A Specific class of interneuron mediates inhibitory plasticity in the lateral amygdala

The lateral amygdala (LA) plays a key role in emotional learning and is the main site for sensory input into the amygdala. Within the LA, pyramidal neurons comprise the major cell population with plasticity of inputs to these neurons thought to underlie fear learning. Pyramidal neuron activity is tightly controlled by local interneurons, and GABAergic modulation strongly influences amygdala-dependent learning. Synaptic inputs to some interneurons in the LA can also undergo synaptic plasticity, but the identity of these cells and the mechanisms that underlie this plasticity are not known. Here we show that long-term potentiation (LTP) in LA interneurons is restricted to a specific type of interneuron that is defined by the lack of expression of synaptic NR2B subunits. We find that LTP is only present at cortical inputs to these cells and is initiated by calcium influx via calcium-permeable AMPA receptors. LTP is maintained by trafficking of GluR2-lacking AMPA receptors that require an interaction with SAP97 and the actin cytoskeleton. Our results define a novel population of interneurons in the LA that control principal neuron excitability by feed-forward inhibition of cortical origin. This selective enhanced inhibition may contribute to reducing the activity of principal neurons engaged during extinction of conditioned fear

Avoiding Fire in the Operating Suite: An Intersection of Prevention and Common Sense

The operating room (OR) is a complex environment that involves large teams and multiple competing priorities, dynamically interacting throughout the entire course of a surgical procedure. The simultaneous presence of flammable substances, volatile gases, and the frequent use of electrical current results in a potentially dangerous combination. Operating room fire (ORF) is a rare but potentially devastating occurrence. To prevent this “never event”, it is critical for institutions to establish and follow proper fire safety protocols. Adherence to proven prevention strategies and awareness of associated risk factors will help reduce the incidence of this dreaded safety event. When ORF does occur despite strict adherence to established safety protocols, the entire OR team should know the steps required to contain and extinguish the fire as well as essential measures to minimize or avoid thermal injury. If injury does occur, it is important to recognize and treat it promptly. Appropriate and honest disclosure to all injured persons and their families should be made without delay. As with all serious patient safety events, regulatory reporting and root cause determinations must take place in accordance with applicable laws and regulations. The goal of patient safety champions at each institution should be the attainment of zero incidence of ORF

Production of interleukin-10 by alveolar macrophages from lung cancer patients

AbstractInterleukin (IL)-10 is known to be an autoregulatory factor of functions of monocyte macrophages. The purpose of this study was to determine whether IL-10 production by alveolar macrophages (AMs) is altered in patients with lung cancer. AMs were obtained by bronchoalveolar lavage from 25 patients with lung cancer and 14 control patients. The production of IL-10 by AMs was quantitated by enzyme immunoassay with or without stimulation with lipopolysaccharide (LPS). No significant difference in spontaneous and LPS-stimulated IL-10 production by AMs was observed between lung cancer patients and control patients (mean ± sem; 288·0 ± 56·7 vs. 249·6 ± 58·4 pg ml−1). IL-10 production of LPS-stimulated AMs was not impaired even in lung cancer patients with systemic metastasis. IL-4 failed to suppress LPS-induced production of IL-10 by AMs both in control patients and in lung cancer patients. In eight patients with lung cancer, IL-10 production by AMs was estimated before and after systemic chemotherapy and IL-10 production by LPS-stimulated AMs tended to increase after systemic chemotherapy from 152·3 ± 51·9 to 278·0 ± 112·8 pg ml−1. As IL-10 is a potent inhibitor of tumour angiogenesis, an important process of tumour progression, these results suggest that, even in advanced cancer patients, macrophages can produce potent angiogenesis inhibitor and systemic chemotherapy may augment this inhibitory activity in the lung

Disability Prevention Programs for Older People: Factors Associated with Medical and Nursing Care Costs

This study aimed to clarify factors associated with medical and nursing care costs for older people living in community and to suggest an effective disability prevention programs. Total of participants in this study was 83 individuals (29 men and 54 women; mean age 81.2 ± 6.3 years old) on November 1st – December 28th, 2014. This study compared the average medical and nursing care costs per month with national average for those aged ≥ 65 years old. Logistic regression test was conducted to examine its association with medical and nursing care costs. Those who had outing activities ≥ 3 times a week were approximately three times less likely to reduce medical and nursing care costs than those who had outing activities < 3 times a week despite three controlled covariates (OR = 3.23 and 95% CI = 1.03 – 10.42). Disability prevention programs that improve frequency of outing at least three times in a week may become a valid economic approach to older people who do not live in nursing home

Interhospital Transfers: Managing Competing Priorities while Ensuring Patient Safety

Interhospital patient transfers (IPTs) are highly complex logistical undertakings, involving a multitude of interdependent procedures, critical steps and a degree of unpredictability. Beginning with interfacility communication and patient acceptance agreement, a cascade of numerous handoffs takes place, ultimately culminating in safe arrival of the patient at the receiving facility. Due to the complexity of the IPT process, significant potential for critical errors and adverse patient safety (PS) outcomes exists. To minimize any associated risks, key PS considerations include checklists, handoffs, vehicle/aircraft safety, distance of travel, crew training, team factors, and many other critical components. Detailed knowledge of factors that may influence the risk of errors or adverse events is critical to optimizing both PS and clinical outcomes