Nerve cross-sectional area in extremes of age.

INTRODUCTION: Nerve cross-sectional area reference values have been reported for many nerves, but there have been few studies in pediatric and geriatric populations. This study was conducted to determine the influence of age on nerve cross-sectional area. METHODS: Thirty-two children (3 months to 16 years) and 20 geriatric adults (67-92 years) without known neurologic conditions underwent bilateral ultrasound to measure the area of the following nerves: median at the wrist and forearm; ulnar at the wrist and elbow; radial in the spiral groove; sciatic in the distal thigh; fibular at the knee; tibial at the knee and ankle; and sural at the ankle. RESULTS: In general, nerve cross-sectional area increased with age. Nerve size correlated most closely with age, but a correlation was also seen with body mass index. CONCLUSIONS: Nerve cross-sectional area increases with age, which is important to note when using ultrasound to evaluate children and geriatric patients.

Pro-anorexia websites: what a clinician should know.

OBJECTIVE: The purpose of this study was to conduct a content analysis of the "Tips and Tricks" section of pro-ana websites to better understand information shared on these sites, and aide clinicians in identification, treatment, and prevention of anorexia. METHOD: Nine pro-ana websites were evaluated to identify categories of information in "Tips and Tricks." A content analysis was performed using emergent coding methods and 16 categories were determined. Reliability was acceptable (Cohen's Kappa = 0.702). Discrepancies were corrected by consensus. Frequencies of individual categories were computed. RESULTS: Most "Tips and Tricks" are directed at dieting/restricting calories (28.6%) and distraction (14.0%). Most disturbing, 11% of comments were directed at lying and concealing symptoms. DISCUSSION: Clinicians aware of "Tips and Tricks" might be better equipped to recognize the symptoms of anorexia early in treatment. Knowledge of "Tips and Tricks" can also facilitate better education, making it difficult for clients to conceal their illness.

Education Research: Neurology resident education: Trending skills, confidence, and professional preparation.

OBJECTIVE: To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. METHODS: An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. RESULTS: Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. DISCUSSION: Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training.

International issues: Obtaining an adult neurology residency position in the United States: an overview.

Around the world, there are marked differences in neurology training, including training duration and degree of specialization. In the United States, adult neurology residency is composed of 1 year of internal medicine training (preliminary year) and 3 years of neurology-specific training. Child neurology, which is not the focus of this article, is 2 years of pediatrics and 3 years of neurology training. The route to adult neurology residency training in the United States is standardized and is similar to most other US specialties. Whereas US medical graduates often receive stepwise guidance from their medical school regarding application for residency training, international graduates often enter this complex process with little or no such assistance. Despite this discrepancy, about 10%-15% of residency positions in the United States are filled by international medical graduates.(1,2) In adult neurology specifically, 35% of matched positions were filled by international graduates in 2013, 75% of whom were not US citizens.(1) In an effort to provide a preliminary understanding of the application process and related terminology (table 1) and thereby encourage international residency applicants, we describe the steps necessary to apply for neurology residency in the United States.

Transcranial Doppler identifies a malfunctioning extraventricular drain.

Transcranial Doppler (TCD) is an invaluable tool allowing real-time monitoring of physiologic blood flow velocity changes. We present a case where TCD monitoring for vasospasm after subarachnoid hemorrhage identified blood flow velocity changes consistent with sudden increased intracranial pressure (ICP) due to a malfunctioning extraventricular drain. The primary team was alerted to these findings, and immediately revised her shunt with normalization of ICP and TCD. Serial TCD monitoring allowed identification of an imminently fatal complication in time to allow a life saving intervention. TCD is a portable, inexpensive, real-time tool providing important physiologic data regarding blood flow velocities and intracranial pressure that is crucial to the care of critically ill patients.

Neuromuscular ultrasonography: quantifying muscle and nerve measurements.

Neuromuscular ultrasonography can be used both descriptively and quantitatively in the evaluation of patients with neuromuscular disorders. This article reviews the quantitative use of this technology, particularly measurements of the size and echogenicity of nerve and muscle, as a tool for assessing the severity, progression, and response of these tissues to therapeutic interventions. Neuromuscular ultrasonography has several features, including portability and noninvasiveness, that make it an attractive research tool for advancing the diagnosis and treatment of neuromuscular disorders.

Mutations within the C-terminus of the gamma subunit of the photosynthetic F1-ATPase activate MgATP hydrolysis and attenuate the stimulatory oxyanion effect.

Two highly conserved amino acid residues near the C-terminus within the gamma subunit of the mitochondrial ATP synthase form a "catch" with an anionic loop on one of the three beta subunits within the catalytic alphabeta hexamer of the F1 segment [Abrahams, J. P., Leslie, A. G. W., Lutter, R., and Walker, J. E. (1994) Nature 370, 621-628]. Forming the catch is considered to be an essential step in cooperative nucleotide binding leading to gamma subunit rotation. The analogous residues, Arg304 and Gln305, in the chloroplast F1 gamma subunit were changed to leucine and alanine, respectively. Each mutant gamma was assembled together with alpha and beta subunits from Rhodospirillum rubrum F1 into a hybrid photosynthetic F1 that carries out both MgATPase and CaATPase activities and ATP-dependent gamma rotation [Tucker, W. C., Schwarcz, A., Levine, T., Du, Z., Gromet-Elhanan, Z., Richter, M. L. and Haran, G. (2004) J. Biol. Chem. 279, 47415-47418]. Surprisingly, changing Arg304 to leucine resulted in a more than 2-fold increase in the kcat for MgATP hydrolysis. In contrast, changing Gln305 to alanine had little effect on the kcat but completely abolished the well-known stimulatory effect of the oxyanion sulfite on MgATP hydrolysis. The MgATPase activities of combined mutants with both residues substituted were strongly inhibited, whereas the CaATPase activities were inhibited, but to a lesser extent. The results indicate that the C-terminus of the photosynthetic F1 gamma subunit, like its mitochondrial counterpart, forms a catch with the alpha and beta subunits that modulates the nucleotide binding properties of the catalytic site(s). The catch is likely to be part of an activation mechanism, overcoming inhibition by free mg2+ ions, but is not essential for cooperative nucleotide exchange.