Review of simulation model for education of point-of-care ultrasound using easy-to-make tools

Point-of-care ultrasound (POCUS) is a powerful diagnostic tool and provides treatment guidelines in acute critical settings. However, the limitation of using POCUS is operator dependent. Appropriate and validated training for acquiring and using skills in practice must be conducted before using POCUS in clinical settings in order to keep patients safe. Simulation education models have been introduced as a way to solve and overcome these concerns. However, the commercial simulator with sufficiently secured fidelity is expensive and not always available. This review focused on the inexpensive and easily made simulators for education on POCUS in critical specific situations related to the airway, breathing, circulation, and disability. We introduced the simulators that used non-infectious materials, with easily transportable features, and that had a sonographic appearance reproducibility similar to human tissue. We also introduced the recipe of each simulator in two parts: Materials surrounding disease simulators (surrounding materials) and specific disease simulators themselves (target simulators). This review article covered the following: endotracheal or oesophageal intubation, lung (A-lines, B-lines, lung sliding, and pleural effusions such as hemothorax), central vein access, pericardial fluid (cardiac tamponade), the structure related to the eyes, soft tissue abscess, nerve (regional nerve block), and skull fracture simulators.     

Clinical Outcomes after Spinal Cord Stimulation According to Pain Characteristics

ObjectiveSpinal cord stimulation (SCS) is an effective treatment for chronic neuropathic pain. However, its clinical efficacy in regard to specific types of pain has not been well studied. The primary objective of this study was to retrospectively analyze the clinical outcomes of paddle-type SCS according to the type of neuropathic pain. MethodsSeventeen patients who underwent paddle-lead SCS at our hospital were examined. Clinical outcomes were evaluated pre- and postoperatively (3 months, 1 year, and last follow-up) using the Neuropathic Pain Symptom Inventory (NPSI). The NPSI categorizes pain as superficial, deep, paroxysmal, evoked, or dysesthesia and assess the duration of the pain (pain time score). Changes in NPSI scores were compared with change in Visual analogue scale (VAS) scores. ResultsAfter SCS, the pain time score improved by 45% (independent t-test, p=0.0002) and the deep pain score improved by 58% (independent t-test, p=0.001). Improvements in the pain time score significantly correlated with improvements in the VAS score (r=0.667, p=0.003, Spearman correlation). Additionally, the morphine milligram equivalent value was markedly lower after vs. before surgery (~49 mg, pared t-test, p=0.002). No preoperative value was associated with clinical outcome. ConclusionThe NPSI is a useful tool for evaluating the therapeutic effects of SCS. Chronic use of a paddle-type spinal cord stimulation improved the deep pain and the pain time scores.     

Vimentin intermediate filaments and filamentous actin form unexpected interpenetrating networks that redefine the cell cortex

The cytoskeleton of eukaryotic cells is primarily composed of networks of filamentous proteins, F-actin, microtubules, and intermediate filaments. Interactions among the cytoskeletal components are important in determining cell structure and in regulating cell functions. For example, F-actin and microtubules work together to control cell shape and polarity, while the subcellular organization and transport of vimentin intermediate filament (VIF) networks depend on their interactions with microtubules. However, it is generally thought that F-actin and VIFs form two coexisting but separate networks that are independent due to observed differences in their spatial distribution and functions. In this paper, we present a closer investigation of both the structural and functional interplay between the F-actin and VIF cytoskeletal networks. We characterize the structure of VIFs and F-actin networks within the cell cortex using structured illumination microscopy and cryo-electron tomography. We find that VIFs and F-actin form an interpenetrating network (IPN) with interactions at multiple length scales, and VIFs are integral components of F-actin stress fibers. From measurements of recovery of cell contractility after transient stretching, we find that the IPN structure results in enhanced contractile forces and contributes to cell resilience. Studies of reconstituted networks and dynamic measurements in cells suggest direct and specific associations between VIFs and F-actin. From these results, we conclude that VIFs and F-actin work synergistically, both in their structure and in their function. These results profoundly alter our understanding of the contributions of the components of the cytoskeleton, particularly the interactions between intermediate filaments and F-actin.

The cytoskeleton is a highly dynamic structure composed of multiple types of filamentous proteins. In eukaryotic cells, actin, microtubules, and intermediate filaments (IFs) each form intricate networks of entangled and cross-linked filaments. The organization of each individual network is precisely controlled to enable essential cellular functions. However, many core processes also require interactions among the different cytoskeletal components. For example, filamentous-actin (F-actin) and microtubules work together to control cell shape and polarity, which are critical for development, cell migration, and division. Close associations between microtubules and vimentin IFs (VIFs) have also been proposed based on similarities in their spatial distributions and the dependence of the organization of VIF networks on the microtubule-associated motors, kinesin and dynein (1–3). Indeed, there is some experimental evidence that microtubules can template VIF assembly and that VIFs can guide microtubules (4, 5), while VIFs stabilize microtubules in vitro (6). In addition, in stratified epithelial cells, a subplasmalemmal rim of keratin IFs can be localized just below the actin cortex, suggesting cooperativity of keratin and actin networks in regulating cell mechanics (7). Despite such interactions, VIFs and F-actin are generally thought to form two coexisting but separate networks. For example, fluorescence microscopy typically reveals the strongest signals for F-actin in the cell periphery, whereas the strongest signals for VIFs are near the nucleus in the bulk cytoplasm, suggesting that the two networks have little or no interaction. Furthermore, the functions of F-actin and VIFs appear to be largely contrasting: F-actin generates forces, whereas VIFs provide stability against these forces. Nevertheless, some evidence suggests there may be connections between vimentin and actin: for example, vimentin knockout cells are less motile and less contractile than their wild-type (WT) counterparts (8). Furthermore, some interactions have been observed between F-actin and VIFs (9–11) as well as the precursors to keratin, another IF system (12). These findings suggest that direct interactions or connections may exist between VIFs and F-actin. However, there have been no reports of direct observations of these interactions through imaging or other means, which would provide conclusive evidence of their significance. Such connections would belie our current understanding of the two independent cytoskeletal networks but could have a profound effect on the mechanical properties of cells. The possibility of such connections demands a closer investigation of both the structural and functional interplay between the F-actin and VIF cytoskeletal networks.Here we present evidence that VIFs and F-actin do work synergistically and form an interpenetrating network (IPN) structure within the cell cortex, defined as the cortical cytoplasm adjacent to the cell surface. We combine high-resolution structured illumination microscopy (SIM) and cryo-electron tomography (cryo-ET) to image mouse embryonic fibroblasts (MEFs) and observe coupling between F-actin and VIF structures within the cortex, contrary to the widely accepted view that they are each spatially segregated. In fact, the association of VIFs with cortical arrays of F-actin stress fibers occurs at multiple length scales. For example, VIFs run through and frequently appear to interconnect with adjacent stress fibers, forming meshworks that surround them. These organizational states are consistent with the formation of an IPN. We show that this IPN structure has important functional consequences in cells and can result in enhanced contractile forces. Moreover, our results indicate that specific associations exist between actin and vimentin proteins in the cytoplasmic environment, which may facilitate the formation of an IPN; the results also show that the VIF network can influence the diffusive behavior of actin monomers, which may, in turn, have downstream effects on other actin-driven processes. Thus, vimentin has a far more comprehensive role in cellular function than previously thought. These findings confirm the importance of the interplay between VIFs and F-actin, especially as it relates to the formation of IPNs and their consequences on the contractile nature of cells.     

High Protein Diet Feeding Aggravates Hyperaminoacidemia in Mice Deficient in Proglucagon-Derived Peptides

(1) Background: Protein stimulates the secretion of glucagon (GCG), which can affect glucose metabolism. This study aimed to analyze the metabolic effect of a high-protein diet (HPD) in the presence or absence of proglucagon-derived peptides, including GCG and GLP-1. (2) Methods: The response to HPD feeding for 7 days was analyzed in mice deficient in proglucagon-derived peptides (GCGKO). (3) Results: In both control and GCGKO mice, food intake and body weight decreased with HPD and intestinal expression of Pepck increased. HPD also decreased plasma FGF21 levels, regardless of the presence of proglucagon-derived peptides. In control mice, HPD increased the hepatic expression of enzymes involved in amino acid metabolism without the elevation of plasma amino acid levels, except branched-chain amino acids. On the other hand, HPD-induced changes in the hepatic gene expression were attenuated in GCGKO mice, resulting in marked hyperaminoacidemia with lower blood glucose levels; the plasma concentration of glutamine exceeded that of glucose in HPD-fed GCGKO mice. (4) Conclusions: Increased plasma amino acid levels are a common feature in animal models with blocked GCG activity, and our results underscore that GCG plays essential roles in the homeostasis of amino acid metabolism in response to altered protein intake.     

Seven‐action approaches for the management of hypertension in Asia – The HOPE Asia network

Asia is a large continent and there is significant diversity between countries and regions. Over the last 30 years, absolute blood pressure (BP) levels in Asia have increased to a greater extent than those in other regions. In diverse Asia‐Pacific populations, for choosing an Asia‐specific approach to hypertension management is important to prevent target organ damage and cardiovascular diseases. In this consensus document of HOPE Asia Network, we introduce seven action approaches for management of hypertension in Asia.     

Higher food literacy scores are associated with healthier diet quality in children and adolescents: the development and validation of a two-dimensional food literacy measurement tool for children and adolescents

BACKGROUND/OBJECTIVESMost child and adolescent food literacy measurement tools focus on nutrition and food safety. However, the importance of aspects related to the food system such as food distribution and food waste and their effects on environmental sustainability is growing. We therefore developed and validated a two-dimensional tool for children (8–12 years old) and adolescents (13–18 years old) that can comprehensively measure food literacy. The association of food literacy with diet quality and self-reported health was assessed.SUBJECTS/METHODSFirst, we developed a food literacy conceptual framework that contains food system and literacy dimensions through a literature review, focus group interviews, and expert review. After a face validity study, we conducted the main survey (n = 200) to validate the questionnaire. Construct validity and reliability were assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Cronbach''s alpha.RESULTSAs a result of the Delphi study, content validity was confirmed for the remaining 30 items after two items were excluded (content validity ratio = 0.86). Eleven items were excluded from the EFA results, while the CFA results indicated appropriate fit indices for the proposed model (comparative fit index = 0.904, root mean square error of approximation = 0.068). The final food literacy questionnaire consisted of 19 questions and comprised 5 factors: production, distribution, selection, preparation and cooking, and intake. Food literacy was positively associated with diet quality, as assessed by the Nutrition Quotient score, in both children and adolescents and with self-reported health in adolescents.CONCLUSIONSBased on this integrated conceptual framework, a two-dimensional 19-item food literacy measurement tool was developed and verified for practical use to improve the diet quality and food-related environmental sustainability awareness of children and adolescents.     

Workplace foodservice meals are associated with higher nutritional quality among adult Korean workers: a nationwide cross-sectional study

BACKGROUND/OBJECTIVESAdequate nutritional intake is essential for good health and well-being. We aimed to compare the nutrient intake from homemade meals, meals sourced externally (“eating out”), and meals from workplace foodservices, as well as the potential association between foodservices used and nutritional quality among adult Korean workers.SUBJECTS/METHODSWe used data from the Korea National Health and Nutrition Examination Survey, a nationwide cross-sectional survey on the health and nutritional status of the Korean population. Data from 6,845 workers aged 20–64 years were included. A survey on dietary behavior and nutrition was conducted using the 24-h dietary recall method. Nutritional quality was examined using the index of nutritional quality (INQ) score. Higher INQ scores reflected poorer nutritional quality, with insufficient intake of a higher number of nutrients. Multivariate linear regression was used to identify the association between the foodservices used and INQ scores after adjusting for other covariates.RESULTSWe found that foodservice users exhibited a higher 1-day intake of total energy and macronutrients (all P < 0.05) and lower INQ scores (P < 0.01) than non-users. The INQ scores for total daily meals decreased with the frequency of foodservice use (P < 0.01). A significant association was observed between the non-use of foodservices and INQ scores (β = 0.29, P < 0.01) after adjusting for other covariates.CONCLUSIONSThe use of workplace foodservices contributed to higher dietary nutritional quality among workers. This study highlights the importance of expanding the scope of workplace foodservices to promote higher nutritional quality and healthy dietary habits among workers.     

Comparison of patency of single and sequential radial artery grafting in coronary artery bypass

Open in a separate window OBJECTIVESSequential radial artery (RA) grafting has the potential to enhance arterial revascularization compared to single grafting. Sequential RA grafting was performed predominantly with a single side-to-side anastomosis. The study aimed to assess if sequential RA grafting improved long-term graft patency compared to single RA grafting. In addition, the anastomotic patencies of side-to-side and end-to-side anastomoses in sequential RA grafting were assessed.METHODSTwo hundred nineteen patients underwent isolated coronary artery bypass grafting with skeletonized RA conduits between 2005 and 2016. Of these, 208 patients underwent radiological graft assessment; thus, 125 and 83 patients underwent single and sequential RA grafting, respectively. The graft and anastomotic patency rates were estimated using the Kaplan–Meier method.RESULTSThe median follow-up period was 9.1 years, and the radiological assessment lasted 5.1 years. The overall RA graft patency rates at 1, 5 and 10 years were 99.4%, 92.7% and 88.1%, respectively. The RA graft patency rate for sequential grafting was similar to that for single grafting (88.7% vs 87.4% at 10 years; P = 0.88). In the stratified analysis of anastomotic patency, the patency rate of side-to-side anastomoses of sequential RA grafting was significantly better than that of end-to-side anastomoses (100% vs 88.7% at 10 years; P = 0.01).CONCLUSIONSThe long-term RA graft patencies of sequential and single grafting were equally high. The anastomotic patency of side-to-side anastomoses of sequential RA grafting was remarkably high. Considering these findings, the RA can be effectively used for multiple arterial coronary revascularizations.     

Cytomegalovirus (CMV) antigenaemia for rapid diagnosis and monitoring of CMV-associated disease after bone marrow transplantation

A technique for the rapid detection of cytomegalovirus (CMV) antigen-positive blood leucocytes (CMV antigenaemia) was evaluated in 15 marrow transplant patients as a means of diagnosis and for monitoring CMV-associated disease. CMV antigenaemia was determined by direct immunoperoxidase staining of leucocytes with a peroxidase-labelled monoclonal antibody, HRP-C7, which binds an immediate-early antigen of human CMV.
CMV antigenaemia occurred in 7/15 marrow transplant patients (47%) and was initially detected between 4 and 6 weeks after transplantation. CMV-associated diseases developed in 3/15 patients (20%). All patients with CMV-associated disease had a relatively large number of CMV antigen-positive leucocytes, exceeding 10 per 50000 white blood cells (WBCs). In the remaining 12 patients, CMV antigen-positive leucocytes were less than 10 per 50000 WBCs or were undetectable. CMV-associated disease did not develop in these patients during the period of monitoring. CMV antigen-positive leucocytes were detected more frequently in patients who developed acute graft-versus-host disease (GVHD) or haemorrhagic cystitis than in those without such complications. CMV antigens were detectable from 1 to 4 weeks before the onset of CMV-associated disease which allowed initiation of ganciclovir treatment at an early stage. The degree of CMV antigenaemia paralleled the clinical symptoms and signs, higher degrees of antigenaemia being associated with more significant disease. Thus, the detection of CMV antigen-positive blood leucocytes is useful for the diagnosis and monitoring of CMV-associated disease following bone marrow transplantation.     

Pharmacological analysis of positive chronotropic and inotropic responses to etilefrine in isolated dog heart preparations

Summary Positive chronotropic and inotropic responses to etilefrine (-[(ethylamino)methyl]-m-hydroxybenzyl alcohol), an orally active cardiovascular agent, were investigated in isolated dog right atrial and left ventricular preparations. Intravenous administration of etilefrine to a support dog increased heart rate and mean systemic blood pressure, and increased sinus rate and atrial contractile force in the isolated right atrium perfused with blood from the support dog. Etilefrine injected intra-arterially to isolated atria and ventricles induced dose-dependent positive chronotropic and inotropic effects. Etilefrine was about 100 times less potent than isoproterenol. The effects of etilefrine in isolated atria were significantly inhibited by treatment with atenolol, but were not significantly inhibited by ICI 118,551. The effects of etilefrine were partially inhibited by imipramine. These results indicate that etilefrine is a highly selective -1 adrenoceptor agonist and suggest a moderate catecholamine-releasing activity by tyramine-like action in the blood-perfused dog heart.