Ultrasonography of a Helical Left Common Carotid Artery

Case Presentation: An 83-year-old woman was admitted to the intensive care unit for septic shock at which point an internal jugular central venous line was placed. The patient’s common carotid artery was visualized in an atypical location, lateral to the internal jugular vein. Further inspection revealed the common carotid artery travelling in a rotational trajectory around the internal jugular vein.Discussion: For at least two decades, point-of-care ultrasound has become the standard of care for placing central venous lines. This surprising anatomical orientation is rare and cautions physicians to fully explore a patient’s anatomy prior to placing central lines

Neuronal control of sleep in Caenorhabditis elegans

Sleep is crucial for all organisms with a nervous system. Amongst other functions, it is required for energy allocation, higher brain functions and the control of physiological processes. Sleep-active neurons have previously been identified in many species. These neurons act as the motor of sleep as their depolarization causes inhibition of wakefulness circuits and leads to sleep induction. However, how these sleep-active neurons get regulated and how exactly they are involved in molecular pathways for the benefits of sleep remains unclear. In this study I focused on the neuronal component of sleep regulation in the model organism Caenorhabditis elegans. In C. elegans the ring interneuron RIS functions as single sleep active neuron. First, I aimed to identify a neuronal circuit that regulates RIS activity. I found that RIS is controlled by the command interneuron PVC through a positive feedback loop. The interneurons PVC and RIM act together to activate RIS and sleep is most likely induced at the transition from forward to reverse locomotion. While RIS activity and hence sleep gets regulated by the nervous system, I could also show through pan-neuronal imaging that the control is reciprocal and RIS depolarization directly inhibits nervous system activity. Next, I intended to design a stand-alone device for optogenetic long-term experiments: the OptoGenBox. Optogenetics is a method in which through genetically knocked-in actuators and light, for instance, individual neurons can get de- or hyperpolarized. Implementation of the OptoGenBox was successful and I could show that long-term optogenetic sleep inhibition by hyperpolarization of RIS leads to a reduced longevity of arrested first larval stage worms. Lastly, I investigated the functions of sleep in C. elegans. Selected health span assays and investigation of synaptic changes did not reveal further functions of sleep. To better assess sleep benefits, strains, in which RIS was either constantly de- or hyperpolarized through genetically knocked-in ion channels, were generated and characterized. Constant de- as well as hyperpolarization of RIS led to a reduction in sleep but diverging longevity effects in the arrested first larval stage. In conclusion, sleep in C. elegans is highly controlled by the nervous system and sleep induction is not only dependent on sleep-active neurons but furthermore wake-active circuits that activate sleep neurons. As sleep is evolutionary conserved, these circuits are most likely also existent in organisms with more complex nervous systems such as mammals. The OptoGenBox as well as the here presented new RIS manipulated worm strains present potent tools to further investigate neuronal circuits and protective pathways downstream of the sleep neuron RIS.2021-10-2

The Financial Dialogue in the Development of Medical Treatment Plans

As patients face increasingly high out-of-pocket costs and difficulties navigating the healthcare system, failing to discuss available treatment options in financial terms can lead to grave consequences for patients. Medical bills are responsible for the majority of bankruptcies in the United States. Given the severe financial implications of medical bills, it is imperative that patients become more involved in discussions of their treatment plans and become aware of the costs of their decisions up front. Counseling about costs ensures that physicians avoid placing a debilitating financial burden on patients and maintain adherence to the ethical principle of non-maleficence. Various studies have shown that physicians lack proper education in health economics, which makes navigation of this aspect of healthcare daunting. Finding a place for teaching economics and health policy has been difficult given the necessity to deliver a voluminous amount of scientific content during medical education. Nevertheless, physicians function as part of a healthcare industry that is not immune from the economic principles that govern commerce in any other service business. We suggest incorporation of customer service techniques from other business settings into the traditional practice of humanistic medicine in order to facilitate cost discussion and improve patient understanding. A physician’s job is to educate the patient about potential plans of action to solve his/her problem, and costs represent key pieces of information for optimizing treatment plans. In the end, it is the patient who is entitled to decide what is best, or, in other words, the customer is always right

Experimental designs for testing differences in survival among salmonid populations

The Yakima Fisheries Project (YFP) is a supplementation plan for enhancing salmon runs in the Yakima River basin. It is presumed that inadequate spawning and rearing, habitat are limiting, factors to population abundance of spring chinook salmon. Therefore, the supplementation effort for spring chinook salmon is focused on introducing hatchery-raised smolts into the basin to compensate for the lack of spawning habitat. However, based on empirical evidence in the Yakima basin, hatchery-reared salmon have survived poorly compared to wild salmon. Therefore, the YFP has proposed to alter the optimal conventional treatment (OCT), which is the state-of-the-art hatchery rearing method, to a new innovative treatment (NIT). The NIT is intended to produce hatchery fish that mimic wild fish and thereby to enhance their survival over that of OCT fish. A limited application of the NIT (LNIT) has also been proposed to reduce the cost of applying the new treatment, yet retain the benefits of increased survival. This research was conducted to test whether the uncertainty using the experimental design was within the limits specified by the Planning Status Report (PSR)

The Maghreb – one more important biodiversity hot spot for tiger beetle fauna (Coleoptera, Carabidae, Cicindelinae) in the Mediterranean region

The tiger beetle fauna of the Maghreb region is one of the richest in the Palaearctic, including 22 species and 5 subspecies and 19% of all Palaearctic species of Cicindelinae. Assembled by their chorotypes, the Maghreb tiger beetles fall into eight different groups that include Maghreb endemics (26% of fauna), Mediterranean (7%), West Mediterranean (40%), North African (4%), Mediterranean-Westturanian (4%), West Palaearctic (4%), Afrotropico-Indo-Mediterranean (4%), and Saharian (11%) species. The Mediterranean Sclerophyl and Atlas Steppe are the Maghreb biogeographical provinces with the highest species richness, while the Sahara Desert has the lowest Cicindelinae diversity. Twenty-five cicindelid species and subspecies (93% of Maghreb fauna) are restricted to only one or two habitat types in lowland areas. Only Calomera littoralis littoralis and Lophyra flexuosa flexuosa are recognized as eurytopic species and occur in three types of habitat. The highest tiger beetle diversity characterizes salt marshes and river banks (in both cases 11 species and subspecies or 41% of Maghreb fauna). Approximately 85% of all Maghreb tiger beetle species and subspecies are found in habitats potentially endangered by human activity