The Psychiatry Milestones 2.0: How Did We Get from 1.0 to 2.0 and What Can Users Expect?

Graduate medical education (GME) in psychiatry, like other medical specialties, has been transitioning to competency-based training and assessment. Competency-based medical education was born from a desire to certify physicians based on training outcomes, rather than training inputs such as the amount of time one spends in training [1]. The transition to a focus on training outcomes has been at least 25 years in the makin

Motor cortical excitability and pre-supplementary motor area neurochemistry in healthy adults with substantia nigra hyperechogenicity

Substantia nigra (SN) hyperechogenicity, viewed with transcranial ultrasound, is a risk marker for Parkinson\u27s disease. We hypothesized that SN hyperechogenicity in healthy adults aged 50 – 70 years is associated with reduced short-interval intracortical inhibition in primary motor cortex, and that the reduced intracortical inhibition is associated with neurochemical markers of activity in the pre-supplementary motor area (pre-SMA). Short-interval intracortical inhibition and intracortical facilitation in primary motor cortex was assessed with paired-pulse transcranial magnetic stimulation in 23 healthy adults with normal (n = 14; 61 ± 7 yrs) or abnormally enlarged (hyperechogenic; n = 9; 60 ± 6 yrs) area of SN echogenicity. Thirteen of these participants (7 SN − and 6 SN+) also underwent brain magnetic resonance spectroscopy to investigate pre-SMA neurochemistry. There was no relationship between area of SN echogenicity and short-interval intracortical inhibition in the ipsilateral primary motor cortex. There was a significant positive relationship, however, between area of echogenicity in the right SN and the magnitude of intracortical facilitation in the right (ipsilateral) primary motor cortex (p = .005; multivariate regression), evidenced by the amplitude of the conditioned motor evoked potential (MEP) at the 10 – 12 ms interstimulus interval. This relationship was not present on the left side. Pre-SMA glutamate did not predict primary motor cortex inhibition or facilitation. The results suggest that SN hyperechogenicity in healthy older adults may be associated with changes in excitability of motor cortical circuitry. The results advance understanding of brain changes in healthy older adults at risk of Parkinson\u27s disease

Pathways to Injury in Chronic Pancreatitis: Decoding the Role of the High-Risk SPINK1 N34S Haplotype Using Meta-Analysis

Background: The complex interactions between recurrent trypsin-mediated pancreatic injury, alcohol-associated pancreatic injury and SPINK1 polymorphisms in chronic pancreatitis (CP) are undefined. We hypothesize that CP occurs as a result of multiple pathological mechanisms (pathways) that are initiated by different metabolic or environmental factors (etiologies) and may be influenced differentially by downstream genetic risk factors. We tested this hypothesis by evaluating the differences in effect size of the high risk SPINK1 N34S haplotype on CP from multiple etiologies after combining clinical reports of SPINK1 N34S frequency using meta-analysis. Methods and Findings: The Pubmed and the Embase databases were reviewed. We studied 24 reports of SPINK1 N34S in CP (2,421 cases, 4,857 controls) using reported etiological factors as surrogates for pathways and multiple meta-analyses to determine the differential effects of SPINK1 N34S between alcoholic and non-alcoholic etiologies. Using estimates of between-study heterogeneity, we sub-classified our 24 studies into four specific clusters. We found that SPINK1 N34S is strongly associated with CP overall (OR 11.00; 95% CI: 7.59-15.93), but the effect of SPINK1 N34S in alcoholic CP (OR 4.98, 95% CI: 3.16-7.85) was significantly smaller than in idiopathic CP (OR 14.97, 95% C.I. = 9.09-24.67) or tropical CP (OR 19.15, 95% C.I. = 8.83-41.56). Studies analyzing familial CP showed very high heterogeneity suggestive of a complex etiology with an I2 = 80.95%. Conclusion: The small effect of SPINK1 N34S in alcoholic subjects suggests that CP is driven through a different pathway that is largely trypsin-independent. The results also suggest that large effect sizes of SPINK1 N34S in small candidate gene studies in CP may be related to a mixture of multiple etiologic pathways leading to the same clinical endpoint. © 2008 Aoun MD et al

Effectiveness of blood flow restriction combined with low load resistance training on quadriceps muscle after knee conditions : systematic review

Purpose/Background: Quadriceps strengthening is considered as a major key in rehabilitation and in preventive protocol for knee conditions. Blood flow restriction (BFR) is based on brief periods of vascular occlusion which improve muscle strength and increase hypertrophy. The purpose of this review was to show the ef-fectiveness of BFR combined with low-load (LL) resistance training on quadriceps muscle after knee injuries when compared to the conventional protocol using 30% or 70% of one repetition maximum (1RM). Methods: A systematic review was realized to identify relevant studies through the databases PubMed, PEJI0Dro, and ScienceDirect from the earliest record up to March 2017. Data including study selection, clinical population characteristics, and rehabilitation protocol and outcome measures were extracted. Study quality and re-porting was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Results: Six studies were included. Concerning knee extensor strength, two studies detected a significant improvements comparing to the conventional group using 30% of 1RM. According to muscle thickness, no studies showed a significant changes except for one study. Regarding the outcomes measures related to both knee pain and functional capacities, three studies presented improvements compar-ing to the control group. Conclusion: Compared to the conventional protocol using 30% of 1RM, LL-BFR showed the same or some improvements in muscle thickness, muscle strength, knee pain and knee function. LL-BFR protocol is considered as a safety alternative for heavy load resistance training for knee conditions in early rehabilitation.Master [60] en kinésithérapie et réadaptation, Université catholique de Louvain, 201

Bladder cancer immunotherapy: Swinging for the fences

SCOPUS: ed.jinfo:eu-repo/semantics/publishe

Unusual cause of upper gastrointestinal bleed, when ogd could be fatal

A 57-year-old man presented with chest pain, dyspnoea and coffee grounds emesis. He was haemodynamically stable without significant drop in haemoglobin. He suddenly developed cardiac arrest with wide complex tachycardia and became comatose. CT scan of the head revealed pneumocephalus and multiple infarcts. Given the recent history of radiofrequency ablation for atrial fibrillation, atrio-oesophageal fistula (AOF) was suspected. CT angiography of the thorax showed a 5 mm diverticulum on the posterior wall of the left atrium, also raising suspicion for AOF. The patient was taken to the operating room. An AOF was found and repaired. He did not have any further gastrointestinal bleeding. There was no neurological recovery at day 11 and life support was withdrawn per his family\u27s request. This case highlights the importance of obtaining history of recent cardiac procedures in patients presenting with an upper gastrointestinal bleed. An oesophagogastroduodenoscopy in this patient could have been instantaneously deadly

Intense pruritus in Epstein-Barr virus (EBV) hepatitis treated with naloxone drip

© Copyright 2015 BMJ Publishing Group. All rights reserved. Pruritus is a manifestation of chronic liver disease. Epstein-Barr virus (EBV) infection often presents as infectious mononucleosis and mild hepatitis. Severe pruritus in the setting of infectious mononucleosis and persistent marked hyperbilirubinaemia is exceedingly uncommon. To the best of our knowledge, we present the first case of a patient with EBV hepatitis and severe pruritus that was successfully treated with an ultra-low dose of intravenous naltraxone

Personalized treatment of prostate cancer: Better knowledge of the patient, the disease and the medicine

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Biliary stent migration presenting with leg pain.

Although the therapeutic benefits of endoscopic retrograde cholangiopancreatography (ERCP) usually outweigh the risks, there can be rare complications, including stent migration leading to perforation, intestinal obstruction or penetration. An 87-year-old woman presented with symptomatic choledocholithiasis. Two previous endoscopic attempts at stone removal were unsuccessful. On repeat ERCP at our institution, multiple large stones were removed, but complete duct clearance could not be achieved. A plastic biliary stent was placed with plans to reattempt in 6 weeks. Postoperatively, she had mild back pain radiating into her right leg that gradually worsened to the point where she was unable to ambulate. An abdominal CT scan showed the distal aspect of the biliary stent extending through the wall of the duodenum with the tip positioned within the right psoas muscle. The stent was successfully removed via a rat-toothed forceps. Our case illustrates an extremely rare complication of biliary stent placement