Gastroesophageal intussusception with complete herniation of the spleen in a 12 months old dog with idiopathic megaoesophagus

A 12 months old, castrated male, mix-breed dog was presented due to acute onset of vomiting, retching, anorexia, and tachypnoea. Idiopathic megaoesophagus was diagnosed three months prior to presentation. Radiographic and CT examination revealed gastroesophageal intussusception with herniation of the complete spleen into the intussusception. After initial stabilization surgical treatment was performed. The stomach and spleen were manually reduced into the abdomen. Due to questionable viability of the gastric wall an inverting suture pattern was used to invaginate the compromised part. Left sided gastropexy was performed to reduce risk of recurrence. Additionally oesophagopexy was performed to reduce the risk of hiatal hernia due to intraoperative damage to the hiatus. The patient recovered uneventful and was discharged from hospital five days following surgery. Conservative treatment of concurrent megaoesophagus was continued. At last follow up, 10 months later, the dog was clinically fine, had gained weight, and showed no signs of regurgitation

Understanding the Healthcare Needs of Our Veterans

Purpose: The program sought to emphasize the importance of interprofessional collaboration and to increase students’ awareness of the healthcare needs of veterans. Background: The nursing program participates in the Joining Forces Initiative, launched in 2011, to support service members, veterans, and their families through wellness, education, and employment opportunities. Part of the charge is to call attention to critical issues facing service members and veterans and to educate healthcare providers about how to meet their unique needs. The School of Nursing and Health Sciences’ Interprofessional Education Committee saw an opportunity to accomplish both. Program Description: A short video, “Fighting Chance,” introduced students to the challenges confronting veterans and their healthcare providers. Three speakers (veteran, nurse, and VA representative) discussed their perspectives of healthcare issues facing veterans. Students reflected on 3 case scenarios of veterans (Korean, Viet Nam, Iraqi Wars). Using an electronic group response system, students responded to questions (What were the 3 top problems? How would you prioritize the problems? Who would you want to be on your healthcare team to address the problems? A discussion followed. Students (over 200) from two schools’ programs (nursing; nutrition; public health; communication disorders; social work, psychology) and alumni, and from Salus University participated. Students completed a pre/post the Readiness for Inter-Professional Learning Scale Questionnaire (RIPLS) and an evaluation of the program. Results: Although there was no statistically significant difference between the pre and posttest scores, after mean scores increased for the combined groups. Students from across disciplines indicated that the program was valuable. One student commented: “Definitely a life changing lecture, amazingly powerful.” Conclusion: An increased number of veterans will be cared for at VA and other healthcare agencies. Healthcare providers will benefit from understanding veterans’ healthcare needs from the vantage of healthcare professionals’ different skills. Objectives: To describe the components of the interprofessional intervention addressing veterans’ and their families’ healthcare needs. To examine the differences across disciplines for items on the Readiness for Inter-Professional Learning Scale Questionnaire

Artificial intelligence and machine learning algorithms for early detection of skin cancer in community and primary care settings: a systematic review.

Skin cancers occur commonly worldwide. The prognosis and disease burden are highly dependent on the cancer type and disease stage at diagnosis. We systematically reviewed studies on artificial intelligence and machine learning (AI/ML) algorithms that aim to facilitate the early diagnosis of skin cancers, focusing on their application in primary and community care settings. We searched MEDLINE, Embase, Scopus, and Web of Science (from Jan 1, 2000, to Aug 9, 2021) for all studies providing evidence on applying AI/ML algorithms to the early diagnosis of skin cancer, including all study designs and languages. The primary outcome was diagnostic accuracy of the algorithms for skin cancers. The secondary outcomes included an overview of AI/ML methods, evaluation approaches, cost-effectiveness, and acceptability to patients and clinicians. We identified 14 224 studies. Only two studies used data from clinical settings with a low prevalence of skin cancers. We reported data from all 272 studies that could be relevant in primary care. The primary outcomes showed reasonable mean diagnostic accuracy for melanoma (89·5% [range 59·7-100%]), squamous cell carcinoma (85·3% [71·0-97·8%]), and basal cell carcinoma (87·6% [70·0-99·7%]). The secondary outcomes showed a heterogeneity of AI/ML methods and study designs, with high amounts of incomplete reporting (eg, patient demographics and methods of data collection). Few studies used data on populations with a low prevalence of skin cancers to train and test their algorithms; therefore, the widespread adoption into community and primary care practice cannot currently be recommended until efficacy in these populations is shown. We did not identify any health economic, patient, or clinician acceptability data for any of the included studies. We propose a methodological checklist for use in the development of new AI/ML algorithms to detect skin cancer, to facilitate their design, evaluation, and implementation

Síntomas de pacientes antes de la primera hospitalización por Síndrome Coronario Agudo

Este estudo objetivou caracterizar os pacientes quanto ao relato da presença de sintomas de dor torácica, dispneia e limitação das atividades diárias uma semana antes da primeira hospitalização por Síndrome Coronariana Aguda, segundo a forma de apresentação clínica, e compará-las. Estudo transversal, descritivo e correlacional. Utilizou-se um instrumento de avaliação clínica que investigou a presença e a gravidade dos sintomas de dispneia, precordialgia e restrição física decorrentes da isquemia do miocárdio. Com relação à limitação para realização de atividades físicas, pacientes com diagnóstico de angina instável mostraram maior comprometimento na semana que antecedeu a internação, assim como relataram a presença de dispneia e precordialgia com maior frequência do que os pacientes infartados em situações que vão desde realizarem grandes esforços como, por exemplo, caminhar na subida ou muito rápido no plano, até situações de repouso ou de pequenos esforços.The objective of this study was to characterize and compare patients regarding their report of experiencing chest pain, dyspnea and limitation of the daily life activities one week before their first hospitalization due to Acute Coronary Syndrome, according to the clinical presentation form, and compare them. This is a cross-sectional, descriptive and correlational study. A clinical evaluation instrument was used to investigate the presence and severity of dyspnea, chest pain and physical restriction due to myocardial ischemia. Regarding the limitation to carry out physical activities, patients diagnosed with unstable angina showed lower capacity the week before hospitalization, and reported experiencing dyspnea and chest pain more frequently than patients who had an infarction in situations ranging from making strong efforts, such as walking uphill or on a flat surface but very quickly, to resting and in situations of little effort.Estudio que objetivó caracterizar a pacientes en cuanto al relato de presencia de síntomas de dolor torácico, disnea y limitación de actividades diarias una semana antes de la primera hospitalización por Síndrome Coronario Agudo, según la forma de presentación clínica, y compararlas. Estudio transversal, descriptivo y correlacional. Se utilizó un instrumento de evaluación clínica que investigó la presencia y gravedad de síntomas de disnea, precordialgia y restricción física derivadas de isquemia de miocardio. En relación a limitaciones para realización de actividades físicas, pacientes con diagnóstico de angina inestable mostraron mayor compromiso en la semana que antecedió a la internación, así como relataron la presencia de disnea y precordialgia con mayor frecuencia que en los pacientes infartados en situaciones tales como realizar grandes esfuerzos como, por ejemplo, caminar en pendiente ascendiente o muy rápido en el llano, hasta situaciones de reposo o pequeños esfuerzos

Bilateral linear scleroderma "en coup de sabre" associated with facial atrophy and neurological complications

BACKGROUND: Linear scleroderma "en coup de sabre" (LSCS) usually affects one side of the face and head in the frontoparietal area with band-like indurated skin lesions. The disease may be associated with facial hemiatrophy. Various ophthalmological and neurological abnormalities have been observed in patients with LSCS. We describe an unusual case of LSC. CASE PRESENTATION: A 23 year old woman presented bilateral LSCS and facial atrophy. The patient had epileptic seizures as well as oculomotor and facial nerve palsy on the left side which also had pronounced skin involvement. Clinical features of different stages of the disease are presented. CONCLUSIONS: The findings of the presented patient with bilateral LSCS and facial atrophy provide further evidence for a neurological etiology of the disease and may also indicate that classic progressive facial hemiatrophy (Parry-Romberg syndrome) and LSCS actually represent different spectra of the same disease

Tool-Use Training in a Species of Rodent: The Emergence of an Optimal Motor Strategy and Functional Understanding

Tool use is defined as the manipulation of an inanimate object to change the position or form of a separate object. The expansion of cognitive niches and tool-use capabilities probably stimulated each other in hominid evolution. To understand the causes of cognitive expansion in humans, we need to know the behavioral and neural basis of tool use. Although a wide range of animals exhibit tool use in nature, most studies have focused on primates and birds on behavioral or psychological levels and did not directly address questions of which neural modifications contributed to the emergence of tool use. To investigate such questions, an animal model suitable for cellular and molecular manipulations is needed.) to use a rake-like tool with their forelimbs to retrieve otherwise out-of-reach rewards. Eventually, they mastered effective use of the tool, moving it in an elegant trajectory. After the degus were well trained, probe tests that examined whether they showed functional understanding of the tool were performed. Degus did not hesitate to use tools of different size, colors, and shapes, but were reluctant to use the tool with a raised nonfunctional blade. Thus, degus understood the functional and physical properties of the tool after extensive training.Our findings suggest that tool use is not a specific faculty resulting from higher intelligence, but is a specific combination of more general cognitive faculties. Studying the brains and behaviors of trained rodents can provide insights into how higher cognitive functions might be broken down into more general faculties, and also what cellular and molecular mechanisms are involved in the emergence of such cognitive functions

Superconductivity in the Intercalated Graphite Compounds C6Yb and C6Ca

In this letter we report the discovery of superconductivity in the isostructural graphite intercalation compounds C6Yb and C6Ca, with transition temperatures of 6.5K and 11.5K respectively. A structural characterisation of these compounds shows them to be hexagonal layered systems in the same class as other graphite intercalates. If we assume that all the outer s-electrons are transferred from the intercalant to the graphite sheets, then the charge transfer in these compounds is comparable to other superconducting graphite intercalants such as C8K 1,2 . However, the superconducting transition temperatures of C6Yb and C6Ca are up to two orders of magnitude greater. Interestingly, superconducting upper critical field studies and resistivity measurements suggest that these compounds are significantly more isotropic than pure graphite. This is unexpected as the effect of introducing the intercalant is to move the graphite layer further apart.Comment: 2 Figures. Please see accompanying theoretical manuscript, "Electronic Structure of the Superconducting Graphite Intercalates" by Csanyi et al., cond-mat/050356

Effectiveness of an online curriculum for medical students on genetics, genetic testing and counseling

Background: It is increasingly important that physicians have a thorough understanding of the basic science of human genetics and the ethical, legal and social implications (ELSI) associated with genetic testing and counseling. Methods: The authors developed a series of web-based courses for medical students on these topics. The course modules are interactive, emphasize clinical case studies, and can easily be incorporated into existing medical school curricula. Results: Results of a ‘real world’ effectiveness trial indicate that the courses have a statistically significant effect on knowledge, attitude, intended behavior and self-efficacy related to genetic testing (p<0.001; N varies between 163 and 596 for each course). Conclusions: The results indicate that this curriculum is an effective tool for educating medical students on the ELSI associated with genetic testing and for promoting positive changes in students' confidence, counseling attitudes and behaviors

Fas/FasL-mediated apoptosis and inflammation are key features of acute human spinal cord injury: implications for translational, clinical application

The Fas/FasL system plays an important role in apoptosis, the inflammatory response and gliosis in a variety of neurologic disorders. A better understanding of these mechanisms could lead to effective therapeutic strategies following spinal cord injury (SCI). We explored these mechanisms by examining molecular changes in postmortem human spinal cord tissue from cases with acute and chronic SCI. Complementary studies were conducted using the in vivo Fejota™ clip compression model of SCI in Fas-deficient B6.MRL-Fas-lpr (lpr) and wild-type (Wt) mice to test Fas-mediated apoptosis, inflammation, gliosis and axonal degeneration by immunohistochemistry, Western blotting, gelatin zymography and ELISA with Mouse 32-plex cytokine/chemokine panel bead immunoassay. We report novel evidence that shows that Fas-mediated apoptosis of neurons and oligodendrocytes occurred in the injury epicenter in all cases of acute and subacute SCI and not in chronic SCI or in control cases. We also found significantly reduced apoptosis, expression of GFAP, NF-κB, p-IKappaB and iba1, increased number of CD4 positive T cells and MMP2 expression and reduced neurological dysfunction in lpr mice when compared with Wt mice after SCI. We found dramatically reduced inflammation and cytokines and chemokine expression in B6.MRL-Fas-lpr mice compared to Wt mice after SCI. In conclusion, we report multiple lines of evidence that Fas/FasL activation plays a pivotal role in mediating apoptosis, the inflammatory response and neurodegeneration after SCI, providing a compelling rationale for therapeutically targeting Fas in human SCI