Severe length-dependent peripheral polyneuropathy in a patient with subacute combined spinal cord degeneration secondary to recreational nitrous oxide abuse: A case report and literature review.

Nitrous oxide abuse can have detrimental effects on the central and peripheral nervous systems. This case study report aims to demonstrate a combination of severe generalized sensorimotor polyneuropathy and cervical myelopathy related to vitamin B12 deficiency following nitrous oxide abuse. We present a clinical case study and literature review examining primary research-published between 2012 and 2022-reporting nitrous oxide abuse affecting the spinal cord (myelopathy) and peripheral nerves (polyneuropathy); 35 articles were included in the review with a total of 96 patients, where the mean "patients" age was 23.9 years and were in a 2:1 male/female ratio. Of the 96 cases, within the review, 56% of patients were diagnosed with polyneuropathy, most commonly impacting the nerves of the lower limb (62%), while 70% of patients were diagnosed with myelopathy, most commonly impacting the cervical region (78%) on the spinal cord. In our clinical case study, a 28-year-old male underwent a multitude of diagnostic investigations for bilateral "foot drop" and sense of lower limb stiffness as ongoing complications of a vitamin B12 deficiency secondary to recreational nitrous oxide abuse. Both the literature review and our case report emphasize the dangers of recreational nitrous oxide inhalation, colloquially termed "nanging" and the risks it presents to both the central and peripheral nervous systems, which is erroneously considered by many recreational drug users to be less harmful than other illicit substances.

Isolated systolic hypertension in young males: a scoping review.

Isolated systolic hypertension typically occurs in young males; however, its clinical significance is unknown. Given the prevalence of the hypertension and its contribution to global morbidity and mortality, a synthesis of the most recent available evidence around isolated systolic hypertension is warranted. This review aims firstly to review the haemodynamic and physical characteristics indicative of cardiovascular risk in young males (aged 18 to 30 years) with isolated systolic hypertension, and secondly to synthesize the associated clinical management recommendations reported in the literature. Six databases were systematically searched for all relevant peer-reviewed literature examining isolated systolic hypertension in young males. Search results were screened and examined for validity, those that did not meet the inclusion criteria were removed. A total of 20 articles were appropriate for inclusion. Key factors indicative of cardiovascular risk in isolated systolic hypertension were characterized by several distinctive haemodynamic parameters and physical characteristics. After the literature was synthesized based around these key factors, two distinct cohorts (healthy and unhealthy) were highlighted. The healthy cohort of younger males with isolated systolic hypertension was associated with a decreased cardiovascular risk and therefore no medical interventions were recommended. The second (unhealthy) cohort was, however, associated with an increased cardiovascular risk and may therefore, benefit from antihypertensive therapy.

Nursing students' perceptions of clinical relevance and engagement with bioscience education: A cross-sectional study of undergraduate and postgraduate nursing students.

BACKGROUND: Bioscience in nursing education covers a broad range of disciplinary areas (anatomy, physiology, pathophysiology and pharmacology) and underpins clinical assessment and critical thinking in nursing practice. This is imperative for patient safety and favourable patient outcomes. In nursing programs for registration, most bioscience content is taught during the early phases of the program and little incorporated into postgraduate nursing programs. OBJECTIVES: The aim of this study was to explore student's perceived relationship between clinical relevance and engagement (attention and time) with bioscience content, by surveying undergraduates and postgraduate nursing students. DESIGN: This sequential mixed methods study included two phases. METHODS: The first phase comprised of focus group interviews from one Australian University. Thematic analysis of these data, coupled with existing literature, informed the second study phase; a quantitative questionnaire. PARTICIPANTS: Focus group interviews included N = 30 students from one tertiary site; 10 from each year level. The questionnaire was administered to nursing students undertaking undergraduate nursing studies (1st, 2nd & 3rd years), and postgraduate nursing studies. RESULTS: Nursing students (n = 406) across three Australian universities (four programmes) completed the questionnaire. The clinical relevance of bioscience was widely appreciated; 91.6% of undergraduate nursing students and 98.5% of postgraduate nursing students indicated that every nurse must have a good understanding of bioscience. However, there was an inverse relationship between engagement with bioscience and timing in the curriculum, as 50% of undergraduate nursing students indicated that bioscience content took up too much of their time, compared to only 20% of postgraduate nurses (odds ratio 0.27 [0.16-0.46], p < 0.001). CONCLUSION: Nursing students' perceptions of the clinical relevance of bioscience for their career strongly corresponds with their progression through their studies. Unfortunately, as students progress to the later years of their nursing education, their engagement with formal bioscience education decreases. This poses the question 'Are we delivering bioscience content to nursing students at the appropriate time?'

Blood culture contamination in the emergency department: An integrative review of strategies to prevent blood culture contamination.

BACKGROUND: Blood culture collection remains the gold standard to diagnose bacteraemia. Current evidence suggests that the emergency department (ED) often has blood culture contamination (BCC) rates above the recommended 3%, contributing to increased hospital length of stay, unnecessary or inappropriate antimicrobial treatment, and increased economic burden. The aim of this review is to identify effective strategies to improve blood culture collection in EDs to decrease contamination rates and improve patient safety. METHODS: An integrative literature review methodology was utilised to conduct a structured search of contemporary literature using CINAHL, Embase, Medline, Pubmed and Scopus databases. All eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool. RESULTS: Eleven reports were included in the final review, which identified bundled approaches, education and feedback, equipment and technique, and stakeholder engagement as strategies that improve BCC rates in the ED. CONCLUSIONS: All studies reported a reduction in BCC rates regardless of the strategies implemented. A bundled approach yielded the most significant results and was identified to be practical, inexpensive, and adaptable. Further research focusing on specific aspects of a bundled approach may be beneficial to understand which strategies are most effective.

Biophysical properties of cells for cancer diagnosis.

Biophysical properties associated with the microenvironment of a tumor has been recognized as an important modulator for cell behaviour and function. Particularly, tissue rigidity is important during tumor carcinogenesis as it affects the tumor's ability to metastasis. Multiple downstream pathways are affected with a difference in rigidity of the extracellular matrix. The insight into tumor mechanosignalling represents a promising field that may lead to novel approaches for cancer diagnostics. Measurement of rigidity of the extracellular matrix or the tissue is a potential diagnostics approach for cancer detection. Altered extracellular matrix states persist for a long period of time and have lower heterogeneity compared to protein or genetic markers, therefore are more reliable as biomarkers. On the other hand, measurement of different kinase associated proteins or transcripts provide an early insight into potential transition of cells towards metastasis. Co-localization of transcriptional factors like YAP/TAZ provide an insight to determine if the cells are undergoing metastatic changes. This review explains the unique biophysical properties of the tumor microenvironment that present the potential targets for the diagnosis of cancer.

Montmorency cherry supplementation improves 15-km cycling time-trial performance.

AIM: Montmorency cherries are rich in polyphenols that possess antioxidant, anti-inflammatory and vasoactive properties. We investigated whether 7-day Montmorency cherry powder supplementation improved cycling time-trial (TT) performance. METHODS: 8 trained male cyclists ([Formula: see text]: 62.3 ± 10.1 ml kg-1 min-1) completed 10-min steady-state (SS) cycling at ~ 65% [Formula: see text] followed by a 15-km TT on two occasions. Participants consumed 6 pills per day (Montmorency cherry powder, MC; anthocyanin 257 mg day-1 or dextrose powder, PL) for a 7-day period, 3 pills in the morning and evening. Capillary blood [lactate] was measured at baseline, post SS and post TT. Pulmonary gas exchange and tissue oxygenation index (TOI) of m. vastus lateralis via near-infrared spectroscopy, were measured throughout. RESULTS: TT completion time was 4.6 ± 2.9% faster following MC (1506 ± 86 s) supplementation compared to PL (1580 ± 102 s; P = 0.004). Blood [lactate] was significantly higher in MC after SS (PL: 4.4 ± 2.1 vs. MC: 6.7 ± 3.3 mM, P = 0.017) alongside an elevated baseline TOI (PL: 68.7 ± 2.1 vs. MC: 70.4 ± 2.3%, P = 0.018). DISCUSSION: Montmorency cherry supplementation improved 15-km cycling TT performance. This improvement in exercise performance was accompanied by enhanced muscle oxygenation suggesting that the vasoactive properties of the Montmorency cherry polyphenols may underpin the ergogenic effects.

Youtube for millennial nursing students; using internet technology to support student engagement with bioscience.

Undergraduate nursing programs typically include students with limited 'on-campus' time who need learning resources that are flexible, technologically appropriate, remotely-accessible (mobile smart devices), and above all, engaging. This has presented academics with challenges surrounding institutional security firewalls, password-access requirements, intellectual property/ownership and staff/student privacy. To overcome these challenges a collection of evidence-based YouTube videos, posted on the Biological Sciences YouTube Channel, supported by the Biosciences in Nurse Education, and underpinned by Benner's pedagogical framework, were developed with the intention of moving students from novice to competent clinical bioscience users. The videos are highly successful; with over 310,000 views, 1.5 million minutes of viewing and more than 5000 subscribers since its inception (<20 months). Spontaneous comments as well as evidence from students identified their usefulness, suggesting the videos enrich student experience and performance with perceivably difficult biosciences content. Student confidence and subsequent access of the YouTube videos was enhanced by their familiarity with the presenter and the breadth of information available in small portions, creating a solid basis for the development of bioscience-competent nursing graduates. Moreover, these open source videos provide a free resource for continual revision and professional development informed by an international minimum bioscience standard for nurses post registration.

The Glia Response after Peripheral Nerve Injury: A Comparison between Schwann Cells and Olfactory Ensheathing Cells and Their Uses for Neural Regenerative Therapies.

The peripheral nervous system (PNS) exhibits a much larger capacity for regeneration than the central nervous system (CNS). One reason for this difference is the difference in glial cell types between the two systems. PNS glia respond rapidly to nerve injury by clearing debris from the injury site, supplying essential growth factors and providing structural support; all of which enhances neuronal regeneration. Thus, transplantation of glial cells from the PNS is a very promising therapy for injuries to both the PNS and the CNS. There are two key types of PNS glia: olfactory ensheathing cells (OECs), which populate the olfactory nerve, and Schwann cells (SCs), which are present in the rest of the PNS. These two glial types share many similar morphological and functional characteristics but also exhibit key differences. The olfactory nerve is constantly turning over throughout life, which means OECs are continuously stimulating neural regeneration, whilst SCs only promote regeneration after direct injury to the PNS. This review presents a comparison between these two PNS systems in respect to normal physiology, developmental anatomy, glial functions and their responses to injury. A thorough understanding of the mechanisms and differences between the two systems is crucial for the development of future therapies using transplantation of peripheral glia to treat neural injuries and/or disease.

Cell stretching devices as research tools: engineering and biological considerations.

Cells within the human body are subjected to continuous, cyclic mechanical strain caused by various organ functions, movement, and growth. Cells are well known to have the ability to sense and respond to mechanical stimuli. This process is referred to as mechanotransduction. A better understanding of mechanotransduction is of great interest to clinicians and scientists alike to improve clinical diagnosis and understanding of medical pathology. However, the complexity involved in in vivo biological systems creates a need for better in vitro technologies, which can closely mimic the cells' microenvironment using induced mechanical strain. This technology gap motivates the development of cell stretching devices for better understanding of the cell response to mechanical stimuli. This review focuses on the engineering and biological considerations for the development of such cell stretching devices. The paper discusses different types of stretching concepts, major design consideration and biological aspects of cell stretching and provides a perspective for future development in this research area.

Developing and evaluating effective bioscience learning activities for nursing students.

Effective engagement of nursing students in the study of biosciences remains a challenge for many tertiary institutes. In this study we attempted to implement and then evaluate a simple hands-on intervention, consisting of a series of hands-on games and puzzles, to increase nursing student engagement with core concepts and anatomical learning involved in clinical anatomy and physiology. The study used a quazi-experimental longitudinal before and after design, to explore the effect of a learning intervention on student performance. Set across three different campuses of the same University, it included 1320 first year undergraduate nursing students from 2013 to 2014 who were studying Anatomy and Physiology. Students were exposed to the interventions or not, and concomitant academic performance, weekly quiz scores, performance in fortnightly worksheets and, across the semester, exam performance were compared. The results show that while the intervention appeared to increase academic performance in students on one campus (2013) compared to the other two, this difference was not sustained into 2014 when a bigger cohort was examined. Despite significant subjective student satisfaction and enthusiasm about these learning and teaching interventions, the data does not support the capacity of these activities to enhance student academic performance. Tertiary entrance scores, being a non-native English speakers and socio-economic status all had a bigger impact on student performance than engagement with fun anatomy and physiology activities.

Bilateral Chondroepitrochlearis Muscle: Case Report, Phylogenetic Analysis, and Clinical Significance.

Anomalous muscular variants of pectoralis major have been reported on several occasions in the medical literature. Among them, chondroepitrochlearis is one of the rarest. Therefore, this study aims to provide a comprehensive description of its anatomy and subsequent clinical significance, along with its phylogenetic importance in pectoral muscle evolution with regard to primate posture. The authors suggest a more appropriate name to better reflect its proximal attachment to the costochondral junction and distal attachment to the epicondyle of humerus, as "chondroepicondylaris"; in addition, we suggest a new theory of phylogenetic significance to explain the twisting of pectoralis major tendon in primates that may have occurred with their adoption to bipedalism and arboreal lifestyle. Finally, the clinical significance of this aberrant muscle is elaborated as a cause of potential neurovascular entrapment and as a possible hurdle during axillary surgeries (i.e., mastectomy).

An electromagnetic cell-stretching device for mechanotransduction studies of olfactory ensheathing cells.

Olfactory ensheathing cells (OECs) are primary candidates for cell transplantation therapy to repair spinal cord injury (SCI). However, the post transplantation survival of these cells remains a major hurdle for a success using this therapy. Mechanical stimuli may contribute to the maintenance of these cells and thus, mechanotransduction studies of OECs may serve as a key benefit to identify strategies for improvement in cell transplantation. We developed an electromagnetic cell stretching device based on a single sided uniaxial stretching approach to apply tensile strain to OECs in culture. This paper reports the design, simulation and characterisation of the stretching device with preliminary experimental observations of OECs in vitro. The strain field of the deformable membrane was investigated both experimentally and numerically. Heterogeneity of the device provided an ideal platform for establishing strain requirement for the OEC culture. The cell stretching system developed may serve as a tool in exploring the mechanobiology of OECs for future SCI transplantation research.

Long term recovery of median nerve repair using laser-activated chitosan adhesive films.

Sutures remain the standard peripheral nerve repair technique, whether applied directly or indirectly to nerve tissue. Unfortunately, significant postoperative complications can result, such as inflammation, neuroma formation and foreign body reactions. Photochemical-tissue-bonding (PTB) using rose Bengal (RB) integrated into a chitosan bioadhesive is an alternative nerve repair device that removes the need for sutures. Rats were arranged into three groups: RB-chitosan adhesives-repair, end-to-end epineural suture-repair (surgical standard) and sham laser-irradiated control. Groups were compared through histological assessment, electrophysiological recordings and grip motor strength. RB-chitosan adhesive repaired nerves displayed comparable results when compared to the standard suture-repair based on histological and electrophysiological findings. Functionally, RB-chitosan adhesive was associated with a quicker and more pronounced recovery of grip force when compared to the suture-repair.

Nerve repair: toward a sutureless approach.

Peripheral nerve repair for complete section injuries employ reconstructive techniques that invariably require sutures in their application. Sutures are unable to seal the nerve, thus incapable of preventing leakage of important intraneural fluids from the regenerating nerve. Furthermore, sutures are technically demanding to apply for direct repairs and often induce detrimental scarring that impedes healing and functional recovery. To overcome these limitations, biocompatible and biodegradable glues have been used to seal and repair peripheral nerves. Although creating a sufficient seal, they can lack flexibility and present infection risks or cytotoxicity. Other adhesive biomaterials have recently emerged into practice that are usually based on proteins such as albumin and collagen or polysaccharides like chitosan. These adhesives form their union to nerve tissue by either photothermal (tissue welding) or photochemical (tissue bonding) activation with laser light. These biomaterial adhesives offer significant advantages over sutures, such as their capacity to unite and seal the epineurium, ease of application, reduced invasiveness and add the potential for drug delivery in situ to facilitate regeneration. This paper reviews a number of different peripheral nerve repair (or reconstructive) techniques currently used clinically and in experimental procedures for nerve injuries with or without tissue deficit.

Tissue repair strength using chitosan adhesives with different physical-chemical characteristics.

A range of chitosan-based biomaterials have recently been used to perform sutureless, laser-activated tissue repair. Laser-activation has the advantage of bonding to tissue through a non-contact, aseptic mechanism. Chitosan adhesive films have also been shown to adhere to sheep intestine strongly without any chemical modification to chitosan. In this study, we continue to investigate chitosan adhesive films and explore the impact on the tissue repair strength and tensile strength characteristics of four types of adhesive film based on chitosan with different molecular weight and degree of deacetylation. Results showed that adhesives based on chitosan with medium molecular weight achieved the highest bonding strength, tensile strength and E-modulus when compared to the other adhesives.

Evaluating the performance of Kalman-filter-based EEG source localization.

Electroencephalographic (EEG) source localization is an important tool for noninvasive study of brain dynamics, due to its ability to probe neural activity more directly, with better temporal resolution than other imaging modalities. One promising technique for solving the EEG inverse problem is Kalman filtering, because it provides a natural framework for incorporating dynamic EEG generation models in source localization. Here, a recently developed inverse solution is introduced, which uses spatiotemporal Kalman filtering tuned through likelihood maximization. Standard diagnostic tests for objectively evaluating Kalman filter performance are then described and applied to inverse solutions for simulated and clinical EEG data. These tests, employed for the first time in Kalman-filter-based source localization, check the statistical properties of the innovation and validate the use of likelihood maximization for filter tuning. However, this analysis also reveals that the filter's existing space- and time-invariant process model, which contains a single fixed-frequency resonance, is unable to completely model the complex spatiotemporal dynamics of EEG data. This finding indicates that the algorithm could be improved by allowing the process model parameters to vary in space.

Distinct amygdala-autonomic arousal profiles in response to fear signals in healthy males and females.

The amygdala has a key role in regulating arousal and vigilance, and responds to both visual and vocal signals of fear, including facial expressions of fear. In this study, we used functional MRI to examine sex differences in the magnitude, extent, lateralization and time course of amygdala responses to facial signals of fear, in a relatively large sample of males and females. Skin conductance was recorded simultaneously with functional imaging to examine concomitant changes in emotional arousal, and to provide an independent index of response attenuation. Scanning and skin conductance recording was undertaken during perception of facial fear stimuli. Sex differences were apparent in the laterality and time course of fear perception. In males, the right amygdala and autonomic arousal attenuated over the late half of the experiment. By contrast, females showed persistent bilateral amygdala responses, with a tendency towards greater left amygdala engagement during the late phase. Females also showed a greater general extent of amygdala response. We suggest that distinct evolutionary pressures might contribute to a lower threshold for vigilance to signals of danger in females, reflected in a profile of sustained amygdala-arousal interaction.

A direct brainstem-amygdala-cortical 'alarm' system for subliminal signals of fear.

We examined whether consciously undetected fear signals engage a collateral brainstem pathway to the amygdala and prefrontal cortex in the intact human brain, using functional neuroimaging. 'Blindsight' lesion patients can respond to visual fear signals independently from conscious experience, suggesting that these signals reach the amygdala via a direct pathway that bypasses the primary visual cortex. Electrophysiological evidence points to concomitant involvement of prefrontal regions in automatic orienting to subliminal signals of fear, which may reflect innervation arising from brainstem arousal systems. To approximate blindsight in 22 healthy subjects, facial signals of fear were presented briefly (16.7 ms) and masked such that conscious detection was prevented. Results revealed that subliminal fear signals elicited activity in the brainstem region encompassing the superior colliculus and locus coeruleus, pulvinar and amygdala, and in fronto-temporal regions associated with orienting. These findings suggest that crude sensory input from the superior colliculo-pulvinar visual pathway to the amygdala may allow for sufficient appraisal of fear signals to innervate the locus coeruleus. The engagement of the locus coeruleus could explain the observation of diffuse fronto-temporal cortical activity, given its role in evoking collateral ascending noradrenergic efferents to the subcortical amygdala and prefrontal cortex. This network may represent an evolutionary adaptive neural 'alarm' system for rapid alerting to sources of threat, without the need for conscious appraisal.