Military trainees can accurately measure optic nerve sheath diameter after a brief training session

Abstract Background Identification of elevated intracranial pressure is important following traumatic brain injury. We assessed the feasibility of educating military trainees on accurately obtaining optic nerve sheath diameter measurements using a brief didactic and hands-on training session. Optic nerve sheath diameter is a noninvasive surrogate marker for elevated intracranial pressure, and may be of value in remote military operations, where rapid triage decisions must be made without access to advanced medical equipment. Methods Military trainees with minimal ultrasound experience were given a 5-min didactic presentation on optic nerve sheath diameter ultrasound. Trainees practiced optic nerve sheath diameter measurements guided by emergency physician ultrasound experts. Trainees then measured the optic nerve sheath diameter on normal volunteers. Following this, a trained physician measured the optic nerve sheath diameter on the same volunteer as a criterion standard. An average of three measurements was taken. Results Twenty-three military trainees were enrolled. A mixed design ANOVA was used to compare measurements by trainees to those of physicians, with a mean difference of − 0.6 mm (P = 0.76). A Bland-Altman analysis showed that the degree of bias in optic nerve sheath diameter measures provided by trainees was very small: d = − 0.004 for the right eye and d = − 0.007 for the left eye. Conclusion This study demonstrates that optic nerve sheath diameter measurement can be accurately performed by novice ultrasonographers after a brief training session. If validated, point-of-care optic nerve sheath diameter measurement could impact the triage of injured patients in remote areas.https://deepblue.lib.umich.edu/bitstream/2027.42/146752/1/40779_2018_Article_189.pd

TGF-β regulates T-cell neurokinin-1 receptor internalization and function

Substance P (SP) is a proinflammatory mediator implicated in inflammatory bowel disease (IBD) and other inflammatory states. SP acts by stimulating the neurokinin-1 receptor (NK-1R) on T lymphocytes and other cell types, and regulates these cells in a complex interplay with multiple cytokines. The mechanisms of interaction among these inflammatory mediators are not yet fully understood. Here, we demonstrate that function of the NK-1R, a member of the G protein-coupled receptor (GPCR) superfamily, is modulated by TGF-β. The latter acts not on a GPCR but via serine-threonine kinase-class receptors. By flow confocal image analysis, we demonstrate that TGF-β delays SP-induced NK-1R internalization on mucosal T cells isolated from a mouse model of IBD and on granuloma T cells in murine schistosomiasis. Furthermore, luciferase reporter-gene assays revealed that NK-1R stimulation activates the nuclear factor of activated T cell- and activator protein-1-dependent signaling pathways, which are known triggers of effector T-cell cytokine production. TGF-β markedly increases SP-induced activation of these signaling cascades, suggesting that delayed NK-1R internalization results in enhanced signaling. Providing a link to amplified immune function, SP and TGF-β, when applied in combination, trigger a strong release of the proinflammatory cytokines IFN-γ and IL17 from intestinal inflammatory T cells, whereas either agonist alone shows no effect. These observations establish precedent that members of two distinct receptor superfamilies can interact via a previously unrecognized mechanism, and reveal a paradigm of GPCR transregulation that is relevant to IBD and possibly other disease processes

Correlates of Unprotected Sex Among Adult Heterosexual Men Living with HIV

The correlates of unprotected sex among a sample of heterosexual men living with HIV (n = 121) were examined to determine whether patient characteristics can be used as a basis for tailoring safer sex counseling in the clinic setting. Potential correlates of self-reported unprotected oral sex (fellatio) and vaginal sex included participant demographics (e.g., age, ethnicity), disease status (CD4 counts, viral load, years since diagnosis), safer sex beliefs (e.g., condom attitudes), substance use, psychological characteristics (depressive symptoms, dispositional optimism and pessimism), and sex partner characteristics (main/casual partner, HIV status of partner, and duration of relationship). A series of logistic regression analyses were used to determine significant relationships. Correlates of reported levels of prior 3-month unprotected fellatio (24%) and vaginal (21%) sex were not associated with the type of relationship (main or casual) or perceived HIV serostatus of the partner (positive, negative, or unknown). Unprotected fellatio was positively associated with age and CD4 count and inversely associated with optimism and positive condom attitudes (all p's < 0.05). Unprotected vaginal sex was positively associated with duration of relationship and inversely associated with positive condom attitudes. Prevention efforts among sexually active adult heterosexual men living with HIV may benefit from focusing on improving attitudes towards condom use regardless of partner relationship status