Spot diagnosis

Question 1: A 52 year old lady with type 2 diabetes mellitus and recurrent acne noted to have these skin and nail changes during a clinic visit. Question 2: A 70 year old man presented with an acute onset of elbow pain and swelling

Physiological roles for ecto-5’-nucleotidase (CD73)

Nucleotides and nucleosides influence nearly every aspect of physiology and pathophysiology. Extracellular nucleotides are metabolized through regulated phosphohydrolysis by a series of ecto-nucleotidases. The formation of extracellular adenosine from adenosine 5’-monophosphate is accomplished primarily through ecto-5’-nucleotidase (CD73), a glycosyl phosphatidylinositol-linked membrane protein found on the surface of a variety of cell types. Recent in vivo studies implicating CD73 in a number of tissue protective mechanisms have provided new insight into its regulation and function and have generated considerable interest. Here, we review contributions of CD73 to cell and tissue stress responses, with a particular emphasis on physiologic responses to regulated CD73 expression and function, as well as new findings utilizing Cd73-deficient animals

Systems and Complexity Thinking to Master Leadership Challenges in Interprofessional Health Professionals Education

The purpose of this article is to propose that knowledge, understanding, and application of systems and complexity thinking can improve assessment, implementation, and evaluation of interprofessional education (IPE). Using a case story, the authors describe and explain a meta-model of systems and complexity thinking to support leaders in implementing and evaluating IPE initiatives. The meta-model incorporates the use of several important, interrelated frameworks that tackle issues of sense making, systems, and complexity thinking as well as polarity management at different levels of scale in an organization. Combined, these theories and frameworks support recognition and management of cross-scale interactions and help leaders make sense of distinctions among simple, complicated, complex, and chaotic situations among IPE issues associated with healthcare disciplines within institutions. The application and use of Liberating Structures and polarity management practices enable leaders to engage people and gain insight into the complexities involved in successful implementation of IPE programs

Age-associated shifts in cardiac gene transcription and transcriptional responses to ischemic stress

Aged hearts exhibit reduced tolerance to ischemia-reperfusion, together with altered structure and post-ischemic remodelling. The molecular bases of such changes are unclear. Using cDNA microarrays and quantitative RT-PCR we characterized shifts in gene expression patterns with aging in normoxic and post-ischemic (20 min global ischemia, 60 min reperfusion) murine hearts (young: 2–4 months; aged: 16–18 months). We identified an age-associated up-regulation of transcripts involved in cell death, oxygen transport and metabolism in normoxic hearts. Down-regulated transcripts were involved in transporter activity, protein binding and hydrolase activity, changes in MAPK, WNT and TGF-β signalling with aging were also observed. Ischemic stress generated a much greater degree of contractile impairment and cellular damage in aged vs. young hearts. This was associated with a substantially modified transcriptional response, with selective changes in Ca2+, WNT, NOTCH and G-protein coupled receptor signalling paths in aged vs. young hearts. Despite some common responses to ischemia in young and aged hearts (induction of heat shock protein transcripts), aging selectively modified ischemic responses of immediate early genes, and genes involved in modulating apoptosis and remodelling/angiogenesis. In summary, aging is associated with shifts in cardiovascular gene expression consistent with the phenotypic features of older hearts. Reduced tolerance with age may be related to modification of signalling (particularly WNT and TGF-β), and shifts in expression of immediate early genes, and genes important in control of cell death/survival, angiogenesis, and cardiac remodelling

Risk Factors for Fecal Quinolone-Resistant Escherichia coli in Mexican Children

We determined the prevalence of, and risk factors for, fecal quinolone-resistant Escherichia coli (QREC) in 324 children from Yucatan, Mexico. QREC was higher in children with recent Salmonella infection (100%) than in children with diarrhea (61%) or healthy children (54%) (P = 0.007). Multivariate analysis identified recent hospitalization of a family member (P = 0.011, odds ratio [OR] = 5.1) and carriage of Salmonella (P = 0.004, OR = 3.7) as independent risk factors for QREC