The Somatotopic Organization Within the Rabbit's Thalamic Reticular Nucleus

The organization of the somatosensory representation within the rabbit's thalamic reticular nucleus (TRN) was studied. Focal injections of horseradish peroxidase (HRP), wheatgerm agglutinin conjugated to HRP, or [³H]proline were made into somatosensory cortical area 1 (S1). The resultant labelling in the thalamus was analysed. Single injections into S1 result in single zones of terminal labelling in TRN that are restricted to the centroventral part of the sheet-like nucleus. In reconstructions from horizontal sections these zones of labelling resemble 'slabs', which lie in the plane of the nucleus parallel to its borders, occupy only a fraction of the thickness of the reticular sheet, and are elongated in the dorsoventral and oblique rostrocaudal dimensions. Thus, the slabs of S1 terminals, which represent various loci of the body surface, and the main distribution of the reticular dendrites have a similar orientation. In comparisons of the zones of labelling following single or double injections at different cortical sites in S1, an inner (medial) to outer (lateral) shift in labelling in the ventrobasal complex (VB) is accompanied by an inner (medial) to outer (lateral) shift in labelling along the thickness of the reticular sheet; a rostral to caudal shift in labelling in VB is accompanied by a rostral to caudal shift in labelling along the plane of the reticular sheet. Thus, like VB, the reticular nucleus receives a topographically accurate projection from S1. Further, the somatotopic map conveyed from S1 to TRN lies perpendicular to the plane of the nucleus and repeats the spatial organization of the map in VB. These findings, together with those for the visual sector of the rabbit's TRN, indicate that the representation of the cortical sheet is broken up into significant parcels at the inner and outer borders of the reticular sheet.     

Lung bullae and pulmonary fibrosis associated with marijuana smoking

A 26‐year‐old man with a history of heavy marijuana and minimal tobacco use was found to have extensive bilateral lung bullae and interstitial fibrosis, heavily infiltrated by pigmented macrophages. These features can be associated with marijuana smoking. The differential diagnoses in this patient are also discussed.     

Home Blood Pressure Monitoring: An Integrated Review of the Literature

Home blood pressure monitoring (HBPM) is a self-management tool that advanced practice nurses can incorporate into care for patients with hypertension. Evidence supports the benefits of patient HBPM compared to office-based monitoring by providers alone. HBPM is a method for patients to partner with providers with their self-care management. The goals of incorporating HBPM into practice include improving quality and outcomes and controlling costs. HBPM interventions include team-based care, patient education and self-management skills, and evidence-based guidelines, concepts that are consistent with Wagner’s Chronic Care Model. HBPM should be considered as policy guideline for hypertensive patients.     

Impact of UK National Guidelines based on FRAX®– comparison with current clinical practice

Objective To assess whether clinician‐determined treatment intervention thresholds are in line with the assessment of fracture risk provided by FRAX^® and treatment recommendations provided by UK guidelines produced by the National Osteoporosis Guidelines Group (NOGG). Design, Patients and Measurements This was a retrospective cohort analysis of 288 patients consecutively referred for dual‐energy X‐ray absorptiometry (DXA) scanning from primary care immediately prior to the introduction of the FRAX^® algorithm. In addition to DXA assessment, patients completed a clinical risk factor questionnaire which included risk factors used in the FRAX^® algorithm. Initial risk assessment and treatment decisions were performed after DXA. FRAX^® was used, retrospectively, with femoral neck T‐score, to estimate fracture risk which was applied to NOGG to generate guidance on treatment intervention. Clinician‐ and NOGG‐determined outcomes were audited for concordance. Results There was concordance between clinician and NOGG treatment decisions in 215 (74·6%) subjects. Discordance was observed in 73 (25·3%) subjects. In the discordant group, seven subjects were given lifestyle advice when NOGG recommended treatment, 42 given treatment when NOGG recommended lifestyle advice only, and 24 were referred to a metabolic bone clinic for further evaluation. The reasons for treatment differences in subjects recommended treatment by clinician but not NOGG were largely (90·2%) attributed to the use of lumbar spine bone mineral density (BMD). Conclusions There is high concordance between clinician‐determined and FRAX^®‐NOGG intervention. The absence of spine BMD from FRAX^® is the primary source of discrepancy. This study provides some assurance of the validity of the treatment thresholds generated from FRAX^®‐NOGG in ‘real‐world’ usage.