The roles of prostaglandins and calcium accumulation in muscular dystrophy

There is good evidence that abnormal calcium accumulation may be a final common pathway of muscle degeneration in the muscular dystrophies. Prostaglandins are able to promote calcium entry into cells and excess prostaglandin activity coupled with a defect in intracellular calcium release could cause toxic accumulations of calcium in intracellular organelles such as mitochondria. Serotonin stimulates prostaglandin synthesis while tricyclic antidepressants inhibit calcium release from intracellular organelles thus possibly accounting for the models of muscular dystrophy reported using this combination. The prostaglandin/calcium hypothesis can account for the effects of vitamin E, steroids and local anaesthetic-like drugs in muscular dystrophy. Since many drugs already in clinical use for other purposes can be used to control prostaglandin synthesis or action this hypothesis has immediate potential clinical applications.     

Mental own-body and body-part transformations in microgravity

The aim of this experiment was to investigate the influence of gravity on the cognitive ability to mentally transform images of bodies or body parts. A total of eight participants were tested in two separate parabolic flight missions. In the main experiment, participants had to make a discrimination judgement (left or right) about pictures of a human figure with one arm outstretched, and pictures of a body part (hand). The stimuli appeared in varying views and orientations. Response times and error rates were measured. In microgravity, the participants showed increased response times overall as well as increased error rates when compared to 1 g for both types of stimuli. Thus, a task that requires the mental transformation of one's own body or body parts becomes more difficult during microgravity. This is in contrast to previous studies showing no effect of microgravity on the mental rotation of abstract 3D objects and to our follow-up case study in which participants applied an object-based mental rotation strategy. Moreover, the analysis of response times suggests that in microgravity body-part stimuli are affected more strongly than body figures.     

Regulation of preproparathyroid hormone messenger RNA and hormone synthesis in human parathyroid adenomata

Preproparathyroid hormone (preproPTH) mRNA and PTH secretion were measured in human parathyroid adenomata (n = 8) cultured in 1.0 or 3.0 mmol calcium/l and compared with changes in bovine parathyroid glands (n = 3) as a control. Incubation of bovine glands in 3.0 mmol calcium/l for 24 h resulted in a fall in mRNA levels to 47.3 +/- 21.7% (mean +/- S.D.) compared with cells incubated in 1.0 mmol calcium/l, with a concomitant decrease in secretion to 62.6 +/- 10.8%. These values fell further to 30.1 +/- 15.5% and 42.1 +/- 18.7% respectively after 48-h incubation. One human adenoma responded to high levels of calcium in a similar manner with mRNA levels falling to 44.6 +/- 11.9% and secretion to 30.3 +/- 17.3% within 24 h. However, in the majority of adenomata (seven out of eight), after 24-h incubation in 3.0 mmol calcium/l, mRNA levels fell to 54.1 +/- 14.6% but there was no change in secretion. In two of these adenomata which were cultured for 48 h, there was no suppression of secretion despite mRNA levels having fallen to approximately 60% of control. Incorporation of [35S]methionine into PTH secreted from human adenomatous cells was quantified by densitometry. There was no difference in the amount of radiolabelled PTH secreted from cells incubated in high levels of calcium compared with those in normal levels of calcium. In similar experiments, the effects of high calcium on the synthesis of PTH in bovine cells was assessed by determination of radiolabelled intracellular PTH.(ABSTRACT TRUNCATED AT 250 WORDS)     

The impact of sleeve gastrectomy on hypertension: a systematic review

Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure associated with an acceptable weight loss and a relatively low morbidity. There is existing evidence suggesting bariatric surgery resolves or improves hypertension. The purpose of this study is to systematically review the effect of LSG on hypertension. An electronic search method was primarily used for identification of the studies. We performed a comprehensive search of all electronic databases (MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, BIOSIS, Previews, TRIP, Web of Science, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database) using broad search terms. All human studies from August 2000 to September 2011 were included. After an initial screening, a total of 326 studies were identified. After assessment of these studies based on our exclusion criteria, 222 studies were considered for the abstract review. A total of 33 studies were identified after a careful screening, involving a total of 3,997 patients. The mean pre-operative body mass index (BMI) was 49.1 ± 7.5 kg/m² (range 37–68). The average follow-up time was 16.9 ± 9.8 months (range 12–48). The mean post-operative BMI was 36 ± 7.0 kg/m² (range 25.6–54). LSG resulted in resolution of hypertension in 58% of patients. On average, 75% of patients experienced resolution or improvement of their hypertension. Based on our systematic review, LSG has a significant effect on hypertension, inducing resolution or improvement in the majority of cases. Therefore, LSG remains a viable surgical option in obese patients with hypertension.     

From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice

Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician’s ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs.     

A retrospective multicenter analysis of elderly Hodgkin lymphoma: outcomes and prognostic factors in the modern era

We investigated a recent (January 1999 to December 2009) cohort of 95 elderly Hodgkin lymphoma subjects. At diagnosis, median age was 67 years (range, 60-89 years), whereas 61% had significant comorbidity, 26% were unfit, 17% had a geriatric syndrome, and 13% had loss of activities of daily living. Overall response rate to therapy was 85%, whereas incidence of bleomycin lung toxicity was 32% (with associated mortality rate, 25%). With 66-month median follow-up, 2-year and 5-year overall survival were 73% and 58%, respectively (advanced-stage, 63% and 46%, respectively). Most International Prognostic Score factors were not prognostic on univariate analyses, whereas Cox multivariate regression identified 2 risk factors associated with inferior overall survival: (1) age more than 70 years (2.24; 95% CI, 1.16-4.33, P = .02) and (2) loss of activities of daily living (2.71; 95% CI, 1.07-6.84, P = .04). Furthermore, a novel survival model based on number of these risk factors (0, 1, or 2) showed differential 2-year OS of 83%, 70%, and 13%, respectively (P < .0001) and 5-year OS of 73%, 51%, and 0%, respectively (P < .0001).     

“iBIM” — Internet-based interactive modules: an easy and interesting learning tool for general surgery residents

Background

The increased use of information technology supports a resident-centred educational approach that promotes autonomy, flexibility and time management and helps residents to assess their competence, promoting self-awareness. We established a web-based e-learning tool to introduce general surgery residents to bariatric surgery and evaluate them to determine the most appropriate implementation strategy for Internet-based interactive modules (iBIM) in surgical teaching.

Methods

Usernames and passwords were assigned to general surgery residents at the University of Alberta. They were directed to the Obesity101 website and prompted to complete a multiple-choice precourse test. Afterwards, they were able to access the interactive modules. Residents could review the course material as often as they wanted before completing a multiple-choice postcourse test and exit survey. We used paired t tests to assess the difference between pre- and postcourse scores.

Results

Out of 34 residents who agreed to participate in the project, 12 completed the project (35.3%). For these 12 residents, the precourse mean score was 50 ± 17.3 and the postcourse mean score was 67 ± 14 (p = 0.020).

Conclusion

Most residents who participated in this study recommended using the iBIMs as a study tool for bariatric surgery. Course evaluation scores suggest this novel approach was successful in transferring knowledge to surgical trainees. Further development of this tool and assessment of implementation strategies will determine how iBIM in bariatric surgery may be integrated into the curriculum.