Health professionals' attitudes towards acupuncture/acupressure for post-operative nausea and vomiting: a survey and implications for implementation.

PURPOSE: Level 1 evidence supports the use of acupuncture/acupressure (A/A) to manage post-operative nausea and vomiting (PONV). This study aimed to survey healthcare professionals' attitudes towards A/A, influencing factors and barriers to implementing this effective non-drug intervention into peri-operative care. METHODS: A validated, anonymous survey with 43 questions was emailed or distributed as a hard copy at meetings to anaesthetists, midwives, nurses, obstetricians, gynaecologists and surgeons at a public hospital in Australia. Descriptive data were presented. Influencing factors were explored using chi-square analysis. Multinomial logistical regression was used to identify the influences of confounding factors. RESULTS: A total of 155 completed surveys were returned, reflecting a response rate of 32%. The majority of participants were female (69%), nurses/midwives (61%) and aged between 20 and 50 years old (76%). Eighty-three percent of respondents considered A/A 'clearly alternative' medicine or 'neither mainstream nor alternative'. Eighty-one percent would encourage patients to use acupressure for PONV if it was offered at the hospital. Previous personal use of A/A was the key factor influencing attitudes and openness to clinical use. The key barriers to implementation were perceived lack of evidence and lack of qualified providers and time. CONCLUSION: Hospital-based healthcare professionals strongly supported the evidence-based use of A/A for PONV despite considering the therapy to be non-mainstream and having limited A/A education or history of personal use, providing a positive context for an acupressure implementation study. Significant gaps in training and a desire to learn were identified.

Acute Esophageal Necrosis Syndrome (Black Esophagus): A Case Report of Rare Presentation.

Acute esophageal necrosis (AEN) is a rare clinical finding due to multifocal factors consisting of an ischemic insult to the esophagus, corrosive injury from gastric content, and diminished mucosal defense. It is also referred to as "black esophagus" or acute necrotizing esophagitis. The clinical presentation mainly consists of upper gastrointestinal bleed and abdominal pain. Associated symptoms include nausea, vomiting, and dysphagia. AEN can be diagnosed by esophagogastroduodenoscopy (EGD) with findings of diffuse circumferential black pigmentation in the distal esophagus that classically extends to the gastroesophageal junction. A diagnostic biopsy is not required but recommended. Treatment of AEN is conservative management to maintain hemodynamic stability and treat coexisting medical conditions. Herein, we present the case of a 78-year-old male who initially presented with hematemesis and abdominal discomfort of five-day duration and was subsequently found to have AEN.

Thermal fluids with high specific heat capacity through reversible Diels-Alder reactions.

Thermal fluids are used as heat transfer fluids and thermal energy storage media in many energy technologies ranging from solar thermal heating to battery thermal management. The heat capacity of state-of-the-art thermal fluids remains ∼50% of that of water (which suffers from a limited operation range between 0°C and 100°C), and their viscosities are typically more than one order of magnitude higher than that of water. Our results demonstrate that the heat capacity of the proposed thermochemical fluid is significantly higher than that of state-of-the-art thermal fluids over a broad temperature range and is also higher than that of water between 60°C and 90°C. The viscosity of our liquid is only 3 times higher than that of water, and the operating temperature range is between -90°C and 135°C. Furthermore, a model was developed allowing for novel design of thermochemical thermal fluids in the future with even higher heat capacity.

Metastasis-Induced Acute Pancreatitis Secondary to Small Cell Lung Carcinoma: A Case Report.

Description Metastasis-induced acute pancreatitis (MIAP) is a condition that occurs when patients develop acute pancreatitis secondary to metastatic malignancy. Most pancreatic cancers are adenocarcinomas that are primary malignancies. On the other hand, metastatic pancreatic lesions are rare, especially from primary pulmonary malignancies. Acute pancreatitis caused by metastatic carcinoma of the pancreas is a very rare presentation. Herein, we present the case of a 63-year-old male with a history of small-cell lung carcinoma presenting to the hospital due to recurrent episodes of acute pancreatitis who was found to have metastatic pancreatic carcinoma. The patient was treated conservatively for his recurrent acute pancreatitis, had a stent placed in the common bile duct to relieve an obstruction and planned for outpatient palliative chemotherapy.

From DNA Damage to Cancer Progression: Potential Effects of Cytolethal Distending Toxin.

Cytolethal distending toxin (CDT), one of the most important genotoxins, is produced by several gram-negative bacteria and is involved in bacterial pathogenesis. Recent studies have shown that bacteria producing this peculiar genotoxin target host DNA, which potentially contributes to development of cancer. In this review, we highlighted the recent studies focusing on the idea that CDT leads to DNA damage, and the cells with inappropriately repaired DNA continue cycling, resulting in cancer development. Understanding the detailed mechanisms of genotoxins that cause DNA damage might be useful for targeting potential markers that drive cancer progression and help to discover new therapeutic strategies to prevent diseases caused by pathogens.

Ding Chuan Tang Attenuates Airway Inflammation and Eosinophil Infiltration in Ovalbumin-Sensitized Asthmatic Mice.

Asthma is a T helper 2 (Th2) cell-associated chronic inflammatory diseases characterized with airway obstruction, increased mucus production, and eosinophil infiltration. Conventional medications for asthma treatment cannot fully control the symptoms, and potential side effects are also the concerns. Thus, complement or alternative medicine (CAM) became a new option for asthma management. Ding Chuan Tang (DCT) is a traditional Chinese herbal decoction applied mainly for patients with coughing, wheezing, chest tightness, and asthma. Previously, DCT has been proved to improve children airway hyperresponsiveness (AHR) in a randomized and double-blind clinical trial. However, the mechanisms of how DCT alleviates AHR remain unclear. Since asthmatic features such as eosinophil infiltration, IgE production, and mucus accumulation are relative with Th2 responses, we hypothesized that DCT may attenuate asthma symptoms through regulating Th2 cells. Ovalbumin (OVA) was used as a stimulant to sensitize BALB/c mice to establish an asthmatic model. AHR was detected one day before sacrifice. BALF and serum were collected for immune cell counting and antibody analysis. Splenocytes were cultured with OVA in order to determine Th2 cytokine production. Lung tissues were collected for histological and gene expression analyses. Our data reveal that DCT can attenuate AHR and eosinophil accumulation in the 30-day sensitization asthmatic model. Histological results demonstrated that DCT can reduce cell infiltration and mucus production in peribronchial and perivascular site. In OVA-stimulated splenocyte cultures, a significant reduction of IL-5 and IL-13 in DCT-treated mice suggests that DCT may alleviate Th2 responses. In conclusion, the current study demonstrates that DCT has the potential to suppress allergic responses through the reduction of mucus production, eosinophil infiltration, and Th2 activity in asthma.

Berberine Inhibits Pro-inflammatory Cytokine-induced IL-6 and CCL11 Production via Modulation of STAT6 Pathway in Human Bronchial Epithelial Cells.

Berberine is an isoquinoline alkaloid isolated from various Chinese herbs that has potential of anti-inflammatory, anti-lipidemic, anti-neoplastic, and anti-diabetic activity. In this study, we evaluated the anti-inflammatory efficacy of berberine on allergic airway inflammation by targeting epithelial cells. Allergic airway inflammation driven by T helper 2 (Th2)-type immunity is characterized by airway hyperresponsiveness, elevated IgE production, and eosinophilic infiltration. For eosinophil recruitment, major chemoattractant CCL11 (eotaxin-1) was secreted by lung epithelial cells. BEAS-2B cells, a human bronchial epithelial cell line, were pre-treated with berberine and then activated by IL-4 plus TNF-α. The viability of BEAS-2B cells was assessed. Expression levels of IL-6 and CCL11 were determined using ELISA and real-time PCR. The signaling pathways of MAP kinases, NF-κB, and STAT6 were analyzed by western blot. Berberine treatment (≤1 µM) didn't significantly affect the viability of BEAS-2B cells with or without IL-4 plus TNF-stimulation. Berberine significantly inhibited the secretion of IL-6 and CCL11 from pro-inflammatory cytokine-activated BEAS-2B cells. NF-κB and MAP kinase pathways were seemingly unaffected in BEAS-2B cells with berberine treatment. Significant reduction of nuclear STAT6 protein expression in activated BEAS-2B cells with berberine treatment was observed. Current study reveals that berberine has inhibitory effect in pro-inflammatory cytokine-activated BEAS-2B cells through reducing IL-6 and CCL11 production, which is possibly modulated by suppressing STAT6 signaling pathway.

DNA methyltransferase inhibitor alleviates bleomycin-induced pulmonary inflammation.

Acute lung injury (ALI) is a severe disease characterized by several inflammatory responses in the lung with high mortality. We applied a mouse model of the pulmonary inflammation induced by the intratracheal instillation of bleomycin which is widely used to induce ALI and fibrosis in animal models. We hypothesized that DNA methyltransferase inhibitor, 5-azacytidine (5-Aza), with its anti-inflammatory benefits, might attenuate bleomycin-induced ALI through the alleviation of inflammation in the lung. We quantified white blood cells with cell blood count (CBC) test, lung inflammation by analyzing cells in the collected bronchoalveolar lavage fluid (BALF) and histological analysis of the lung tissues, and gene expression levels by real-time PCR. Intratracheal administration of bleomycin in mice induced pulmonary inflammation, characterized by increased neutrophil infiltration and inflammatory cytokine expression in the lungs. Mice treated with 5-Aza showed a significant reduction of lung neutrophilia, together with lower expressions of CXCL2 and MCP-1. Furthermore, 5-Aza treatment decreased the expression of proinflammatory cytokines in the lung tissue. Collectively, our data show that DNA methyltransferase inhibitor can alleviate the lung inflammation of bleomycin-induced ALI, indicating an alternative treatment option for the inflammation-triggered lung injury.

Using patient self-checklist to improve the documentation of risk of postoperative nausea and vomiting: an implementation project.

BACKGROUND AND AIMS: Postoperative nausea and vomiting (PONV) is a common surgical complication, affecting 30-50% of patients and 80% in high risk populations. Successful prevention and management of PONV relies on accurately assessing individual risk prior to surgery. A valid and reliable Apfel score is commonly used to assess patients' risk. It is however challenging to translate this evidence into clinical practice. This evidence-based project aimed to identify the current practice of assessing and documenting the risk factors of PONV prior to surgery, and to develop strategies to improve the practice. METHODS: The project had three phrases, including forming a team and conducting the baseline audit; identifying problems and developing strategies; and conducting a follow-up tool to assess the impact on compliance with best practice. A research team was formed. A baseline audit was conducted at a public hospital in Victoria in June 2016 to examine PONV risk assessment practice through checking medical files of surgical patients. A getting research into practice audit and feedback tool was used to identify barriers, implementation strategies, stakeholders and resources. After implementation, a second audit was conducted between June and October 2017. Audit criteria were based on a reliable and valid Apfel score. RESULTS: At baseline, accurate PONV risk could only be calculated from 8% of patient files with no file formally recording the risk factors. The proportion of patients with three risk factors preoperatively, indicating high PONV risk, was 5.3%. Barriers identified were the perceived lack of necessity to record the risk, time constraint and too much paperwork. A self-checklist for risk assessment was developed to enable patients to check their own level of risk. Its face validity, construct validity and accuracy were examined. The checklist was then implemented for patients to complete prior to surgery. A number of strategies were used to improve the implementation. The second audit of 1308 files showed that at the end of audit period, 74% of patients had risk assessment conducted and documented postimplementation. 16.8% of the patients were identified as having high PONV risk, nearly triple the number identified at baseline. CONCLUSION: A simple self-checklist of PONV risk was implemented. It greatly improved PONV risk assessment and documentation in a public hospital in Australia and enabled the identification of patients at high risk.

Measuring the impact of cushion design on buttocks tissue deformation: An MRI approach.

AIM: To establish a research approach for describing how different wheelchair cushion designs impact buttocks tissue deformation during sitting. MATERIALS AND METHODS: The buttocks of 4 individuals with spinal cord injury and significant atrophy were scanned sitting in a FONAR Upright MRI. Scans were collected with the individuals' buttocks fully suspended without pelvic support, and seated on 3 different commercially available wheelchair cushions. Multi-planar scans were analyzed to provide 3D renderings and measurements of tissue thickness and shape. RESULTS: Bulk tissue thicknesses at the ischium, which rarely included muscle, were reduced by more than 60% on enveloping cushion designs studied (i.e., Roho HP and Matrx Vi), and more variably (23-60%) on an orthotic off-loading design (i.e., Java). Adipose was typically displaced posterior and superior from the unloaded condition, with more lateral displacement on the Roho HP and Matrx Vi and more medial displacement present on the Java. Large changes in angle at the sacro-coccygeal joint indicated significant loading on the region. Deformation at the greater trochanter was more consistent across surfaces. Greater interface pressures tended to be associated with greater deformation, but the relationship varied by individuals and was highly non-linear. CONCLUSIONS: The buttocks in this study all deformed significantly, but at different locations and in different manners across all 3 surfaces. Attention needs to be paid to the regions of greatest deformation. A future metric of shape compliance should consider cushion performance at all high risk regions, and changes to the amount and shape of tissue in the regions of interest.

Development and evaluation of a novel smart device-based application for burn assessment and management.

We have developed a novel software application that provides a simple and interactive Lund-Browder diagram for automatic calculation of total body surface area (TBSA) burned, fluid formula recommendations, and serial wound photography on a smart device platform. The software was developed for the iPad (Apple, Cupertino, CA) smart device platforms. Ten burns ranging from 5 to 95% TBSA were computer generated on a patient care simulator using Adobe Photoshop CS6 (Adobe, San Jose, CA). Burn clinicians calculated the TBSA first using a paper-based Lund-Browder diagram. Following a one-week "washout period", the same clinicians calculated TBSA using the smart device application. Simulated burns were presented in a random fashion and clinicians were timed. Percent TBSA burned calculated by Peregrine vs. the paper-based Lund-Browder were similar (29.53 [25.57] vs. 28.99 [25.01], p=0.22, n=7). On average, Peregrine allowed users to calculate burn size significantly faster than the paper form (58.18 [31.46] vs. 90.22 [60.60]s, p<0.001, n=7). The smart device application also provided 5 megapixel photography capabilities, and acute burn resuscitation fluid calculator. We developed an innovative smart device application that enables accurate and rapid burn size assessment to be cost-effective and widely accessible.

Role of MT1 melatonin receptors in methamphetamine-induced locomotor sensitization in C57BL/6 mice.

RATIONALE: Melatonin modifies physiological and behavioral responses to psychostimulants, with the MT1 and MT2 melatonin receptors specifically implicated in facilitating methamphetamine (METH)-induced sensitization in melatonin-proficient mice. OBJECTIVE: The objective of the study is to assess differences in locomotor sensitization after a single dose of methamphetamine in low-melatonin-expressing C57BL/6 wild-type and MT1 receptor knockout (MT1KO) mice, comparing with melatonin-expressing C3H/HeN mice. METHODS: Mice received a vehicle or methamphetamine (1.2 mg/kg, i.p.) pretreatment (day 1) during the light (ZT5-9) or dark (ZT 19-21) periods in novel test arenas. Locomotor sensitization was assessed by methamphetamine challenge after an eight-day abstinence (day 9). TH protein expression was evaluated by immunofluorescence and Western blot analysis. RESULTS: Methamphetamine pretreatment induced statistically significant locomotor sensitization upon challenge after eight-day abstinence in C3H and C57 wild-type mice during the light period. The magnitude of sensitization in C57 mice was diminished in the dark period and completely abrogated in MT1KO mice. No differences were observed in tyrosine hydroxylase immunoreactivity in the mesolimbic dopamine system. Additional exposures to the test arenas after methamphetamine pretreatment (nights 2-6) enhanced sensitization. CONCLUSIONS: Deletion of the MT1 melatonin receptor abolishes sensitization induced by a single METH pretreatment. The magnitude of sensitization is also altered by time of day and contextual cues. We conclude that the MT1 melatonin receptor is emerging as a novel target of therapeutic intervention for drug abuse disorders.

Pediatric musculoskeletal nuclear medicine.

This article reviews the current role of nuclear medicine in common benign and malignant pediatric musculoskeletal conditions and discusses future applications.

High-resolution breath-hold contrast-enhanced MR angiography of the entire carotid circulation.

OBJECTIVE: The purpose of this study was to evaluate the effect of breathing on image quality of the aortic arch and carotid vessels during contrast-enhanced MR angiography and to show that high-resolution breath-hold contrast-enhanced MR angiography combined with a timing-bolus technique can produce high-quality images of the entire carotid circulation. MATERIALS AND METHODS: Forty patients underwent high-resolution contrast-enhanced MR angiography on a 1.5-T Magnetom Symphony. A coronal three-dimensional (3D) gradient-echo sequence (TR/TE, 4.36/1.64; flip angle, 25 degrees) with asymmetric k-space acquisition was used. The 136 x 512 matrix yielded voxel sizes of 1.33 x 0.64 x 1.0 mm. A timing-bolus acquisition, orientated in the coronal plane to include the aortic arch, was obtained initially during free-breathing. Twenty milliliters of gadopenetate dimeglumine was injected at 2 mL/sec. Unenhanced and enhanced 3D volumes were recorded. A subtracted 3D set was calculated and subjected to a maximum-intensity-projection algorithm. Half of the patients held their breath during angiography and the other half did not. Aortic arch motion was measured on the timing-bolus acquisition as the distance moved by a single pixel in both the x and y directions. Maximum-intensity-projection MR images were assessed independently by two observers, and vessel sharpness was scored on a scale of 1-5. Sharpness was also assessed quantitatively by generating a signal intensity profile across the aortic arch vessel wall and calculating the average of the upslope and downslope at full-width half maximum. Visualization of carotid branch vessels was scored on a scale of 0-5, and venous contamination was scored on a scale of 0-3. RESULTS: Average in-plane aortic arch movement was 10.3 mm in the x direction and 8.7 mm in the y direction. Quantitative and qualitative sharpness of the aortic arch and great vessel origins was better (p < 0.05) during breath-holding than during non-breath-holding. No difference in the sharpness of the carotid vessels was noted between the two groups. Carotid branch vessels were well visualized from the aortic arch to the intracerebral circulation. The average venous contamination score was 0.56. CONCLUSION: Breath-holding greatly improves the sharpness of the aortic arch and great vessel origins but has no effect on visualization of the carotid vessels. High-resolution breath-hold contrast-enhanced MR angiography can produce high-quality, artifact-free images of the entire carotid circulation from the aortic arch to the intracerebral circulation.