Use of slime dispersants to promote antibiotic penetration through the extracellular polysaccharide of mucoid Pseudomonas aeruginosa.

Agents with the potential to reduce Pseudomonas aeruginosa alginate viscosity (slime dispersants) were shown to promote the diffusion of antipseudomonal antibiotics through alginate but were more effective in facilitating the diffusion of gentamicin than that of ceftazidime. EDTA increased the diffusion rates of these antibiotics by factors of 4.0 and 1.5, respectively, although sodium chloride significantly reduced viscosity and enhanced gentamicin diffusion.     

Selective parasympathectomy increases the quantity of inhibitory guanine nucleotide-binding proteins in canine cardiac ventricle

In mammalian heart, vagal stimulation or the direct application of acetylcholine produces profound direct effects on the electro-physiologic characteristics of atrial myocytes. At the tissue level, these effects are observed as shortening of atrial action potential duration. Despite anatomic, biochemical, and physiologic evidence for significant vagal input to the mammalian ventricle, similar direct effects of acetylcholine on the ventricular action potential have been difficult to demonstrate. Chronic denervation via cervical vagotomy is one method that has been shown to render previously unresponsive ventricular myocytes sensitive to acetylcholine, but the molecular mechanism has not been defined. In the experiments described, selective cardiac para-sympathectomy was performed on mongrel dogs. Five to seven days after parasympathectomy, the dogs were sacrificed, electrophysiologic responses to acetylcholine were measured, and sarcolemmal vesicles were prepared. After parasympathectomy, ventricular myocytes were responsive to the effects of acetylcholine, manifested as shortening of the action potential duration. A quantitative and functional assessment of the transmembrane signalling mechanisms of the muscarinic receptor was carried out. After parasympathectomy, the density of muscarinic receptors in the sarcolemma was increased, compared with control ventricles. After parasympathectomy, ventricular sarcolemma displayed significant increases in both basal and oxotremorine-stimulated GTPase activity. ADP-ribosylation revealed significantly increased quantities of the pertussis toxin substrates Gi and Go. The quantity of ADP ribose incorporated was correlated with the increased level of GTPase activity in control and oxotremorine-stimulated membranes. Quantitation of the alpha and beta gamma subunits of the guanine nucleotide-binding proteins by immunoblot confirmed the increase in density of inhibitory guanine nucleotide-binding proteins following parasympathectomy. The results offer new insights into possible mechanisms of altered electrophysiologic responsiveness to acetylcholine following cardiac parasympathectomy.     

Cytologic diagnosis of cat scratch disease (CSD) by fine-needle aspiration

Cat scratch disease (CSD) is usually a benign, self-limited lymphadenitis, characterized by suppurative granulomas. It can, however, produce a wide spectrum of clinical symptoms and cytologic changes and be the source of diagnostic dilemmas. Identification of pleomorphic bacilli (PB) with silver impregnation stains aids in the diagnosis, but this has not been well documented in cytologic preparations or in cases without the classic morphologic changes. We reviewed 13 aspirations from eight patients (aged 13–36 yr) occurring over a 15 mo time period, all clinically or cytologically suspicious for CSD. Sites included: axilla (6), parotid (3), epitrochlear (1), neck (1), submental (1), and intraclavicular (1) nodes. Neoplasia was initially suspected clinically in 38% of the cases. All but two patients had cat exposure on subsequent interview. The cytologic differential included bacterial abscess and lymphoproliferative disorders in 31%. Neither granulomas nor suppurative inflammation were seen in all cases. Changes included: granulomas (77%), PMNs (62%), dispersed epithelioid histiocytes (46%), and suppurative granulomas (38%). A modified silver stain (Modified Steiner, Sigma Diagnostics, St. Louis, MO) was performed on all specimens. Silver positive organisms were seen in 69% of cases and were not limited to those preparations with suppurative granulomas. Fine-needle aspiration biopsy (FNAB) is an effective method for diagnosing CSD despite its heterogeneous appearance; and, when combined with clinical information and silver staining, may obviate the need for excision. © 1995 Wiley-Liss, Inc.     

Direct target NOTES: prospective applications for next generation robotic platforms

Background

A new era in surgical robotics has centered on alternative access to anatomic targets and next generation designs include flexible, single-port systems which follow circuitous rather than straight pathways. Such systems maintain a small footprint and could be utilized for specialized operations based on direct organ target natural orifice transluminal endoscopic surgery (NOTES), of which transanal total mesorectal excision (taTME) is an important derivative.

Methods

During two sessions, four direct target NOTES operations were conducted on a cadaveric model using a flexible robotic system to demonstrate proof-of-concept of the application of a next generation robotic system to specific types of NOTES operations, all of which required removal of a direct target organ through natural orifice access. These four operations were (a) robotic taTME, (b) robotic transvaginal hysterectomy in conjunction with (c) robotic transvaginal salpingo-oophorectomy, and in an ex vivo model, (d) trans-cecal appendectomy.

Results

Feasibility was demonstrated in all cases using the Flex^® Robotic System with Colorectal Drive. During taTME, the platform excursion was 17 cm along a non-linear path; operative time was 57 min for the transanal portion of the dissection. Robotic transvaginal hysterectomy was successfully completed in 78 min with transvaginal extraction of the uterus, although laparoscopic assistance was required. Robotic transvaginal unilateral salpingo-oophorectomy with transvaginal extraction of the ovary and fallopian tube was performed without laparoscopic assistance in 13.5 min. In an ex vivo model, a robotic trans-cecal appendectomy was also successfully performed for the purpose of demonstrating proof-of-concept only; this was completed in 24 min.

Conclusions

A flexible robotic system has the potential to access anatomy along circuitous paths, making it a suitable platform for direct target NOTES. The conceptual operations posed could be considered suitable for next generation robotics once the technology is optimized, and after further preclinical validation.

     

3D image guidance assisted identification of colorectal cancer liver metastases not seen on intraoperative ultrasound: results from a prospective trial

Background

Neoadjuvant treatment of colorectal liver metastases has become increasingly common, and while effective, often renders small metastases difficult to visualize on intraoperative US. The objective of this study was to determine the utility of a 3D image-guidance system in patients with intraoperative sonographically-occult CRLM.

Achieving Dietary Sodium Recommendations and Atherosclerotic Cardiovascular Disease Prevention through Culinary Medicine Education

Sodium-reduction initiatives have been a cornerstone of preventing hypertension and broader atherosclerotic cardiovascular disease (ASCVD) since the early 1970s. For nearly 50 years, public health and clinical guidelines have concentrated on consumer education, behavioral change, and, to a lesser extent, food policy to help reduce sodium intake among Americans. While these efforts undoubtedly helped improve awareness, average sodium consumption remains at approximately 4200 mg/day in men and 3000 mg/day in women, well above the United States Dietary Guidelines of 2300 mg/day. Culinary medicine is an emerging discipline in clinical and public-health education that provides healthcare professionals and community members with food-based knowledge and skills. With the hands-on teaching of kitchen education to individuals, culinary medicine provides eaters with tangible strategies for reducing sodium through home cooking. Here, we review opportunities for culinary medicine to help improve both individual- and population-level sodium-reduction outcomes through five main areas: increasing adherence to a plant-forward dietary pattern, food literacy, the enhancement of complementary flavors, disease-specific teaching-kitchen modules, and the delivery of culturally specific nutrition education. Through this process, we hope to further underline the value of formal, hands-on teaching-kitchen education among healthcare professionals and community members for ASCVD prevention.     

Optimistic bias and preventive behavioral engagement in the context of COVID-19

BackgroundThe coronavirus (COVID-19) pandemic presents a global crisis. To remain safe, individuals must take preventive measures. Health behavior theories suggest that perceived risk is a key determinant of engagement in preventive behavior. People often underestimate their risk for disease compared with similar others’, a phenomenon known as optimistic bias (OB).ObjectiveThis study aimed to explore how OB affected individuals' engagement in COVID-19 preventive behavior/intentions. Based on health behavior theories, this study considered risk perception and risk response as mediators of the relationship between OB and individuals’ preventive health behaviors and intentions.MethodsThis study used a cross-sectional survey design. Online survey platforms were used to recruit U.S. adults. A total of 293 valid responses were included in the analyses. Multivariate regression analyses were conducted to determine the relationship of OB to the respondents’ health information seeking intention and related behavioral outcomes.ResultsResults from the first regression model showed that OB was negatively related to risk perception. In other words, optimistically biased respondents perceived their risk of COVID-19 to be low. The second model demonstrated that perceived risk was related positively to affective responses to risk (e.g., worry and fear). That is, the lower their perceived risk of COVID-19, the less likely respondents were to feel anxiety and fear about this disease. Models 3 and 4 revealed positive relationships between risk response and respondents’ intentions and behaviors. Finally, the results supported a fully mediated pathway: OB → risk perception → risk response → information seeking intention and behavioral outcomes.ConclusionsThe study findings suggest that by decreasing their perceived risk and subsequent responses, optimistic bias can undermine individuals’ motivation to take precautions. To reduce this bias, the actual risk of COVID-19 should be reinforced.     

Self-Efficacy for Healthy Eating Moderates the Impact of Stress on Diet Quality Among Family Child Care Home Providers

ObjectiveTo examine associations of stress and sleep with diet quality of family child care home (FCCH) providers, and whether self-efficacy for healthy eating influences these associations.DesignA cross-sectional analysis was performed using baseline data (2013–2015) from a randomized control trial with FCCH providers.ParticipantsThe study included 166 licensed FCCH providers, aged >18 years, from central North Carolina.Main Outcome Measure(s)Diet quality was assessed with a food frequency questionnaire, used to calculate a modified 2010-Healthy Eating Index score. Stress, sleep quality, and diet self-efficacy were measured via self-administered questionnaires.AnalysisUsing observations from 158 participants with complete data, multiple linear regression models were created to assess whether stress, sleep quality, and diet self-efficacy were associated with diet quality and whether diet self-efficacy moderated these associations (significance set at P < 0.05).ResultsIn the initial model, only diet self-efficacy was significantly associated with diet quality (β = 0.32; P < 0.001). Moderation analyses showed that higher stress was associated with lower diet quality, but only when diet self-efficacy was low.ConclusionsBuilding FCCH providers’ self-efficacy for healthy eating is an important component of health promotion and can buffer the impact of stress on their diet quality.     

Evaluation of Communities That Care—Effects on Municipal Youth Crime Rates in Victoria,Australia: 2010–2019

Prevention Science - Internationally, youth crime is a significant social problem. Violent youth crime has been rising over the past decade in the state of Victoria, Australia. Communities That...