Supplemental organic trace minerals and a yeast culture product in newly weaned steers: effects of use and delivery method on growth performance and hepatic trace mineral content.

The objective of this study was to determine if supplementation and delivery method of a "stress pack" composed of organic trace minerals and Saccharomyces cerevisiae yeast culture product influenced growth performance, feed efficiency, and hepatic trace mineral concentration in newly weaned steers. Crossbred steers (n = 192; 256 ±â€…14.0 kg) were used in a 49-day receiving phase experiment. Within 36 hours of weaning, steers were weighed, allotted to 24 pens (n = 8 steers/pen; 8 pens/treatment), and randomly assigned to treatments: 1) a traditional receiving diet (CON), 2) a traditional receiving diet plus the "stress-pack" directly in the diet (FORCE), and 3) a traditional receiving diet plus a low-moisture, cooked molasses block fortified with the "stress-pack" (TUB). The "stress-pack" was offered the first 28 day of the 49-day receiving period. Due to adverse weather conditions forecasted on day 1, biopsy samples were collected from a subsample of steers (n = 14 steers) on day 1 to establish hepatic trace mineral concentration baseline. Steers were selected based on the mean body weight (BW) from allotment (day -1) of the pen for collection of subsequent samples (n = 1 steer/pen) on days 14, 28, and 49 for hepatic trace mineral concentration determination. Cumulative dry matter intake (DMI) (P = 0.01) was greater for FORCE compared to CON and TUB. Final BW and average daily gain (ADG) tended (P ≤ 0.10) to be greater for FORCE compared to TUB and CON by 5.4% and 9.4%, respectively. Feed efficiency did not differ between treatments (P = 0.28). A treatment × day interaction (P ≤ 0.01) for hepatic Cu concentration was noted. The FORCE treatment had greater hepatic Cu compared to TUB and CON for the entire period. The steers that received TUB had greater hepatic Cu compared to CON on days 14 and 28, but similar to CON on day 49. The addition of a "stress-pack" to diets offered to newly weaned cattle enhanced hepatic trace mineral concentration, and delivery method influences DMI and daily gain.

Evaluation of a ruminally protected blend of pantothenic acid, pyridoxine, folic acid, biotin, and vitamin B12 on finishing steer growth performance, efficiency of dietary net energy utilization, carcass trait responses, and liver abscess prevalence and severity.

The objective of this study was to determine the influence that a ruminally-protected B-vitamin (RPBV) blend (containing vitamin B5, B6, B7, B9, and B12) had on growth performance, efficiency of dietary net energy utilization, carcass trait responses, and liver abscess severity and prevalence in beef steers fed a finishing diet. Steers (n = 246; initial shrunk body weight [BW] = 411 ±â€…25.8 kg) from two different sources, were used in a 126-d RCBD experiment. Within 48 h after arrival, steers were individually weighed and allotted to 1 of 24 pens (n = 8 to 12 steers; 8 pens per treatment) and randomly assigned to 1 of 3 treatments: (1) No RPBV; (2) RPBV1 at 1 g/steer d-1; 3) RPBV2 at 2 g/steer d-1. During the first 14 d, cattle received two transition diets with increasing concentrate. From days 15 to 126, cattle were fed the final diet containing 53% dry-rolled corn; 23% corn silage; 20% MDGS; and 4% suspended supplement. On the first 28 d, steers of RPBV1 had a greater average daily gain (ADG) and better feed conversion (G:F), both by 9% (quadratic effect, P ≤ 0.02). However, cumulatively, no differences (P ≥ 0.13) among treatments were found for dry-matter intake (DMI), live final BW, ADG, or G:F. Carcass-adjusted final BW, ADG, and G:F were not influenced by treatment (P ≥ 0.59). Additionally, carcass weight, dressing percentage, marbling score, kidney-pelvic-heart fat, or BW at 28% empty body fat did not differ among treatments (P ≥ 0.11). Ribeye area (REA) was altered (quadratic effect, P = 0.02) by treatment; steers from RPBV1 had decreased REA compared to others. Additionally, calculated yield grade (YG) and calculated retail yield (RY) were altered (quadratic effect, P ≤ 0.01) by treatment; steers from RPBV1 had increased YG and decreased RY compared to others. Estimated empty body fatness tended (P = 0.06) to be greater from steers-fed RPBV compared to control. Overall USDA YG distribution was altered by dietary treatment (P = 0.01). The proportions of YG1 and YG5 carcasses were unaffected by treatment, but there was a shift in the proportion of carcasses that graded YG2, YG3, and YG4 among treatments. Distribution of USDA Quality Grade was not altered by treatment (P = 0.53). No treatment differences in liver abscess incidence or severity were observed (P = 0.13). The use of RPBV altered carcass muscularity and rib fat accumulation affecting the overall YG distribution. However, RPBV did not appreciably influence any cumulative growth performance measures or liver abscess outcome.

Theophylline for the management of respiratory disorders in adults in the 21st century: A scoping review from the American College of Clinical Pharmacy Pulmonary Practice and Research Network.

Theophylline is an oral methylxanthine bronchodilator recommended as alternate therapy for the treatment of asthma and chronic obstructive pulmonary disease (COPD). However, it is not generally recommended for the treatment of other respiratory disorders such as obstructive sleep apnea (OSA) or hypoxia. Most clinical practice guidelines rely on evidence published prior to the year 2000 to make these recommendations. This scoping review aimed to gather and characterize evidence describing theophylline for the management of respiratory disorders in adults between January 1, 2000 and December 31, 2020. Databases searched included Ovid MEDLINE, Embase, CINAHL Complete, Scopus, and International Pharmaceutical Abstracts. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Studies were included if they were published in English, theophylline was used for any respiratory disorder, and the study outcomes were disease- or patient-oriented. After removal of duplicates, 841 studies were screened and 55 studies were included. Results aligned with current clinical guideline recommendations relegating theophylline as an alternative therapy for the treatment of respiratory disorders, in favor of inhaled corticosteroids and inhaled bronchodilators. This scoping review identified the need for future research including: theophylline versus other medications deemed alternative therapies for asthma and COPD, meta-analyses of low-dose theophylline, and studies evaluating evidence-based patient-oriented outcomes for OSA, hypoxia, ventilator-induced diaphragmatic dysfunction, and spinal cord injury-related pulmonary function.

Evaluation of vitamin A status on myogenic gene expression and muscle fiber characteristics.

A randomized complete block design experiment with 30 yearling crossbred steers (average BW = 436.3 ± 39.8 kg) fed a steam-flaked corn-based diet was used to evaluate the effects dietary vitamin A (Rovimix A 1000; DSM Nutritional Products Ltd., Sisseln, SUI) supplementation on myogenic gene expression and skeletal muscle fiber characteristics during the finishing phase. Steers were blocked by BW (n = 5 blocks; 6 steers/block), randomly assigned to pens (n = 2 steers/pen), and one of the following treatments: no added vitamin A (0 IU; 0.0 IU/kg of dietary dry matter intake of additional vitamin A), vitamin A supplemented at the estimated requirement (2,200 IU; 2,200 IU/kg of dietary dry matter (DM) of additional vitamin A), and vitamin A supplemented at 5× the estimated requirement (11,000 IU; 11,000 IU/kg of dietary DM of additional vitamin A). After all treatments underwent a 91-d vitamin A depletion period, additional vitamin A was top-dressed at feeding via a ground corn carrier. Blood, longissimus muscle, and liver biopsy samples were obtained on days 0, 28, 56, 84, and 112. Biopsy samples were used for immunohistochemical and mRNA analysis. Sera and liver samples were used to monitor circulating vitamin A and true vitamin A status of the cattle. Expression for myosin heavy chain (MHC)-I diminished and rebounded (P = 0.04) over time. The intermediate fiber type, MHC-IIA, had a similar pattern of expression (P = 0.01) to that of MHC-I. On day 84, C/EBPß expression was also the greatest (P = 0.03). The pattern of PPARγ (P < 0.01) and PPARδ (P < 0.01) expression seemed to mimic that of MHC-I expression, increasing from days 84 to 112. Distribution of MHC-IIA demonstrated a change over time (P = 0.02). Muscle fiber cross-sectional area increased by day (P < 0.01) for each MHC with the notable increase between days 0 and 56. Total nuclei density decreased (P = 0.02) over time. Cells positive for only Myf5 increased (P < 0.01) in density early in the feeding period, then declined, indicating that satellite cells were fusing into fibers. The dual-positive (PAX7+Myf5) nuclei also peaked (P < 0.01) around day 56 then declined. These data indicated that gene expression associated with oxidative proteins may be independent of vitamin A status in yearling cattle.

Chromium propionate supplementation alters animal growth performance, carcass characteristics, and skeletal muscle properties in feedlot steers.

The objective of this study was to evaluate the effects of increasing concentrations of Cr propionate (CrP) on feedlot performance, blood parameters, carcass characteristics, and skeletal muscle fiber properties in feedlot steers. Crossbred steers (n = 32; 367 ± 2.5 kg; 16 pens; 2 hd/pen) were blocked by body weight (BW), and treatment was randomly assigned to pen: (1) 0 mg added Cr/kg diet dry matter (DM) (control), (2) 0.15 mg added Cr/kg diet DM (CrP; KemTRACE Chromium 0.04%, Kemin Industries, Des Moines, IA), (3) 0.30 mg added Cr/kg diet DM, and (4) 0.45 mg added Cr/kg diet DM. Steers were fed ad libitum, and the treatment was top-dressed at the time of feeding. Body weights, blood samples, and longissimus biopsies were collected before feeding on days 0, 28, 56, 91, 119, and 147. Blood sera were harvested for analysis of glucose, insulin, sera urea nitrogen, and non-esterified fatty acid concentrations. Longissimus biopsies were collected for gene expression, protein expression, and immunohistochemical (IHC) analysis. Pen was the experimental unit for live and carcass data, and steer was the experimental unit with day as a repeated measure for sera and IHC analyses. For the entire duration of the trial, a linear increase in average daily gain (ADG) (P = 0.01) and improvement in G:F was observed (P = 0.01) with no change in DMI (P = 0.11) with increasing CrP. A linear increase in hot carcass weight (HCW) (P ≤ 0.01) with no other changes in carcass composition were noted (P ≥ 0.38) as the level of dietary CrP increased. There was no effect of treatment on any sera parameters measured (P ≥ 0.10). No difference was detected for gene or protein expression of glucose transporter type 4 (GLUT4) due to CrP supplementation (P ≥ 0.10). For skeletal muscle fiber distribution and cross-sectional area, there was no effect of treatment (P ≥ 0.10). Density of total GLUT4 did not change due to CrP (P ≥ 0.10). Internalization of GLUT4 was increased in the 0.30 and 0.45 mg/kg treatments (P < 0.01). For total nuclei density and myonuclei density, there were treatment × day interaction tendencies (P ≤ 0.08). Supplementation of CrP did not alter density of satellite cells (P ≥ 0.10). The number of transporters located in the sarcolemma of skeletal muscle fibers did decrease, implying fewer proteins were needed to transport extracellular glucose into the muscle fiber. Therefore, CrP may augment cellular function and growth via increased efficiency of GLUT4 function. These results indicated CrP increases BW, ADG, and HCW, without changes in circulating sera parameters or total GLUT4 expression.

Evaluation of the dietary vitamin A requirement of finishing steers via systematic depletion and repletion, and its effects on performance and carcass characteristics.

A randomized complete block design experiment with 30 yearling crossbred steers (initial average body weight [BW] = 297.6 ± 32.8 kg) fed a steam-flaked corn-based diet was used to evaluate finishing performance and carcass characteristics when provided with different concentrations of vitamin A (Rovimix A 1000; DSM Nutritional Products Ltd., Sisseln, Switzerland) subsequent to a depletion phase. Steers were blocked by BW (n = 5 blocks; 6 steers per block), assigned to pens (n = 2 steers per pen), and randomly assigned to one of the following dietary treatments: no added vitamin A (0IU; 0.0 IU/kg dry matter [DM] basis of additional vitamin A), vitamin A supplemented at the estimated National Academies of Sciences, Engineering, and Medicine (NASEM) requirement (2,200IU; 2,200 IU/kg of dietary DM of additional vitamin A), and vitamin A supplemented at 5× the estimated requirement (11,000IU; 11,000 IU/kg of dietary DM of additional vitamin A). The basal diet included minimal vitamin A activity (<200 IU of vitamin A activity/kg of dietary DM) via the provitamin A, beta-carotene. After all animals underwent a 91-d vitamin A depletion period, additional vitamin A was top-dressed at feeding via a ground corn carrier. Liver biopsy samples, BW, and blood were obtained on days -91, -35, 0, 28, 56, 84, and 112. Final BW was collected prior to shipping on day 112. Carcass data were collected by trained personnel upon harvest. Sera and liver samples were used to monitor circulating vitamin A and evaluate true vitamin A status of the cattle. Vitamin A status did not affect interim average daily gain or feed efficiency (G:F; P > 0.05). Throughout the duration of the study, dry matter intake for the 0IU cattle was depressed (P = 0.01). Differences were not observed across treatments for hot carcass weight, rib eye area, back fat thickness, kidney-pelvic-heart fat %, marbling score, or dressing percent (P ≥ 0.10). A treatment × day interaction occurred for both (P < 0.01) sera retinol and liver retinol during phase 2 of the trial. The treatments and sera retinol concentrations were incorporated into a repletion model, resulting in an estimation of liver retinol changes (P < 0.01; R2 = 0.682). However, models used to evaluate depleted animals were less effective. The current NASEM recommended that vitamin A requirement of 2,200 IU/kg is adequate for repletion of vitamin A status of feedlot steers.

Effects of zinc propionate supplementation on growth performance, skeletal muscle fiber, and receptor characteristics in beef steers.

A randomized complete block design experiment with 32 yearling crossbred steers (average body weight [BW] = 442 ± 17.0 kg) fed a steam-flaked corn-based diet was used to evaluate the effects of dietary Zn (KemTRACE Zn propionate 27; Kemin Industries, Inc., Des Moines, IA) supplementation on live growth performance, skeletal muscle fiber, and beta-adrenergic receptor (ß-AR) characteristics during the finishing phase. Steers were blocked by BW (n = 4 blocks; 8 steers/block), assigned to pens (n = 4 steers/pen), and randomly assigned to the following treatments: control (CON; 0.0 g/[head (hd) · d] of additional Zn) or additional dietary Zn (ZnP; 1.0 g/[hd · d] additional Zn). The basal diet contained Zn (60 ppm dry matter basis) from ZnSO4; additional Zn was top-dressed at feeding. Ractopamine hydrochloride (RH; Optaflexx: Elanco Animal Health, Greenfield, IN) was included at 300 mg/(hd · d) for the final 28 d of the 111-d feeding period. Longissimus muscle biopsy samples, BW, and blood were obtained on days 0, 42, 79, and 107. Final BW was collected prior to shipping on day 111. Biopsy samples were used for immunohistochemical (IHC), mRNA, and protein analysis. Serum urea nitrogen (SUN) and nonesterified fatty acid (NEFA) concentrations were measured. Steers fed ZnP had a greater average daily gain (P = 0.02) and gain to feed ratio (G:F; P = 0.03) during the RH feeding period compared with CON. There were no differences (P > 0.05) in other growth performance variables, carcass traits, mRNA abundance, or relative protein concentration for fiber type and ß-AR. Fiber types I and IIA had no differences in the cross-sectional area; however, the IIX area was greater for CON (P < 0.04) compared with ZnP and increased (P < 0.02) over time. There were no differences between treatments for the ß1-AR density (P > 0.05) in skeletal muscle tissue throughout the study. A treatment × day interaction was observed in ß2-AR density (P = 0.02) and ß3-AR density (P = 0.02) during the RH feeding period, where the abundance of the receptors increased with ZnP but did not change in CON. Compared with CON, ZnP had greater (P < 0.01) mean NEFA concentrations. Mean SUN concentrations did increase by day (P < 0.01). Additional dietary Zn, supplied as Zn propionate, upregulates ß2-AR and ß3-AR and improves growth performance in feedlot steers during the RH feeding period, likely through a shift of resource utilization from lipogenesis to muscle maintenance and hypertrophy.

Screening of nutritional and genetic anemias using elastic light scattering.

Anemia affects more than » of the world's population, mostly concentrated in low-resource areas, and carries serious health risks. Yet current screening methods are inadequate due to their inability to separate iron deficiency anemia (IDA) from genetic anemias such as thalassemia trait (TT), thus preventing targeted supplementation of oral iron. Here we present an accurate approach to diagnose anemia and anemia type using measures of pediatric red cell morphology determined through machine learning applied to optical light scattering measurements. A partial least squares model shows that our system can accurately extract mean cell volume, red cell size heterogeneity, and mean cell hemoglobin concentration with high accuracy. These clinical parameters (or the raw data itself) can be submitted to machine learning algorithms such as quadratic discriminants or support vector machines to classify a patient into healthy, IDA, or TT. A clinical trial conducted on 268 Chinese children, of which 49 had IDA and 24 had TT, shows >98% sensitivity and specificity for diagnosing anemia, with 81% sensitivity and 86% specificity for discriminating IDA and TT. The majority of the misdiagnoses are IDA patients with particularly severe anemia, possibly requiring hospital care. Therefore, in a screening paradigm where anyone testing positive for TT is sent to the hospital for gold-standard diagnosis and care, we maximize patient benefit while minimizing use of scarce resources.

A new red cell index and portable RBC analyzer for screening of iron deficiency and Thalassemia minor in a Chinese population.

Anemia is a widespread public health problem with 1/4 ~1/3 of the world's population being affected. In Southeast Asia, Thalassemia trait (TT) and iron deficiency anemia (IDA) are the two most common anemia types and can have a serious impact on quality of life. IDA patients can be treated with iron supplementation, yet TT patients have diminished capacity to process iron. Therefore, distinguishing between types of anemia is essential for effective diagnosis and treatment. Here, we present two advances towards low-cost screening for anemia. First: a new red-cell-based index, Joint Indicator A, to discriminate between IDA, TT, and healthy children in a Chinese population. We collected retrospective data from 384 Chinese children and used discriminant function analysis to determine the best analytic function to separate healthy and diseased groups, achieving 94% sensitivity and 90% specificity, significantly higher than reported indices. This result is achieved using only three red cell parameters: mean cell volume (MCV), red cell distribution width (RDW) and mean cell hemoglobin concentration (MCHC). Our second advance: the development of a low cost, portable red cell analyzer to measure these parameters. Taken together, these two results may help pave the way for widespread screening for nutritional and genetic anemias.

A Novel Protocol Obviates Endoscope Sampling for Carbapenem-Resistant Enterobacteriaceae: Experience of a Center with a Prior Outbreak.

BACKGROUND: Numerous published outbreaks, including one from our institution, have described endoscope-associated transmission of multidrug-resistant organisms (MDROs). Individual centers have adopted their own protocols to address this issue, including endoscope culture and sequestration. Endoscope culturing has drawbacks and may allow residual bacteria, including MDROs, to go undetected after high-level disinfection. AIM: To report the outcome of our novel protocol, which does not utilize endoscope culturing, to address our outbreak. METHODS: All patients undergoing procedures with elevator-containing endoscopes were asked to permit performance of a rectal swab. All endoscopes underwent high-level disinfection according to updated manufacturer's guidance. Additionally, ethylene oxide (EtO) sterilization was done in the high-risk settings of (1) positive response to a pre-procedure risk stratification questionnaire, (2) positive or indeterminate CRE polymerase chain reaction (PCR) from rectal swab, (3) refusal to consent for PCR or questionnaire, (4) purulent cholangitis or infected pancreatic fluid collections. Two endoscopes per weekend were sterilized on a rotational basis. RESULTS: From September 1, 2015 to April 30, 2016, 556 endoscopy sessions were performed using elevator-containing endoscopes. Prompted EtO sterilization was done on 46 (8.3%) instances, 3 from positive/indeterminate PCR tests out of 530 samples (0.6%). No CRE transmission was observed during the study period. Damage or altered performance of endoscopes related to EtO was not observed. CONCLUSION: In this pilot study, prompted EtO sterilization in high-risk patients has thus far eliminated endoscope-associated MDRO transmission, although no CRE infections were noted throughout the institution during the study period. Further studies and a larger patient sample will be required to validate these findings.

Self-Expanding Metal Stents Improve Swallowing and Maintain Nutrition During Neoadjuvant Therapy for Esophageal Cancer.

BACKGROUND: Patients with locally advanced esophageal cancer can have significant dysphagia. Nutritional support during neoadjuvant therapy is often delivered via nasoenteric or percutaneous feeding tubes. These approaches do not allow for per-oral feeding. AIMS: Evaluate the safety and efficacy of fully covered self-expanding metal esophageal stents for nutritional support during neoadjuvant therapy. METHODS: This was a pilot, prospective study at a single tertiary center. From March 2012 to May 2013, consecutive patients with esophageal cancer eligible for neoadjuvant therapy were enrolled. Metal stents were placed prior to starting neoadjuvant therapy. Data were collected at baseline and predetermined intervals until an endpoint (surgery or disease progression). Outcomes included dysphagia grade, satisfaction of swallowing score, nutritional status (weight, serum albumin), impact on surgery, and adverse events. RESULTS: Fourteen stents were placed in 12 patients (59.1 ± 9.5 years, 11 men, 1 woman). Dysphagia grade (pre 3.4 ± 0.5 vs post 0.2 ± 0.4, p < 0.0001) and swallowing scores (20.2 ± 5.9 vs 6.3 ± 4.7, p < 0.0001) significantly improved after stent placement. Improvements were sustained throughout neoadjuvant therapy. Body weight and serum albumin levels remained stable. Adverse events included severe chest pain (2), food impaction (1), and delayed stent migration (2). Five patients underwent surgical resection. No significant chemoradiation or operative adverse events occurred due to the presence of a stent. CONCLUSIONS: During neoadjuvant therapy for esophageal cancer, self-expanding metal stents are safe and effective in relieving dysphagia and maintaining nutrition. They allow patients to eat orally, thereby improving patient satisfaction. The presence of an in situ stent did not interfere with surgery.

Re-examining the relationship between number of cochlear implant channels and maximal speech intelligibility.

This study reconsiders the number of effective channels in contemporary cochlear implants. Subjects listened to matrix sentences with a competing talker using their clinical map (up to 22 electrodes) and reduced-channel maps using 12, 8, and 4 electrodes. Spectro-temporal modulation thresholds and reading span were measured to explore intersubject variability. Results show that speech understanding significantly improved with increasing active electrodes up to 22, particularly for subjects with better spectro-temporal resolution. These findings suggest some listeners may be able to utilize the full electrode array and may not be limited to eight channels of information as indicated in previous studies.

Trigeminal and sphenopalatine ganglion stimulation for intractable craniofacial pain--case series and literature review.

INTRODUCTION: Facial pain is often debilitating and can be characterized by a sharp, stabbing, burning, aching, and dysesthetic sensation. Specifically, trigeminal neuropathic pain (TNP), anesthesia dolorosa, and persistent idiopathic facial pain (PIFP) are difficult diseases to treat, can be quite debilitating and an effective, enduring treatment remains elusive. METHODS: We retrospectively reviewed our early experience with stimulation involving the trigeminal and sphenopalatine ganglion stimulation for TNP, anesthesia dolorosa, and PIFP between 2010-2014 to assess the feasibility of implanting at these ganglionic sites. Seven patients received either trigeminal and/or sphenopalatine ganglion stimulation with or without peripheral nerve stimulation, having failed multiple alternative modalities of treatment. The treatments were tailored on the physical location of pain to ensure regional coverage with the stimulation. RESULTS: Fluoroscopy or frameless stereotaxy was utilized to place the sphenopalatine and/or trigeminal ganglion stimulator. All patients were initially trialed before implantation. Trial leads implanted in the pterygopalatine fossa near the sphenopalatine ganglion were implanted via transpterygoid (lateral-medial, infrazygomatic) approach. Trial leads were implanted in the trigeminal ganglion via percutaneous Hartel approach, all of which resulted in masseter contraction. Patients who developed clinically significant pain improvement underwent implantation. The trigeminal ganglion stimulation permanent implants involved placing a grid electrode over Meckel's cave via subtemporal craniotomy, which offered a greater ability to stimulate subdivisions of the trigeminal nerve, without muscular (V3) side effects. Two of the seven overall patients did not respond well to the trial and were not implanted. Five patients reported pain relief with up to 24-month follow-up. Several of the sphenopalatine ganglion stimulation patients had pain relief without any paresthesias. There were no electrode migrations or post-surgical complications. CONCLUSIONS: Refractory facial pain may respond positively to ganglionic forms of stimulation. It appears safe and durable to implant electrodes in the pterygopalatine fossa via a lateral transpterygoid approach. Also, implantation of an electrode grid overlying Meckel's cave appears to be a feasible alternative to the Hartel approach. Further investigation is needed to evaluate the usefulness of these approaches for various facial pain conditions.

Development of inexpensive blood imaging systems: where are we now?

Clinical applications in the developing world, such as malaria and anemia diagnosis, demand a change in the medical paradigm of expensive care given in central locations by highly trained professionals. There has been a recent explosion in optical technologies entering the consumer market through the widespread adoption of smartphones and LEDs. This technology commoditization has enabled the development of small, portable optical imaging systems at an unprecedentedly low cost. Here, we review the state-of-the-field of the application of these systems for low-cost blood imaging with an emphasis on cellular imaging systems. In addition to some promising results addressing specific clinical issues, an overview of the technology landscape is provided. We also discuss several key issues that need to be addressed before these technologies can be commercialized.

Examining the electro-neural interface of cochlear implant users using psychophysics, CT scans, and speech understanding.

This study examines the relationship between focused-stimulation thresholds, electrode positions, and speech understanding in deaf subjects treated with a cochlear implant (CI). Focused stimulation is more selective than monopolar stimulation, which excites broad regions of the cochlea, so may be more sensitive as a probe of neural survival patterns. Focused thresholds are on average higher and more variable across electrodes than monopolar thresholds. We presume that relatively high focused thresholds are the result of larger distances between the electrodes and the neurons. Two factors are likely to contribute to this distance: (1) the physical position of electrodes relative to the modiolus, where the excitable auditory neurons are normally located, and (2) the pattern of neural survival along the length of the cochlea, since local holes in the neural population will increase the distance between an electrode and the nearest neurons. Electrode-to-modiolus distance was measured from high-resolution CT scans of the cochleae of CI users whose focused-stimulation thresholds were also measured. A hierarchical set of linear models of electrode-to-modiolus distance versus threshold showed a significant increase in threshold with electrode-to-modiolus distance (average slope = 11 dB/mm). The residual of these models was hypothesized to reflect neural survival in each subject. Consonant-Nucleus-Consonant (CNC) word scores were significantly correlated with the within-subject variance of threshold (r(2) = 0.82), but not with within-subject variance of electrode distance (r(2) = 0.03). Speech understanding also significantly correlated with how well distance explained each subject's threshold data (r(2) = 0.63). That is, subjects with focused thresholds that were well described by electrode position had better speech scores. Our results suggest that speech understanding is highly impacted by individual patterns of neural survival and that these patterns manifest themselves in how well (or poorly) electrode position predicts focused thresholds.

Wide-dynamic-range forward suppression in marmoset inferior colliculus neurons is generated centrally and accounts for perceptual masking.

An organism's ability to detect and discriminate sensory inputs depends on the recent stimulus history. For example, perceptual detection thresholds for a brief tone can be elevated by as much as 50 dB when following a masking stimulus. Previous work suggests that such forward masking is not a direct result of peripheral neural adaptation; the central pathway apparently modifies the representation in a way that further attenuates the input's response to short probe signals. Here, we show that much of this transformation is complete by the level of the inferior colliculus (IC). Single-neuron extracellular responses were recorded in the central nucleus of the awake marmoset IC. The threshold for a 20 ms probe tone presented at best frequency was determined for various masker-probe delays, over a range of masker sound pressure levels (SPLs) and frequencies. The most striking aspect of the data was the increased potency of forward maskers as their SPL was increased, despite the fact that the excitatory response to the masker was often saturating or nonmonotonic over the same range of levels. This led to probe thresholds at high masker levels that were almost always higher than those observed in the auditory nerve. Probe threshold shifts were not usually caused by a persistent excitatory response to the masker; instead we propose a wide-dynamic-range inhibitory mechanism locked to sound offset as an explanation for several key aspects of the data. These findings further delineate the role of subcortical auditory processing in the generation of a context-dependent representation of ongoing acoustic scenes.