Estimation of Surgical Blood Loss by Anesthesia and Surgical Trainees: Impact of an Educational Intervention on Interrater Reliability.

Intraoperative blood loss estimation by members of the anesthesia and surgical teams is often inaccurate, with potentially detrimental clinical consequences. Despite this, few trainees receive standardized training in blood loss estimation. This study examined the impact of an educational intervention for visual blood loss estimation on anesthesia and surgical trainees' accuracy and interrater reliability. A quasi-experimental study was conducted with student registered nurse anesthetists (SRNAs) and orthopedic surgery residents. The groups' mean visual blood loss estimations at 7 simulated stations were compared before and after an educational intervention. Low, moderate, and high blood loss volumes were simulated with common operating room materials and theater blood. Of the 42 participants, 29 (70%) reported no previous formal training in blood loss estimation. Before the educational intervention, orthopedic surgery residents underestimated blood loss values at all stations, whereas the SRNAs tended toward overestimation. Following the educational intervention, there was no significant difference between the groups' mean estimations. Both groups had a significant reduction in estimation error and improved interrater reliability (P<.001). The results of this study demonstrate that a multimodal educational intervention can improve visual blood loss estimations by surgical and anesthesia trainees, supporting implementation of such programs during anesthesia and surgical training.

The Role of Metabotropic Glutamate Receptor 1 Dependent Signaling in Glioma Viability.

Glioma refers to malignant central nervous system tumors that have histologic characteristics in common with glial cells. The most prevalent type, glioblastoma multiforme, is associated with a poor prognosis and few treatment options. On the basis of reports of aberrant expression of mGluR1 mRNA in glioma, evidence that melanoma growth is directly influenced by glutamate metabotropic receptor 1 (mGluR1), and characterization of ß-arrestin-dependent prosurvival signaling by this receptor, this study investigated the hypothesis that glioma cell lines aberrantly express mGluR1 and depend on mGluR1-mediated signaling to maintain viability and proliferation. Three glioma cell lines (Hs683, A172, and U87) were tested to confirm mGluR1 mRNA expression and the dependence of glioma cell viability on glutamate. Pharmacologic and genetic evidence is presented that suggests mGluR1 signaling specifically supports glioma proliferation and viability. For example, selective noncompetitive antagonists of mGluR1, CPCCOEt and JNJ16259685, decreased the viability of these cells in a dose-dependent manner, and glutamate metabotropic receptor 1 gene silencing significantly reduced glioma cell proliferation. Also, results of an anchorage-independent growth assay suggested that noncompetitive antagonism of mGluR1 may decrease the tumorigenic potential of Hs683 glioma cells. Finally, data are provided that support the hypothesis that a ß-arrestin-dependent signaling cascade may be involved in glutamate-stimulated viability in glioma cells and that ligand bias may exist at mGluR1 expressed in these cells. Taken together, the results strongly suggest that mGluR1 may act as a proto-oncogene in glioma and be a viable drug target in glioma treatment.

Atypical signaling of metabotropic glutamate receptor 1 in human melanoma cells.

The metabotropic glutamate 1 (mGlu1) receptor has emerged as a novel target for the treatment of metastatic melanoma and various other cancers. Our laboratory has demonstrated that a selective, non-competitive mGlu1 receptor antagonist slows human melanoma growth in vitro and in vivo. In this study, we sought to determine if the activation of a canonical G protein-dependent signal transduction cascade, which is often used as an output of mGlu1 receptor activity in neuronal cells, correlated with mGlu1 receptor-mediated melanoma cell viability. Glutamate, the endogenous ligand of mGlu1 receptors, significantly increased melanoma cell viability, but did not stimulate phosphoinositide (PI) hydrolysis in several human melanoma cell lines. In contrast, melanoma cell viability was not increased by quisqualate, a highly potent mGlu1 receptor agonist, or DHPG, a selective group I mGlu receptor agonist. Similarly to glutamate, quisqualate also failed to stimulate PI hydrolysis in mGlu1 receptor-expressing melanoma cells. These results suggest that the canonical G protein-dependent signal transduction cascade is not coupled to mGlu1 receptors in all human melanoma cells. On the other hand, dynamin inhibition selectively decreased viability of mGlu1 receptor-expressing melanoma cells, suggesting that a mechanism requiring internalization may control melanoma cell viability. Taken together, these data demonstrate that the approaches commonly used to study mGlu1 receptor function and signaling in other systems may be inappropriate for studying mGlu1 receptor-mediated melanoma cell viability.