Evidence that preimmunization with a heat-killed preparation of Mycobacterium vaccae reduces corticotropin-releasing hormone mRNA expression in the extended amygdala in a fear-potentiated startle paradigm

Posttraumatic stress disorder (PTSD) is a trauma and stressor-related disorder that is characterized by dysregulation of glucocorticoid signaling, chronic low-grade inflammation, and impairment in the ability to extinguish learned fear. Corticotropin-releasing hormone (Crh) is a stress- and immune-responsive neuropeptide secreted from the paraventricular nucleus of the hypothalamus (PVN) to stimulate the hypothalamic-pituitary-adrenal (HPA) axis; however, extra-hypothalamic sources of Crh from the central nucleus of the amygdala (CeA) and bed nucleus of the stria terminalis (BNST) govern specific fear- and anxiety-related defensive behavioral responses. We previously reported that preimmunization with a heat-killed preparation of the immunoregulatory environmental bacterium Mycobacterium vaccae NCTC 11659 enhances fear extinction in a fear-potentiated startle (FPS) paradigm. In this follow-up study, we utilized an in situ hybridization histochemistry technique to investigate Crh, Crhr1, and Crhr2 mRNA expression in the CeA, BNST, and PVN of the same rats from the original study [Fox et al., 2017, Brain, Behavior, and Immunity, 66: 70–84]. Here, we demonstrate that preimmunization with M. vaccae NCTC 11659 decreases Crh mRNA expression in the CeA and BNST of rats exposed to the FPS paradigm, and, further, that Crh mRNA expression in these regions is correlated with fear behavior during extinction training. These data are consistent with the hypothesis that M. vaccae promotes stress-resilience by attenuating Crh production in fear- and anxiety-related circuits. These data suggest that immunization with M. vaccae may be an effective strategy for prevention of fear- and anxiety-related disorders.     

Spill Over Effects of Inpatient Bed Capacity on Accident and Emergency Performance in England

The English National Health Service (NHS) has failed to meet the four-hour waiting time target to admit, transfer or discharge 95 per cent of patients attending Accident and Emergency Departments (A&E) since 2013. A growing number of patients requiring inpatient care are waiting on trolleys longer than four hours before admission to a hospital bed. This study examines the role of bed occupancy in the deterioration of A&E performance in the NHS. Longitudinal panel data methods are used to analyse hospital data (n = 72,129,886) for 143 Trusts from 1^st June 2016 to 31^st October 2019. The average bed occupancy rate across the study period was 93.2%. A 1% increase in bed occupancy was associated with a 9.5 percentage point decrease in the Trusts’ probabilitay of meeting the waiting target, and an approximately 6 patient increase in four hours to 12 -hs trolley waits per 1,000 admissions. These relationships became more pronounced with rising bed occupancy levels above a 90% threshold. Bed occupancy is associated with significant negative spill-over effects on A&E performance. We estimate a minimum investment in 3,861 additional inpatient beds across the NHS to improve A&E performance in England. Relevant lessons can be derived for health care systems that have observed similar trends in increasing bed occupancy and deteriorations in A&E performance, including Ireland, Canada and Israel.     

Placing volunteered geographic health information: Socio-spatial bias in 311 bed bug report data for New York City

Health researchers and policy-makers increasingly use volunteered geographic information (VGI) to analyze spatial variation in health and wellbeing and to develop interventions. As socially constructed data, health VGI reflect the people who perceive issues and choose to report them, and the digital systems that structure the reporting process. We propose a conceptual framework that describes the interlocking effects of socioeconomic, behavioral, geographic, and technological processes on VGI accuracy and credibility. GIS and statistical methods are used to analyze social and geographical biases in health-related VGI through a case study of bed bug complaint data from New York City's 311 system. Reports of bed bug infestation from 311 are mapped and modeled to uncover associations with socioeconomic and built environment characteristics. Factors associated with bed bug report credibility are examined by comparing characteristics of confirmed reports with those for reports in which inspectors found no evidence of infestation (negative reports). A multilevel model of credibility incorporating report-, building-, and tract-level variables reveals strong geographical and socioeconomic biases, with negative reports generated more frequently from high-value residential buildings located in high-income neighborhoods with predominately white, non-Hispanic populations. Using 311 data for all bed bug reports, rather than confirmed reports, obscures the burden of these pests in high poverty neighborhoods and diminishes socioeconomic disparities. Mistaken reporting also has economic costs, as each report triggers an inspection by city inspectors that entails time, monetary, and opportunity costs.     

四位数码翻号床牌在复苏室手术患者床位标识中的应用体会

目的：探讨四位数码翻号床牌在复苏室手术患者床位标识的方法。方法巧用四位数码翻号床牌对我院所有需进入复苏室的手术患者进行床位标识。结果在使用过程中，翻号床牌操作简单方便，标识清楚，可准确和直观的看到复苏病人的床位标识，分辨率极高。结论四位数码翻号床牌，能准确标识手术复苏患者的床位号，便于医护人员三查七对，避免差错事故的发生，提高了复苏室抢救效率。     

Effect of simulated microgravity on salivary and serum oxidants, antioxidants, and periodontal status

Background: Microgravity is associated with an increase in peroxidative damage. The effect is more pronounced after long‐duration space flights and can even last for several weeks after landing. The objective of the study is to determine the influence of simulated microgravity on the periodontal status and salivary and serum oxidant/antioxidant status of the body in simulated microgravity (?6° head‐down‐tilt [HDT) bed rest). Methods: Twenty healthy male volunteers were studied before and after 60 days of simulated microgravity (?6° HDT bed rest). We measured salivary and serum oxidative markers, such as malondialdehyde (MDA), 8‐oxo‐7,8 dihydro‐2 deoxyguanosine (8‐OHdG), and vitamins C and E, and clinical periodontal parameters (probing depth [PD] and clinical attachment level [CAL]). Results: Serum and salivary vitamin C and E concentrations were significantly decreased, whereas MDA and 8‐OHdG levels were significantly increased after 60 days of simulated microgravity. Serum and salivary markers showed a strong and significant correlation. CAL and PD were higher but not statistically significant in simulated microgravity. Conclusions: This study suggests that oxidative stress in the microgravity environment was increased but did not significantly influence periodontal parameters after 2 months. Also, this study indicates the possibility that the findings may have a broader clinical relevance to patients on bed rest or who are physically inactive. Studies on larger patient samples and follow‐up for a longer time are required to verify the relationship between antioxidant status in the space microgravity condition and periodontal health.     

“碱性成纤维细胞生长因子”治疗褥疮、烧伤的临床观察

应用bFGF治疗褥疮及烧伤,bFGF对轻度、中度褥疮及烧伤疗效很好,对重度褥疮亦有明显疗效。bFGF使创面干燥,结痂快,肌肉等软组织生长良好,bFGF高效、简便、无毒、无副作用,值得临床应用。     

Maternally responsive neurons in the bed nucleus of the stria terminalis and medial preoptic area: Putative circuits for regulating anxiety and reward

Postpartum neuropsychiatric disorders are a major source of morbidity and mortality and affect at least 10% of childbearing women. Affective dysregulation within this context has been identified in association with changes in reproductive steroids. Steroids promote maternal actions and modulate affect, but can also destabilize mood in some but not all women. Potential brain regions that mediate these effects include the medial preoptic area (mPOA) and ventral bed nucleus of the stria terminalis (vBNST). Herein, we review the regulation of neural activity in the mPOA/vBNST by environmental and hormonal concomitants in puerperal females. Such activity may influence maternal anxiety and motivation and have significant implications for postpartum affective disorders. Future directions for research are also explored, including physiological circuit-level approaches to gain insight into the functional connectivity of hormone-responsive maternal circuits that modulate affect.     

Optimal occupancy in the ICU: A literature review

IntroductionIn intensive care, occupancy is a commonly used measure. There is inconsistency however in its measurement and optimal occupancy targets need to be defined. The objectives of this literature review were to explore how occupancy is measured, reported, and interpreted and investigate optimal occupancy levels for ICUs.MethodA literature search was performed using the Medline, Embase and CINAHL databases and citation tracking identified additional relevant articles. Articles published since 1997, written in English and focused on the adult ICU setting were included. As a result, 16 articles were selected for this review.ResultsAlthough it was apparent there was no commonly accepted or used method for calculating ICU occupancy, methods described as more accurate enumerate actual patient hours in the ICU, use operational (and preferably fully staffed) beds as the denominator, and are calculated daily. Issues pertaining to the utility, interpretation, and reporting of ICU occupancy measures were identified and there were indications that optimal ICU occupancy rates were around 70–75%. It was evident however that setting a uniform target figure for all ICUs would be problematic as there are a range of factors both at the unit and the hospital level that impact occupancy figures and optimal occupancy levels.ImplicationsThis literature review informed the recommendation of a proposed method for calculating ICU occupancy which provides a realistic measure of occupied bed hours as a percentage of available beds. Despite the importance of gaining an understanding of ICU occupancy at the local and broader health system levels, there are a number of unknown factors that require further research. Appropriate occupancy targets, impact of unavailable beds, and the intrinsic and extrinsic factors on occupancy measurement are a few examples of where more information is required to adequately inform ICU monitoring, planning and evaluation activities.