Peri-operative cardiac biomarker screening: a narrative review.

Peri-operative risk estimation has traditionally focused on assessing the likelihood of postoperative morbidity and mortality using pre-operative functional assessment. Although this strategy is currently recommended by most major society guidelines, contemporary evidence suggests that cardiac biomarker measurement has important advantages over pre-operative functional assessment. These advantages include superior predictive discrimination and inclusion of the postoperative course in risk estimation. In this review, we provide an overview of the evidence supporting the peri-operative utilisation, compare risk estimation methods and discuss which patients may benefit most from cardiac biomarker screening. We also discuss protocols for biomarker screening and management of patients with abnormal results.

Medical education for millennials: How anatomists are doing it right.

Millennial students born between 1980 and 1999 are currently the most prevalent generation in medical schools. Understanding this generation of inspiring yet challenging learners is key to satisfying instructional interaction. Effective strategies for teaching millennial learners can be summarized with 5 R's: ensuring a relaxed learning environment, building rapport with learners, highlighting the relevance and rationale of learning objectives and assessments, and implementing research-based educational methods. These strategies are exemplified by anatomists who relate (through platforms that encourage team-based learning in a relaxed environment), resonate (by highlighting the relevance and rationale of basic science learning objectives and feedback strategies), and innovate (by adopting cutting edge, research-proven technologies) within their curricula. Anatomists lead the way in effectively engaging, teaching and evaluating Millennial medical students in the 21st century. Broad application of these principles by other medical educators can further enhance Millennial education. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

Placental amino acid uptake. IV. Transport microvillous membrane vesicles.

The recent characterization of a vesicular microvillous plasma membrane preparation from human placenta has made possible study of the characteristics of amino acid transport by the isolated membrane. Variation of medium osmolality demonstrated that alpha-aminoisobutyric acid (AIB) is taken up virtually entirely into a vesicular space. Vesicular volume was determined from equilibrium uptake of three dissimilar nonamino acid substrates, all of which gave a common value. Temperature dependence, saturability, specificity, and similarity of kinetic constants all indicated that AIB uptake by the vesicles resembles that by whole villous tissue. AIB uptake was stimulated specifically by an inward sodium gradient and unaffected by an outward potassium gradient. The persistence of stimulation up to 2 h after the gradient was established could be correlated with the slow equilibration of sodium across the membrane. AIB exodus could be studied with minimal problems of substrate recapture by using preloaded membrane vesicles bound tightly to cellulose ester filters to facilitate transfer to fresh medium. The exodus process was saturable with a Km considerably greater than that for entry.