Sleep Deprivation Induced Tauopathies

Sleep deprivation is a common occurrence among many adults that can have inherently negative effects. While some of these effects are apparent, such as fatigue, irritability, and depressed mood, some are less apparent. One less apparent effect is the increased neural activity that results from being sleep deprived. Chronic Sleep Deprivation leads to increased neurological activity over a prolonged period of time. Researchers have shown that increased neurological activity results in an increase in extracellular tau protein and increased cerebrospinal fluid levels of amyloid beta. Tau protein in particular has been implicated in neurodegeneration because of its propensity for becoming neurofibrillary tangles upon aggregation. Physicians in training in all medical specialties, also known as residents and fellows, airplane pilots, and truck drivers have been known to suffer from sleep deprivation due to the unforgiving hours and context of their work. Understanding exactly how sleep deprivation causes neurological issues and who is most likely to suffer from them is of utmost importance in attempting to reduce the incidence of neurological disorders caused by “Tauopathies” secondary to sleep deprivation. In order to assess potential risk of sleep deprivation amongst individuals in professions with unforgiving hours this review focused on the effects of sleep deprivation as it relates to neurological functions. This investigation specifically examined medical residents and follows who are highly sleep deprived when compared to the rest of the population. An additional literature review was performed in order to determine if sleeping strategies, primarily changing sleep schedules as an interventional effort, could minimize the effects of reduced sleep. If these strategies prove to be effective, this would suggest that implementation of the sleep strategies would be beneficial for the neurological wellbeing of those in training to become physicians

Free versus Pedicled Perforator Flaps for Lower Extremity Reconstruction: A Multicenter Comparison of Institutional Practices and Outcomes.

BACKGROUND:  Of all body regions, lower extremity wounds have been and remain the greatest challenge. Perforator free flaps have been accepted as a reasonable option to solve this dilemma but require the complexity of microsurgery. As a consequence, the possibility that pedicled perforator flaps could supplant even perforator free flaps has recently gained intense enthusiasm. METHODS:  A retrospective investigation was undertaken to compare the validity for the use of perforator flaps of all types at three dissimilar institutions, that is, a university, a regional center, and a community hospital. All flaps performed in the 5-year period, 2011 to 2015, were included to allow at least 1-year follow-up before data analysis. A total of 433 free perforator flaps and 52 pedicled perforator flaps had been performed specifically for the lower extremity. RESULTS:  Patient demographics, wound etiology, and comorbidities were similar for all institutions. Free flaps were more commonly needed after trauma and for chronic ulcers. Pedicled flaps were more likely an option after tumor excision. Large defects or those involving the foot were better served by free flaps. Overall success for free perforator flaps was 90.1% and for pedicled perforator flaps was 92.3%, with no significant difference noted ( CONCLUSION:  Perforator flaps in general have become a reasonable solution for soft tissue defects of the lower extremity. Following careful consideration of the etiology, dimensions, location, patient comorbidities, and presence of adequate perforators, a pedicled or free perforator flap could potentially be successful. Pedicled perforator flaps, if adequate healthy soft tissues remain adjacent to the defect, forecast a continuance of the evolution in seeking simplicity yet reliability by the best flap possible for soft tissue closure of the lower limb wound

Risk Categorization Using New American College of Cardiology/American Heart Association Guidelines for Cholesterol Management and Its Relation to Alirocumab Treatment Following Acute Coronary Syndromes

10.1161/CIRCULATIONAHA.119.042551CIRCULATION140191578-158