Remodeling of dendrites and spines in the C1q knockout model of genetic epilepsy.

PURPOSE: To determine whether developmental synaptic pruning defects in epileptic C1q-knockout (KO) mice are accompanied by postsynaptic abnormalities in dendrites and/or spines. METHODS: Immunofluorescence staining was performed on biocytin-filled layer Vb pyramidal neurons in sensorimotor cortex. Basal dendritic arbors and their spines were reconstructed with NEUROLUCIDA software, and their morphologic characteristics were quantitated in Neuroexplorer. KEY FINDINGS: Seven to nine completely filled pyramidal neurons were analyzed from the wild-type (WT) and C1q KO groups. Compared to WT controls, KO mice showed significant structural modifications in their basal dendrites including (1) higher density of dendritic spines (0.60 ± 0.03/µm vs. 0.49 ± 0.03/µm dendritic length in WT, p < 0.05); (2) remarkably increased occurrence of thin spines (0.26 ± 0.02/µm vs. 0.14 ± 0.02/µm dendritic length in control, p < 0.01); (3) longer dendritic length (2,680 ± 159 µm vs. 2,119 ± 108 µm in control); and (4) increased branching (22.6 ± 1.9 vs. 16.2 ± 1.3 in WT at 80 µm from soma center, p < 0.05; 12.4 ± 1.4 vs. 8.2 ± 0.6 in WT at 120 µm from soma center, respectively, p < 0.05). Dual immunolabeling demonstrated the expression of putative glutamate receptor 2 (GluR2) on some thin spines. These dendritic alterations are likely postsynaptic structural consequences of failure of synaptic pruning in the C1q KO mice. SIGNIFICANCE: Failure to prune excessive excitatory synapses in C1q KO mice is a likely mechanism underlying abnormalities in postsynaptic dendrites, including increased branching and alterations in spine type and density. It is also possible that seizure activity contributes to these abnormalities. These structural abnormalities, together with increased numbers of excitatory synapses, likely contribute to epileptogenesis in C1q KO mice.

Collaboration in maternity care is achievable and practical.

BACKGROUND: Enhancing collaboration has been highlighted as a marker for future success in maternity care, although this suggestion comes with little methodological guidance. This study assessed the efficacy of a collaborative partnership between obstetric doctors and midwives providing Midwifery Group Practice (MGP) care. METHODS: A retrospective analysis was undertaken with notes from weekly case review meetings held between the obstetricians and midwives over a 12-month period; audio recordings and a prospective analysis of 16 meetings with verbal contributions of the different professions; the number and types of cases discussed and referred, medical records kept at these meetings and a professional satisfaction questionnaire. Consistency of care was measured against the Australian National Midwifery Guidelines for Consultation and Referral. RESULTS: Of the 337 women booked with MGP, 50% were discussed at least once. Of these, 35% were referred for consultation with an obstetrician. Women as 'Patients' were most commonly discussed, followed by educational discussions and anecdotes with equal verbal contributions from midwives and doctors. Plans for each case were recorded 97% of the time, and adhered to 90% of the time. A high level of consistency of care between similar cases (75% of the time) and with the consultation and referral guidelines (85% of the time) were achieved. Professional satisfaction with this model of care rated highly for both groups. CONCLUSION: Inter-professional collaboration between midwifery and obstetric staff is highly attainable within this model of care. This study reinforces the effectiveness of collaboration in the MGP model of care for women of all risk levels and should encourage other maternity care providers to consider adopting this collaborative model.

Partial anomalous pulmonary venous connection in a dog.

A 2-year-old male intact Belgian Malinois was presented for exercise intolerance. A grade III/VI left basilar systolic murmur was detected. Echocardiography revealed moderate right atrial and ventricular dilation and increased pulmonic outflow velocity. Thoracic radiographs showed right heart enlargement and a dilated caudal vena cava. In addition, on the left lateral projection, an enlarged aberrant right cranial pulmonary lobar vein was suspected to be diverging ventrally from the course of the right cranial lobar bronchus and inserting more ventrally than normal in the region of the right atrium. A left-to-right pulmonary vascular shunt was suspected, and the patient underwent further diagnostics under general anesthesia. An agitated saline study was positive, suggestive of a concurrent right to left shunt. A right heart catheterization was performed. Angiography was inconclusive. Oximetry testing revealed an increase in oxygen saturation within the right atrium at the level of the caudal cava supportive of a left-to-right shunt in this region. Computed tomography angiography revealed a large single pulmonary vein that anomalously entered into the caudolateral aspect of the right atrium (left-to-right shunt) and was suspicious for a small arteriovenous malformation between the right caudal pulmonary artery and the right pulmonary vein returning to the left atrium (right to left shunt). The patient was diagnosed with a partial anomalous pulmonary venous connection and a possible arteriovenous malformation.

Audit of budesonide/formoterol prescribing for asthma in community pharmacy in the U.K.

The rapid action of the long acting beta agonist formoterol allows it to be used as both a preventer and reliever in the management of asthma. The Symbicort® SMART dosing regime has been shown to reduce the number of asthma exacerbations. The aim was to determine the current prescribing of Symbicort®, the prescribing of the SMART regimen and the co-prescribing of a short acting beta agonist with this regimen by means of an audit of prescriptions dispensed in a pharmacy multiple in the U.K. Anonymised data were collected on a standard form. Symbicort® prescribing data for six months were extracted from the pharmacy Patient Medication Record (PMR). Data were stratified by age and analysed to determine adherence with Symbicort® SMART prescribing as defined by the U.K. product license. Data were received from 51 of the 118 (43.2%) pharmacies contacted. Complete information from 2484 PMRs was included in the study. 2.81% (70/2484) of patients were prescribed SMART as defined by the U.K. summary of product characteristics. Of the 18-35 year age group 7.44% (27/363) were prescribed SMART correctly. However, Symbicort® was prescribed twice a day and when required, with either the co-prescription of a SABA, or at an unlicensed dose in 2.46% (61/2484) and 0.28% (7/2484) patients respectively. The incidence of Symbicort® SMART prescribing in this study is low but may be underestimated due to unclear dosing instructions.