Goal-Oriented Anesthesia Week for MS III Students.

BACKGROUND: Third year medical students at our institution are required to complete a one-week rotation in anesthesia as part of their required twelve week surgery clerkship. During this constrained time, our aim was to provide students with a focused and goal-oriented preview of anesthesiology which would allow students going into various fields to have an appreciation of the field. CURRICULUM DESIGN: The one-week curriculum is a combination of lecture, simulation, operating room teaching and hands on experience aimed at providing students with some fundamentals of procedural skills and a knowledge base of anesthesia. To address the basic knowledge component, students are assigned a daily topic to review and discuss with their assigned resident mentor. From a procedural perspective, students gain basic airway management and IV skills during a half day in the Electroconvulsive Therapy (ECT) clinic where they primarily learn bag-mask ventilation and peripheral IV techniques. They additionally have a preoperative evaluation lecture and an airway simulation workshop. CURRICULUM EVALUATION: At the end of the rotation, students are required to fill out an online survey. Feedback from the survey was used to help further modify the goal-oriented curriculum. CONCLUSIONS: The results of the survey overall revealed students had an overwhelmingly positive experience during their week in the newly designed curriculum. Continued feedback will help us with further curriculum modifications as necessary.

Proinflammatory cytokines differentially regulate adipocyte mitochondrial metabolism, oxidative stress, and dynamics.

Proinflammatory cytokines differentially regulate adipocyte mitochondrial metabolism, oxidative stress, and dynamics. Macrophage infiltration of adipose tissue and the chronic low-grade production of inflammatory cytokines have been mechanistically linked to the development of insulin resistance, the forerunner of type 2 diabetes mellitus. In this study, we evaluated the chronic effects of TNFα, IL-6, and IL-1ß on adipocyte mitochondrial metabolism and morphology using the 3T3-L1 model cell system. TNFα treatment of cultured adipocytes led to significant changes in mitochondrial bioenergetics, including increased proton leak, decreased ΔΨm, increased basal respiration, and decreased ATP turnover. In contrast, although IL-6 and IL-1ß decreased maximal respiratory capacity, they had no effect on ΔΨm and varied effects on ATP turnover, proton leak, or basal respiration. Only TNFα treatment of 3T3-L1 cells led to an increase in oxidative stress (as measured by superoxide anion production and protein carbonylation) and C16 ceramide synthesis. Treatment of 3T3-L1 adipocytes with cytokines led to decreased mRNA expression of key transcription factors and control proteins implicated in mitochondrial biogenesis, including PGC-1α and eNOS as well as deceased expression of COX IV and Cyt C. Whereas each cytokine led to effects on expression of mitochondrial markers, TNFα exclusively led to mitochondrial fragmentation and decreased the total level of OPA1 while increasing OPA1 cleavage, without expression of levels of mitofusin 2, DRP-1, or mitofilin being affected. In summary, these results indicate that inflammatory cytokines have unique and specialized effects on adipocyte metabolism, but each leads to decreased mitochondrial function and a reprogramming of fat cell biology.

Capillary electrophoretic analysis of hydroxyl radicals produced by respiring mitochondria.

Here, we report the use of a capillary electrophoretic method with laser-induced fluorescence detection to evaluate hydroxyl radicals produced by respiring mitochondria. The probe, hydroxyphenylfluorescein (HPF), is separated from the product, fluorescein, in under 5 min with zeptomole and attomole limits of detection for fluorescein and HPF, respectively. Purification of the probe with a C-18 SPE column is necessary to reduce the fluorescein impurity in the probe stock solution from 0.4% to less than 0.001%. HPF was responsive to hydroxyl radicals produced by isolated mitochondria from L6 cells, and this signal was blunted when DMSO was added to scavenge hydroxyl radicals and when carbonyl cyanide m-chlorophenylhydrazone was added to depolarize the mitochondria. The method was used to compare hydroxyl radical levels in mitochondria isolated from brown adipose tissue of lean and obese mice. Mitochondria from obese mice produced significantly more hydroxyl radicals than those from lean mice.

Protein carbonylation and adipocyte mitochondrial function.

Carbonylation is the covalent, non-reversible modification of the side chains of cysteine, histidine, and lysine residues by lipid peroxidation end products such as 4-hydroxy- and 4-oxononenal. In adipose tissue the effects of such modifications are associated with increased oxidative stress and metabolic dysregulation centered on mitochondrial energy metabolism. To address the role of protein carbonylation in the pathogenesis of mitochondrial dysfunction, quantitative proteomics was employed to identify specific targets of carbonylation in GSTA4-silenced or overexpressing 3T3-L1 adipocytes. GSTA4-silenced adipocytes displayed elevated carbonylation of several key mitochondrial proteins including the phosphate carrier protein, NADH dehydrogenase 1α subcomplexes 2 and 3, translocase of inner mitochondrial membrane 50, and valyl-tRNA synthetase. Elevated protein carbonylation is accompanied by diminished complex I activity, impaired respiration, increased superoxide production, and a reduction in membrane potential without changes in mitochondrial number, area, or density. Silencing of the phosphate carrier or NADH dehydrogenase 1α subcomplexes 2 or 3 in 3T3-L1 cells results in decreased basal and maximal respiration. These results suggest that protein carbonylation plays a major instigating role in cytokine-dependent mitochondrial dysfunction and may be linked to the development of insulin resistance in the adipocyte.

Water-assisted femtosecond laser machining of electrospray nozzles on glass microfluidic devices.

Using water-assisted femtosecond laser machining, we fabricated electrospray nozzles on glass coverslips and on assembled microfluidic devices. Machining the nozzles after device assembly facilitated alignment of the nozzles over the microchannels. The basic nozzle design is a through-hole in the coverslip to pass liquids and a trough machined around the through-hole to confine the electrospray and prevent liquid from wicking across the glass surface. Electrospray from the nozzles was stable with and without pressure-driven flow applied and was evaluated using mass spectra of the peptide bradykinin.