Lower total cholesterol and triglyceride levels in ankylosing spondylitis than non-inflammatory rheumatic disease controls in a 1978-98 study: a potential effect of increased physical energetics in manual occupations in the pre-2000 chronologic era.

OBJECTIVES: No article on serum lipids in ankylosing spondylitis (AS) and control subjects has been reported from USA. The primary aim of this study was to determine if any difference occurred in serum lipid levels in AS and control rheumatic disorders in two time periods, 1978-98 and 2000-10. The secondary aim was to investigate variables associated with lipid levels and if a difference was found between AS and control disorders. METHODS: The AS patients were compared to non-inflammatory rheumatic disorders (NIRDs) in 1978-98 and 2000-10 surveys and to rheumatoid arthritis (RA) in the 2000-10 survey. Patients were matched within 5 years of age, sex, and clinic or hospital source. RESULTS: In the 1978-98 survey, entry mean (SEM) serum cholesterol level [mg/dL] was highly (p<0.001) significantly lower in 69 AS [179.0 (4.8)] than 69 matched NIRD controls [208.0 (5.6)]. In 29 pairs of AS and NIRD subjects having manual labour occupations, mean (SEM) cholesterol level was additionally lower in AS [156.7 (5.9)] and higher in 29 NIRD controls [213.3 (8.6)] (p<0.001). In manual labour workers, mean (SEM) serum triglyceride was significantly lower (p=0.004) in 15 AS [110.3 (14.1)] than 14 NIRD controls [185.2 (19.3)]. In the 2000-10 survey, no lipid difference was found between AS vs. NIRD control patients. CONCLUSIONS: In the 1978-98 survey, AS had significantly lower mean serum cholesterol and triglyceride levels than NIRD control patients. Associated manual labour occupations may have significantly contributed to results, possibly related to increased energy expenditures from physical activity in the pre-2000 era.

Trauma Teams That Train as One Work as One: Invasive Procedure Training in Residency Education.

BACKGROUND: Invasive surgical procedures occur infrequently in an emergency department setting; however, procedural competence is expected from trauma residents. Emergent procedures are challenging to train in a formal manner because of the urgent nature when they present. To supplement education, new and creative teaching tools such as simulation and multidisciplinary training are being used. Our study organized a multidisciplinary simulated learning workshop with surgery and emergency medicine residents for invasive, emergent procedures. MATERIALS AND METHODS: In total, 14 surgical and 36 emergency medicine residents at our institution participated in a simulated learning experience. Ten workshops were organized, with six to seven residents participating in each session. Using a human cadaveric model, all residents were taught by senior-level residents and attendings from both specialties on how to perform uncommonly or anatomically challenging emergent invasive procedures. A pre- and post-laboratory survey was completed by all the residents to assess confidence in performing each of the 13 procedures. RESULTS: All residents (N = 50), who participated in the study, completed pre- and post-laboratory surveys. Comparison of the pre- and post-laboratory confidence levels indicated significant increases in confidence in performing all procedures. Residents stated that this multidisciplinary approach to education in a controlled setting was helpful and fostered a collaborative relationship between both specialties. CONCLUSIONS: Although some surgical procedures remain uncommon in the emergency department, competency is nevertheless expected for appropriate patient care. Using a collaborative simulation-based cadaver laboratory to teach emergent procedures significantly improved residents' confidence while concurrently fostering professional relationships.

Telemedicine and telerobotics: from science fiction to reality.

Advances in communication technologies have paved the way for telemedicine to transform the delivery of medical care throughout the world. Coinciding developments in minimally invasive surgery and in particular teleoperated robotic surgical systems will allow the surgeon to deliver expert care in remote locations. This study presents a systematic review of telemedicine, focusing on telerobotic surgical systems. A brief historical review of telemedicine and telerobotics is provided, including a description of the various subtypes of telemedicine. Currently available systems and recent experimental utilization, including long-distance remote telesurgery, are discussed. Experimental telerobotic surgical systems and future developments in the field are reviewed and the potential applications are considered. Future challenges to the implementation and opinions on the future direction of telerobotics are provided in this review.

Identification and characterization of the nuclear isoform of Drosophila melanogaster CTP:phosphocholine cytidylyltransferase.

CTP:phosphocholine cytidylyltransferase (CCT) catalyzes the conversion of phosphocholine and cytidine 5'-triphosphate (CTP) to CDP-choline for the eventual synthesis of phosphatidylcholine (PC). The enzyme is regulated by reversible association with cellular membranes, with the rate of catalysis increasing following membrane association. Two isoforms of CCT appear to be present in higher eukaryotes, including Drosophila melanogaster, which contains the tandem genes Cct1 and Cct2. Before this study, the CCT1 isoform had not been characterized and the cellular location of each enzyme was unknown. In this investigation, the cDNA encoding the CCT1 isoform from D. melanogaster has been cloned and the recombinant enzyme purified and characterized to determine catalytic properties and the effect of lipid vesicles on activity. CCT1 exhibited a V max of 23904 nmol of CDP-choline min (-1) mg (-1) and apparent K m values for phosphocholine and CTP of 2.29 and 1.21 mM, respectively, in the presence of 20 muM PC/oleate vesicles. Cytidylyltransferases require a divalent cation for catalysis, and the cation preference of CCT1 was found to be as follows: Mg (2+) > Mn (2+) = Co (2+) > Ca (2+) = Ni (2+) > Zn (2+). The activity of the enzyme is stimulated by a variety of lipids, including phosphatidylcholine, phosphatidylinositol, phosphatidylglycerol, phosphatidylserine, diphosphatidylglycerol, and the fatty acid oleate. Phosphatidylethanolamine and phosphatidic acid, however, did not have a significant effect on CCT1 activity. The cellular location of both CCT1 and CCT2 isoforms was elucidated by expressing green fluorescent fusion proteins in cultured D. melanogaster Schneider 2 cells. CCT1 was identified as the nuclear isoform, while CCT2 is cytoplasmic.