donor betaine and the betaine homocysteine methyltransferase (BHMT) enzyme can act in the nucleus to repair epigenetic control and activate neuroprotective transcriptional programs. ChIP-seq data suggest that BHMT acts on chromatin to increase the SAM/SAH ratio and histone methyltransferase activity locally to increase H3K4me3 and activate transcriptional programs that support neuronal energetics. These data suggest that the methyl donor betaine may provide neuroprotection in MS where mitochondrial impairment damages axons and causes disability.
Singhal Naveen K; Sternbach Sarah; Fleming Sheila; Alkhayer Kholoud; Shelestak John; Popescu Daniela; Weaver Alyx; Clements Robert; Wasek Brandi; Bottiglieri Teodoro; Freeman Ernest J; McDonough Jennifer
Epigenetics
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1080/15592294.2020.1735075" target="_blank" rel="noreferrer noopener">10.1080/15592294.2020.1735075</a>
A Call for Diversity and Inclusivity in the HEC-C Program.
Humans; BIOETHICS; CERTIFICATION; Consultants; Ethicists; ETHICAL decision making; MEDICAL ethics; CERTIFICATION; BIOETHICS; MEDICAL consultants; NATIONAL competency-based educational tests; PROFESSIONAL licensure examinations
Aultman Julie; Pathmathasan Cynthia
The American journal of bioethics : AJOB
2020
2020-03
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Journal Article
<a href="http://doi.org/10.1080/15265161.2020.1714811" target="_blank" rel="noreferrer noopener">10.1080/15265161.2020.1714811</a>
Preoperative testing for urethroplasty is not associated with outcomes - A NSQIP study.
Urethra; Health policy; Complications; Perioperative period; Preoperative care
OBJECTIVE: To assess the current practice of routine preoperative testing before urethroplasty and to determine if the results are clinically significant. METHODS: Data was obtained from the National Surgical Quality Improvement Program (NSQIP) database. We identified 1,527 patients who underwent urethroplasty from 2010 to 2017. Chi square and one-way ANOVA tests were used to compare categorical and continuous variables, respectively. Multivariable logistic regression analyses were utilized to assess the rate of complications between testing groups. RESULTS: A total of 8,455 individual laboratory tests were performed on 1,156 patients (average of 7 tests per patient), with only 959 labs (11.3%) showing abnormal results. Of the 1,156 patients, 629 (54.4%) patients had at least one abnormal lab. Patients who had at least one abnormal preoperative lab were found to be significantly older (51.49+/-16.57 years vs. 48.14+/-16.32 years; p<0.001), and to be smokers (112 (17.8%) vs. 63 (12%); p=0.005). Additionally, they were more likely to have diabetes mellitus (112 (17.8%) vs. 63 (12%); p<0.001), dyspnea (18 (2.9%) vs. 16(3.0%); p=0.029), and ASA class >/=3 when compared to the group with normal preoperative labs. On a multivariable logistic regression, abnormal preoperative tests were not predictive of intra- or postoperative complications in patients with ASA /= 3, the only lab predictive of postoperative complications was an abnormal coagulation profile. CONCLUSION: Obtaining routine preoperative labs, especially in patients with ASA
Mishra Kirtishri; Avila Amanda; Mahran Amr; Raina Richa; Sidagam Vasu; Ponsky Lee E; Gonzalez Chris M; Bukavina Laura
Urology
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1016/j.urology.2020.02.018" target="_blank" rel="noreferrer noopener">10.1016/j.urology.2020.02.018</a>
Teres minor and quadrilateral space syndrome: A review.
Treatment; Surgical; Quadrilateral Space Syndrome; Teres minor; Neurogenic Quadrilateral Space Syndrome; nQSS; PCHA; Posterior Circumflex Humeral Artery; QS; QSS; Quadrilateral Space; Quadrilateral Space Syndrome; Vascular Quadrilateral Space Syndrome; vQSS
The teres minor is one of four rotator cuff muscles that is involved in many shoulder pathologies. The integrity of the teres minor can be indicative of treatment success for disorders including rotator cuff tears, impingement syndrome, and quadrangular space syndrome. Quadrangular or quadrilateral space syndrome is a debilitating disorder that may require surgical intervention in chronic cases and can lead to atrophy of the teres minor. A review of the diagnostic techniques and treatment methods for disorders involving teres minor, with a focus on quadrilateral space syndrome, are presented in order to summarize the current understanding of these pathologies.
Dalagiannis Nicholas; Tranovich Meaghan; Ebraheim Nabil
Journal of orthopaedics
2020
2020-08
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Journal Article
<a href="http://doi.org/10.1016/j.jor.2020.01.021" target="_blank" rel="noreferrer noopener">10.1016/j.jor.2020.01.021</a>
Songling Xuemaikang Capsule inhibits isoproterenol-induced cardiac hypertrophy via CaMKIIdelta and ERK1/2 pathways.
ERK1/2; Cardiac hypertrophy; Isoproterenol; CaMKIIdelta; Songling xuemaikang capsule; CaMKIIδ
ETHNOPHARMACOLOGICAL RELEVANCE: Cardiac hypertrophy is a key pathologic process in heart failure. Songling Xuemaikang Capsule (SXC), is a formulae of Chinese Medicine commonly used in China to treat hypertension and heart failure. However, its mechanism of effects on cardiac hypertrophy is still unclear. AIM OF THE STUDY: The aims of the present study were to investigate the cardio-protection roles and detailed mechanisms of SXC on cardiac hypertrophy in vivo and in vitro. MATERIALS AND METHODS: A rat model of cardiac hypertrophy was constructed by isoproterenol (ISO) intraperitoneal injection (i.p), 10 mg/kg/day for 3 days, and 4 groups were compared: CON (n = 8), ISO (n = 8), MET (metoprolol, positive drug treatment, n = 7), and SXC (SXC treatment, n = 6). Cardiac structure and function were evaluated with echocardiography in vivo. Dose-dependent curve was obtained with SXC different concentrations. In addition, H9C2 rat cardiomyocytes were cultured in vitro and the phosphorylation of ERK1/2, p38, JNK, AKT, and protein expression of CaN, CaMKIIdelta, GATA4 were detected with Western blot test. RESULTS: The results showed that SXC reduced diastolic thickness of left ventricular posterior wall, while did not change ejection fraction and fraction shortening significantly (P > 0.05). SXC inhibit ISO-induced cardiac hypertrophy dose-dependently with 50% inhibiting concentration (IC50) is 0.504 g/kg/day. Moreover, SXC inhibited the protein expression of CaMKIIdelta, and the phosphorylation of ERK1/2, so inhibiting protein expression of GATA4 in nucleus, and brain natriuretic peptide in serum (P < 0.001). CONCLUSION: The mechanism of SXC in the treatment of heart diseases involves SXC dose-dependently inhibited the ISO-induced cardiac hypertrophy via inhibiting CaMKIIdelta and ERK1/2/GATA4 signaling pathway.
Qi Jianyong; Tan Yafang; Fan Dancai; Pan Wenjun; Yu Juan; Xu Wen; Wu Jiashin; Zhang Minzhou
Journal of ethnopharmacology
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1016/j.jep.2020.112660" target="_blank" rel="noreferrer noopener">10.1016/j.jep.2020.112660</a>
Multiple tender bluish nodules.
familial; glomus cells; glomus tumors
Kromer Courtney; Milani-Nejad Nima; Chung Catherine; Tyler Kelly
JAAD case reports
2020
2020-03
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Journal Article
<a href="http://doi.org/10.1016/j.jdcr.2020.01.022" target="_blank" rel="noreferrer noopener">10.1016/j.jdcr.2020.01.022</a>
Conversion to Positive Latent Tuberculosis Infection Status is Low in Hidradenitis Suppurativa Patients Taking Biologic Medications.
biologics; Hidradenitis Suppurativa; latent tuberculosis; Quantiferon; TNF inhibitors
Ellis Ariana; Khanna Urmi; Galadari AbdulAziz; Fernandez Anthony
Journal of the American Academy of Dermatology
2020
2020-01
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Journal Article
<a href="http://doi.org/10.1016/j.jaad.2020.01.012" target="_blank" rel="noreferrer noopener">10.1016/j.jaad.2020.01.012</a>
Generation of a ChAT(Cre) mouse line without the early onset hearing loss typical of the C57BL/6J strain.
Acetylcholine; Age-related hearing loss; Presbycusis; Choline acetyltransferase; Normal hearing; Transgenic mouse
The development of knockin mice with Cre recombinase expressed under the control of the promoter for choline acetyltransferase (ChAT) has allowed experimental manipulation of cholinergic circuits. However, currently available ChAT(Cre) mouse lines are on the C57BL/6J strain background, which shows early onset age-related hearing loss attributed to the Cdh23(753A) mutation (a.k.a., the ahl mutation). To develop ChAT(Cre) mice without accelerated hearing loss, we backcrossed ChAT(IRES-Cre) mice with CBA/CaJ mice that have normal hearing. We used genotyping to obtain mice homozygous for ChAT(IRES-Cre) and the wild-type allele at the Cdh23 locus (ChAT(Cre,Cdh23WT)). In the new line, auditory brainstem response thresholds were approximately 20 dB lower than those in 9 month old ChAT(IRES-Cre) mice at all frequencies tested (4-31.5 kHz). These thresholds were stable throughout the period of testing (3-12 months of age). We then bred ChAT(Cre,Cdh23WT) animals with Ai14 reporter mice to confirm the expression pattern of ChAT(Cre). In these mice, tdTomato-labeled cells were observed in all brainstem regions known to contain cholinergic cells. We then stained the tissue with a neuron-specific marker, NeuN, to determine whether Cre expression was limited to neurons. Across several brainstem nuclei (pontomesencephalic tegmentum, motor trigeminal and facial nuclei), 100% of the tdTomato-labeled cells were double-labeled with anti-NeuN (n = 1896 cells), indicating Cre-recombinase was limited to neurons. Almost all of these cells (1867/1896 = 98.5%) also stained with antibodies against ChAT, indicating that reporter label was expressed almost exclusively in cholinergic neurons. Finally, an average 88.7% of the ChAT+ cells in these nuclei were labeled with tdTomato, indicating that the Cre is expressed in a large proportion of the cholinergic cells in these nuclei. We conclude that the backcrossed ChAT(Cre,Cdh23WT) mouse line has normal hearing and expresses Cre recombinase almost exclusively in cholinergic neurons. This ChAT(Cre,Cdh23WT) mouse line may provide an opportunity to manipulate cholinergic circuits without the confound of accelerated hearing loss associated with the C57BL/6J background. Furthermore, comparison with lines that do show early hearing loss may provide insight into possible cholinergic roles in age-related hearing loss.
Beebe Nichole L; Sowick Colleen S; Kristaponyte Inga; Galazyuk Alexander V; Vetter Douglas E; Cox Brandon C; Schofield Brett R
Hearing research
2020
2020-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.heares.2020.107896" target="_blank" rel="noreferrer noopener">10.1016/j.heares.2020.107896</a>
Renal Replacement Therapy in Pediatric Acute Kidney Injury.
Acute kidney injury; Dialysis; Pediatric; Renal replacement therapy
Acute kidney injury (AKI) is common in critically ill children and affects nearly
Sethi Sidharth Kumar; Chakraborty Ronith; Joshi Hirva; Raina Rupesh
Indian journal of pediatrics
2020
2020-01
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Journal Article
<a href="http://doi.org/10.1007/s12098-019-03150-9" target="_blank" rel="noreferrer noopener">10.1007/s12098-019-03150-9</a>
Effects of Superior Laryngeal Nerve Lesion on Kinematics of Swallowing and Airway Protection in an Infant Pig Model.
Deglutition; Deglutition disorders; Kinematics; Biomechanics; Animal model; Airway; Superior laryngeal nerve; Neural control; Swallow
The superior laryngeal nerve provides detailed sensory information from the mucosal surfaces of laryngeal structures superior to the vocal folds, including the valleculae. Injury to this nerve results in airway penetration and aspiration. Furthermore, such injuries might have an impact on the function of multiple structures involved in intraoral transport and swallowing due to connections within the brainstem. We sought to determine the effects of a surgical lesion of the superior laryngeal nerve on kinematics of the tongue, hyoid, and epiglottis during swallowing. We implanted radio-opaque markers into five infant pigs under anesthesia. Then we fed milk mixed with contrast agent to the pigs while they were recorded via video fluoroscopy, before and after a surgery to transect the superior laryngeal nerve. We digitized and rated airway protection in 177 swallows. We found that in most animals, swallow duration was shorter after nerve lesion. The hyoid also traveled a shorter distance after lesion. Frequently, individuals reacted differently to the same nerve lesion. We suggest that these differences are due to individual differences in neurological connections. When comparing hyoid kinematics between swallows with successful or failed airway protection, we found more consistency among individuals. This indicates that protecting the airway requires specific sets of kinematic events to occur, regardless of the neurological differences among individuals.
Lammers Andrew R; Abid Saja; Ding Peng; German Rebecca Z
Dysphagia
2020
2020-03
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Journal Article
<a href="http://doi.org/10.1007/s00455-020-10100-7" target="_blank" rel="noreferrer noopener">10.1007/s00455-020-10100-7</a>
Swallow Safety in Infant Pigs With and Without Recurrent Laryngeal Nerve Lesion.
Respiration; Animal model; Dysphagia; Neonate; Aerodigestive
Aerodigestive coordination is critical for safe feeding in mammals, and failure to do so can result in aspiration. Using an infant pig model, we analyzed the impact of recurrent laryngeal nerve (RLN) lesion on aerodigestive coordination and swallow safety at two time points prior to weaning. We used high-speed videofluoroscopy to record 23 infant pigs longitudinally at two ages (7 days, 17 days) feeding on barium milk. We measured respiration with a plethysmograph and used the Infant Mammalian Penetration-Aspiration Scale (IMPAS) to identify unsafe swallows. We tested for changes in swallow safety longitudinally in control and lesion pigs, and whether there was any interaction between the four different groups. On postnatal day 7, lesioned pigs exhibited differences in the frequency distribution of IMPAS scores relative to control pigs on day 7, and 17 day old lesion and control pigs. There were longitudinal changes in performance following RLN lesion through time, suggesting that the impact of RLN lesion decreases with time, as older lesioned pigs performed similarly to older control pigs. We found minimal differences in the impact of aerodigestive coordination on swallow safety, with shorter delays of inspiration onset reflecting higher rates of penetration in young lesioned pigs. Healthy pigs aspirated at a similar rate to those with an RLN lesion indicating that the occasional occurrence of dysphagia in infants may be a normal behavior.
Stricklen Bethany M; Bond Laura E; Gould Francois D H; German Rebecca Z; Mayerl Christopher J
Dysphagia
2020
2020-02
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Journal Article
<a href="http://doi.org/10.1007/s00455-020-10099-x" target="_blank" rel="noreferrer noopener">10.1007/s00455-020-10099-x</a>
TRPV4 deletion protects heart from myocardial infarction-induced adverse remodeling via modulation of cardiac fibroblast differentiation.
Mechanotransduction; TRPV4; Myocardial infarction; Myocardial infarction; TGF-beta1; Rho/Rho kinase; Mechanotransduction; TGF-β1; Myocardial infarction; EXTRACELLULAR matrix; HEART failure; HEART fibrosis; HEART; Cardiac fibroblast; Cardiac fibrosis; Rho/Rho kinase; TRPV4; Cardiac fibroblast; Cardiac fibrosis; DELETION mutation
Cardiac fibrosis caused by adverse cardiac remodeling following myocardial infarction can eventually lead to heart failure. Although the role of soluble factors such as TGF-beta is well studied in cardiac fibrosis following myocardial injury, the physiological role of mechanotransduction is not fully understood. Here, we investigated the molecular mechanism and functional role of TRPV4 mechanotransduction in cardiac fibrosis. TRPV4KO mice, 8 weeks following myocardial infarction (MI), exhibited preserved cardiac function compared to WT mice. Histological analysis demonstrated reduced cardiac fibrosis in TRPV4KO mice. We found that WT CF exhibited hypotonicity-induced calcium influx and extracellular matrix (ECM)-stiffness-dependent differentiation in response to
Adapala Ravi K; Kanugula Anantha K; Paruchuri Sailaja; Chilian William M; Thodeti Charles K
Basic research in cardiology
2020
2020-01
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Journal Article
<a href="http://doi.org/10.1007/s00395-020-0775-5" target="_blank" rel="noreferrer noopener">10.1007/s00395-020-0775-5</a>
Surgeon Experience with Parental Leave Policies Varies Based on Practice Setting.
BACKGROUND: The increase in female surgeons has resulted in scrutiny of widely variable parental leave policies. We hypothesized that academic and private practice surgeons have different experiences based on difference in workplace expectations. METHODS: A 25-question survey was disseminated via social media and through the Association of Women Surgeons social media platforms from June 1 to September 15, 2017. An analysis of attending surgeons working in the USA in an academic or private practice setting was performed. RESULTS: Of 1115 total respondents, 477 were attending surgeons practicing in the USA. Practice distribution was 34% private and 47% academic. There was no difference in marital status, work status, or the number who report having been pregnant between the groups. Compared to academic surgeons, private practice surgeons were statistically less likely to have paid leave (p < 0.001) and were more likely to continue to pay benefits while on leave (p < 0.001). Private practitioners were more likely to return to work sooner than desired due to financial (p = 0.022) and supervisor (p = 0.004) pressures and were more likely to leave a job (p = 0.01). Academic surgeons were more likely to experience a delay in job advancement (p = 0.031). On multivariate analysis, more than two pregnancies were associated with an increased risk of perception of a bias and discrimination against pregnancy in the workplace. CONCLUSIONS: Parental leave policies and attitudes vary between academic and private practice, creating unique challenges for female surgeons and different issues for family planning depending on employment model.
Bingmer Katherine; Walsh Danielle S; Gantt Nancy L; Sanfey Hilary A; Stein Sharon L
World journal of surgery
2020
2020-03
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Journal Article
<a href="http://doi.org/10.1007/s00268-020-05447-9" target="_blank" rel="noreferrer noopener">10.1007/s00268-020-05447-9</a>
ASPEN Consensus Recommendations for Refeeding Syndrome.
magnesium; potassium; consensus; phosphorus; nutrition assessment; nutrition support; refeeding syndrome
INTRODUCTION: In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. METHODS: Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. FINDINGS/RECOMMENDATIONS: This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%-20% (mild), 20%-30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories. CONCLUSIONS: These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.
da Silva Joshua S V; Seres David S; Sabino Kim; Adams Stephen C; Berdahl Gideon J; Citty Sandra Wolfe; Cober M Petrea; Evans David C; Greaves June R; Gura Kathleen M; Michalski Austin; Plogsted Stephen; Sacks Gordon S; Tucker Anne M; Worthington Patricia; Walker Renee N; Ayers Phil
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
2020
2020-04
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Journal Article
<a href="http://doi.org/10.1002/ncp.10474" target="_blank" rel="noreferrer noopener">10.1002/ncp.10474</a>