The impact of gross anatomy laboratory on first year medical students’ interest in a surgical career

This study sought to determine the impact of gross anatomy laboratory (GA) on first year medical students’ (M1) interest in a surgical career. Secondary objectives included identifying other influences in M1s’ career decision making. This prospective study included surveys before and after GA. All M1s enrolled in GA were invited to participate. Sixty students completed both the pre‐ and post‐test surveys. A 5‐point Likert‐type scale surveyed participants’ interests, specific personality traits, experience during the course of GA, and likelihood of pursuing a surgical career. Statistical analysis included Wilcoxon Signed Rank Test and (Polychotomous) Ordinal Logistic Regression Model. Students’ desire to work with their hands increased (50 vs. 33.3%) and enjoyment working with instruments and tools similarly increased (50 vs. 41.7%). Likelihood of pursuing a surgical career after gross anatomy increased in 31.7% of students, decreased in 16.7%, and was unchanged in 51.7%. Over 75% of students with a prior interest in surgery and 21% of those who previously felt neutral agreed that they were likely to pursue a career in surgery at the conclusion of the laboratory. Students with a surgeon family member were 0.1976 times as likely to exhibit a positive change in interest (P values 0.024). Gross anatomy may influence up to a third of the class to consider a surgical career, especially those with a prior interest in surgery and those previously feeling ambivalent. Students with a surgeon family member became less likely to enter a surgical career after gross anatomy. Clin. Anat. 29:691–695, 2016. © 2016 Wiley Periodicals, Inc.     

Neurological and developmental outcomes of prenatally cocaine-exposed offspring from 12 to 36 months

Second generation studies of prenatal cocaine exposure failed to find gross deficits after controlling for confounders. Concern remained that exposure could cause subtle deficits. This prospective, cohort study evaluated effects of cocaine on development at 12, 18, 24, and 36 months. From 1991-1993, 361 mother-infant pairs were recruited from the Children's Hospital of New York, Presbyterian Medical Center's prenatal clinic or delivery room suite. Mothers were assigned to the cocaine group based on report of prenatal cocaine use or positive urine toxicology. Control mothers were enrolled from the same clinic and matched for age and socioeconomic status (SES). Women with serious medical problems were excluded from either group. Of the retained cohort, at 12 months, 147 infants were exposed and 89 were unexposed case controls. Both groups were raised in impoverished environments with few supports. Developmental evaluations were conducted blinded to group. Cross-sectional analysis revealed cocaine-related deficits in neurological exams and speech across all time periods, in spite of catch up in weight, length, and head circumference. Overall analysis of development was evaluated using Generalized Estimating Equations regression analysis. Bayley Mental [Badj = -6.5 (CI--9.4, -3.5, p < or = 0.001)] and Psychomotor [Badj = -3.9 (CI--7.4, -0.5, p = 0.02)] Developmental Indices showed deficits after controlling for confounders. Males were more vulnerable to cocaine exposure for height, motor development, and emotional regulation. Dose-response relationships existed for abnormal neurological exams (Ptrends < 0.08), Mental Development Index (MDI) (Ptrend < 0.001), and Psychomotor Development Index (PDI) (Ptrend < 0.001) deficits. Although nonexposed children performed poorly, cocaine-exposed children showed worse performance. Both groups showed declines at 18 months in mental and psychomotor development from which only nonexposed children rebounded. Overall, cocaine exposure adds an additional risk to disadvantaged children's development. Cocaine-exposed children are less resilient to effects of these multiple risks.     

Randomized controlled trial of biofeedback for fecal incontinence

BACKGROUND & AIMS: Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care. METHODS: A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry. RESULTS: Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment. CONCLUSIONS: Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education.     

The new histologic classification of chronic rhinosinusitis

Two histologic patterns of disease are found in chronic rhinosinusitis. The first is dominated by eosinophilia and polypoid changes. Glandular hyperplasia and hypertrophy characterize the second. We present the evidence supporting the existence of these two patterns of disease and link these histologic patterns to the larger pathophysiologic processes that drive them. This histologic classification should be acknowledged both in the clinical setting and in laboratory research of chronic rhinosinusitis.     

Mushroom Consumption and Cardiovascular Health: A Systematic Review

IntroductionEdible mushrooms have a great nutritional value including high protein, essential amino acids, fiber, vitamins (B₁, B₂, B₁₂, C, and D), minerals (calcium [Ca], potassium [K], magnesium [Mg], sodium [Na], phosphorus [P], copper [Cu], iron [Fe], manganese [Mn], and selenium [Se]), low fatty foods, and sodium. The objective of this systematic review was to determine the relationship between edible mushroom consumption and overall cardiovascular risk.MethodsWe systematically searched Ovid MEDLINE, Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through August 2020 for observational studies that reported the association between edible mushroom consumption and cardiovascular risk. Two investigators independently reviewed data. Conflicts were resolved through consensus discussion.ResultsOf 1479 studies, we identified 7 prospective studies. Edible mushroom consumption may have favorable effects on lipid profiles by changing some metabolic markers such as low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol, and triglycerides. Moreover, edible mushroom consumption is probably associated with reduced mean blood pressure. The beneficial overall cardiovascular risk, stroke risk, and coronary artery disease of edible mushroom consumption are not consistent.ConclusionsEdible mushroom consumption has not been shown to conclusively affect cardiovascular risk factors to date. However, potential health benefits may exist, including a favorable alteration of lipid profiles and blood pressure reduction.     

Historically‐informed nursing: A transnational case study in China

The term ‘nurse’ (hushi—’caring scholar’) did not enter the Chinese language until the early 20th century. Modern nursing—a fundamentally Western notion popularized by Nightingale and introduced to China in 1884—profoundly changed the way care of the sick was practiced. For 65 years, until 1949, nursing developed in China as a transnational project, with Western and Chinese influences shaping the profession of nursing in ways that linger today. Co‐authored by Chinese, Canadian, and American nurses, this paper examines the early stages of nursing in one province of China as an exemplar of the transnational nature of nursing development. By identifying sociopolitical influences on the early development of nursing in Shandong, the authors aimed not only to contribute to the nascent body of knowledge on China nursing history, but also to heighten readers’ sensitivity to the existence of historical echoes, residue, and resonances in their own nursing practices. Tracing current issues, values, or practices back to their roots provides context and helps us to better understand the present. Whether we are aware of the details or not, the gestalt of nursing practice in a particular place has been shaped by its history—including in Shandong province in China.     

Processing of vestibular inputs by the medullary lateral tegmental field of conscious cats: implications for generation of motion sickness

The dorsolateral reticular formation of the caudal medulla, the lateral tegmental field (LTF), participates in generating vomiting. LTF neurons exhibited complex responses to vestibular stimulation in decerebrate cats, indicating that they received converging inputs from a variety of labyrinthine receptors. Such a convergence pattern of vestibular inputs is appropriate for a brain region that participates in generating motion sickness. Since responses of brainstem neurons to vestibular stimulation can differ between decerebrate and conscious animals, the current study examined the effects of whole-body rotations in vertical planes on the activity of LTF neurons in conscious felines. Wobble stimuli, fixed-amplitude tilts, the direction of which moves around the animal at a constant speed, were used to determine the response vector orientation, and also to ascertain whether neurons had spatial–temporal convergence (STC) behavior (which is due to the convergence of vestibular inputs with different spatial and temporal properties). The proportion of LTF neurons with STC behavior in conscious animals (25 %) was similar to that in decerebrate cats. Far fewer neurons in other regions of the feline brainstem had STC behavior, confirming findings that many LTF neurons receive converging inputs from a variety of labyrinthine receptors. However, responses to vertical plane vestibular stimulation were considerably different in decerebrate and conscious felines for LTF neurons lacking STC behavior. In decerebrate cats, most LTF neurons had graviceptive responses to rotations, similar to those of otolith organ afferents. However, in conscious animals, the response properties were similar to those of semicircular canal afferents. These differences show that higher centers of the brain that are removed during decerebration regulate the labyrinthine inputs relayed to the LTF, either by gating connections in the brainstem or by conveying vestibular inputs directly to the region.     

Aerobic Fitness and the Brain: Increased N-Acetyl-Aspartate and Choline Concentrations in Endurance-Trained Middle-Aged Adults

Engagement in regular aerobic exercise is associated with cognitive benefits, but information on the mechanisms governing these changes in humans is limited. The goal of the current study was to compare neurometabolite concentrations relating to cellular metabolism, structure, and viability in endurance-trained and sedentary middle-aged adults. Twenty-eight endurance-trained and 27 sedentary adults, aged 40–65 years, underwent general health assessment, cardiorespiratory fitness measurement, neuropsychological testing, and proton magnetic resonance spectroscopy (¹H MRS). ¹H MRS was used to examine N-acetyl-aspartate (NAA), creatine (Cr), myo-inositol (mI), choline (Cho), and glutamate (Glu) concentrations in frontal and occipitoparietal grey matter. Group differences in concentrations of NAA, Cho, mI, and Glu, calculated as ratios over Cr, were explored using ANOVA. There were no significant differences in global cognitive function, memory, and executive function performance between the groups. In comparison to sedentary adults, the endurance-trained group displayed significantly higher NAA/Cr in the frontal grey matter (F(1, 53) = 5.367, p = 0.024) and higher Cho/Cr in the occipitoparietal grey matter (F(1, 53) = 5.138, p = 0.028). Within our middle-aged sample, endurance-trained adults demonstrated higher levels of NAA/Cr in the frontal grey matter and higher Cho/Cr in the occipitoparietal grey matter. Higher levels of NAA may indicate greater neuronal integrity and higher cerebral metabolic efficiency in association with cardiorespiratory fitness, whereas increased Cho may represent increased phospholipid levels secondary to neural plasticity.     

Warm Partner Contact Is Related to Lower Cardiovascular Reactivity

Abstract

The authors investigated the relationship between brief warm social and physical contact among cohabitating couples and blood pressure (BP) reactivity to stress in a sample of healthy adults (66 African American, 117 Caucasian; 74 women, 109 men). Prior to stress, the warm contact group underwent a 10-minute period of handholding while viewing a romantic video, followed by a 20-second hug with their partner, while the no contact group rested quietly for 10 minutes and 20 seconds. In response to a public speaking task, individuals receiving prestress partner contact demonstrated lower systolic BP, diastolic BP, and heart rate increases compared with the no contact group. The effects of warm contact were comparable for men and women and were greater for African Americans compared with Caucasians. These findings suggest that affectionate relationships with a supportive partner may contribute to lower reactivity to stressful life events and may partially mediate the benefit of marital support on better cardiovascular health.