A Kidney Biopsy Simulation Training Program: First Year\u27s Results

BACKGROUND: Nephrology attracts fewer medical graduates despite the growing care and workforce demand. Interventional Nephrology could re-foster interest in this subspecialty. Percutaneous kidney biopsy (PKB) is the most common procedure and should be adequately taught through simulation training according to ACGME requirements. We initiated a PKB simulation training program and we designed a two-year study in order to examine its effect on the confidence level, the procedural competence and the satisfaction with this training of Nephrology fellows compared to historical controls (fellows trained on PKBs before the initiation of the program). METHODS: All fellows were consented and trained at UNM’s simulation center (BATCAVE) with a renal biopsy ultrasound training model (CAE Healthcare Blue PhantomTM). Participants demographics and previous PKB experience was collected. Pre-assigned readings, online videos and hands-on practice on the simulation model were utilized as educational strategies. Performance of the trainee during each one-hour session was graded by the use of an evaluation form specifically designed for PKBs. Pre-and post-simulation surveys evaluated the participants’ confidence level quantitatively. All participants completed the satisfaction with PKB simulation experience scale (PKB-SSE). RESULTS: All three 1st and 2nd year current renal fellows completed the simulation training. The following table summarizes the basic information acquired from their training. Overall, the program enhanced the confidence level of fellows without previous experience on performing PKBs. All fellows expressed a high level of satisfaction from their participation in this training. CONCLUSIONS: PKB simulation training may improve trainees’ confidence level especially for those without prior experience as well as their satisfaction with the training. The procedural competence of the trainees on PKBs will be evaluated during the second year of their fellowship and will be compared to the procedural competence of historical controls

Προαγωνιστικό άγχος στο άθλημα του Tae Kwon Do

Σκοπός της έρευνας ήταν να μελετήσει πώς επιδρά το άγχος των αθλητών στο άθλημα του TAE KWON DO. Συγκεκριμένα, αρχικά αναλύθηκε η έννοια, η σημασία και οι επιδράσεις που έχει το άγχος στην ανθρώπινη καθημερινότητα αλλά και στην υγεία. Έπειτα αναλύθηκε το άθλημα του TAE KWON DO και πώς το άγχος μπορεί να επηρεάσει το άτομο να αποδώσει αγωνιστικά και να εξελιχθεί σε αυτό. Τέλος βαρύτητα δόθηκε στο πώς το άγχος επηρεάζει τον αθλητή του συγκεκριμένου αθλήματος μιας και από μόνο του το άθλημα αυτό είναι ιδιαίτερα στρεσογόνο. Ο αθλητής ιδιαίτερα πριν από κάθε αγώνα έχει αυξημένο άγχος προκειμένου να μπορέσει να προκριθεί με επιτυχία αλλά και λόγω της ανησυχίας ενός πιθανού τραυματισμού. Η εργασία ήταν ανασκοπική και αναπτύχθηκε μέσα από κριτική θεώρηση συγκεκριμένων βιβλιογραφικών πηγών/άρθρων για το συγκεκριμένο θέμα.The aim of the research was to study how the stress of athletes affects the sport of TAE KWON DO. Specifically, the concept, importance and effects of stress on human daily life and health were initially analyzed. The sport of TAE KWON DO was then analyzed and how stress can affect the individual to perform competitively and develop in it. Finally, emphasis was placed on how stress affects the athlete of the specific sport since this sport alone is particularly stressful. The athlete especially before each race has increased stress in order to be able to qualify successfully but also due to the concern of a possible injury. The work was reviewed and developed through a critical review of specific bibliographic sources / articles on the specific topic

A Kidney Biopsy Simulation Training Program for Renal Fellows: Two Years of Results

Renal interventions could re-foster interest in Nephrology and attract more medical graduates. Percutaneous kidney biopsy (PKB) is an important diagnostic tool and should be taught through simulation. We initiated a PKB simulation training program and designed a 2-year study to examine its effect on the confidence level, the procedural competence and the satisfaction with this training of Nephrology fellows compared to historical controls. All fellows were consented and trained at UNM’s simulation center (BATCAVE) with a simulation training model (CAE Healthcare Blue PhantomTM). Trainees’ demographics and previous PKB experience were collected. We utilized pre-assigned readings, online videos and hands-on simulation practice. Performance of each trainee during each session was graded with a procedural competence evaluation form. Drs. JO and MER were present in all sessions and completed these forms. Each session lasted 1 to 1-1 1/2 h. Pre-and post-simulation surveys evaluated the participants’ confidence level quantitatively on a 5-point Likert scale. All participants completed the satisfaction with PKB simulation experience scale (PKB-SSE). All three 1st and 2nd year renal fellows completed the simulation training in 2018 and two first year fellows completed the training in 2019. Independent of their previous experience on PKBs all renal fellows expressed a high level of satisfaction from their participation (4 to 5) and increased their confidence level. This year’s trainees increased their performance level from 2 to 5 and from 1 to 5, respectively. PKB simulation may improve trainees’ confidence level and their satisfaction with the training. The procedural competence of the trainees on PKBs will be evaluated during the 2nd year of their fellowship and will be compared to the procedural competence of historical controls. We expect that the simulation training will reduce the discomfort and minimize the adverse PKB outcomes in patients undergoing PKB in UNMH

EglD, a putative endoglucanase, with an expansin like domain is localized in the conidial cell wall of Aspergillus nidulans

a b s t r a c t Although the process of conidial germination in filamentous fungi has been extensively studied, many aspects remain to be elucidated since the asexual spore or conidium is vital in their life cycle. Breakage and reformation of cell wall polymer bonds along with the maintenance of cell wall plasticity during conidia germination depend upon a range of hydrolytic enzymes whose activity is analogous to that of expansins, a highly conserved group of plant cell wall proteins with characteristic wall loosening activity. In the current study, we identified and characterized the eglD gene in Aspergillus nidulans, an expansinlike gene the product of which shows strong similarities with bacterial and fungal endo-b1,4-glucanases. However, we failed to show such activity in vitro. The eglD gene is constitutively expressed in all developmental stages and compartments of A. nidulans asexual life cycle. However, the EglD protein is exclusively present in conidial cell walls. The role of the EglD protein in morphogenesis, growth and germination rate of conidia was investigated. Our results show that EglD is a conidial cell wall localized expansin-like protein, which could be involved in cell wall remodeling during germination

Fluid balance concepts in medicine: Principles and practice.

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance

Sleep and Fatigue Symptoms in Children and Adolescents With CKD: A Cross-sectional Analysis From the Chronic Kidney Disease in Children (CKiD) Study

Although symptoms of sleepiness and fatigue are common among adults with Chronic Kidney Disease (CKD), little is known about the prevalence of these symptoms in children with CKD

Relative validity of a semiquantitative food frequency questionnaire designed for schoolchildren in western Greece

<p>Abstract</p> <p>Background</p> <p>The use of food frequency questionnaires (FFQs) has become increasingly important in epidemiologic studies. During the past few decades, a wide variety of nutritional studies have used the semiquantitative FFQ as a tool for assessing and evaluating dietary intake. One of the main concerns in a dietary analysis is the validity of the collected dietary data.</p> <p>Methods</p> <p>This paper discusses several methodological and statistical issues related to the validation of a semiquantitative FFQ. This questionnaire was used to assess the nutritional habits of schoolchildren in western Greece. For validation purposes, we selected 200 schoolchildren and contacted their respective parents. We evaluated the relative validity of 400 FFQs (200 children's FFQs and 200 parents' FFQs).</p> <p>Results</p> <p>The correlations between the children's and the parents' questionnaire responses showed that the questionnaire we designed was appropriate for fulfilling the purposes of our study and in ranking subjects according to food group intake.</p> <p>Conclusion</p> <p>Our study shows that the semiquantitative FFQ provides a reasonably reliable measure of dietary intake and corroborates the relative validity of our questionnaire.</p

Chronic p53-independent p21 expression causes genomic instability by deregulating replication licensing

The cyclin-dependent kinase inhibitor p21WAF1/CIP1 (p21) is a cell-cycle checkpoint effector and inducer of senescence, regulated by p53. Yet, evidence suggests that p21 could also be oncogenic, through a mechanism that has so far remained obscure. We report that a subset of atypical cancerous cells strongly expressing p21 showed proliferation features. This occurred predominantly in p53-mutant human cancers, suggesting p53-independent upregulation of p21 selectively in more aggressive tumour cells. Multifaceted phenotypic and genomic analyses of p21-inducible, p53-null, cancerous and near-normal cellular models showed that after an initial senescence-like phase, a subpopulation of p21-expressing proliferating cells emerged, featuring increased genomic instability, aggressiveness and chemoresistance. Mechanistically, sustained p21 accumulation inhibited mainly the CRL4–CDT2 ubiquitin ligase, leading to deregulated origin licensing and replication stress. Collectively, our data reveal the tumour-promoting ability of p21 through deregulation of DNA replication licensing machinery—an unorthodox role to be considered in cancer treatment, since p21 responds to various stimuli including some chemotherapy drugs