Trends in open abdominal exposure among vascular surgery trainees.

BACKGROUND: This retrospective study evaluates the trends in open abdominal surgery cases among integrated vascular surgery residents compared with their 5 + 2 counterparts. METHODS: The Accreditation Council for Graduate Medical Education (ACGME) case logs between 2007 and 2016 were collected from a pool of 9861 residents and fellows from 371 institutions. Trainees were grouped into three categories: general surgery residency (GSR), integrated vascular surgery residency (IVSR), and vascular surgery fellowship in the United States. Inclusion criteria were specific to open abdominal cases of or including the anatomy adjacent to the aorta performed by the surgeon chief. RESULTS: The 5 + 2 graduates have obtained significantly more open vascular surgery training experience than their IVSR graduate counterparts (P < .01). GSR chief residents performed significantly more open abdomen cases than IVSR chief residents (P < .01). IVSR chiefs performed significantly more open vascular procedures than GSR chiefs (P < .01). On the completion of vascular surgery fellowship, 5 + 2 graduates had significantly more open abdominal aortic aneurysm (AAA) exposure during training than IVSR graduates did (P < .01); however, IVSR trainees had performed significantly more open AAA procedures than their GSR counterparts (P < .01). CONCLUSIONS: Up to 2016, graduates of the 5 + 2 vascular training pathway had significantly higher open abdominal exposure than those of the IVSR track. However, graduates of the IVSR track had significantly higher open AAA exposure than GSR graduates.

Flipping the Nursing Classroom Without Flipping Out the Students.

Flipping the class has been touted as a method of increasing student participation and improving learning outcomes. In this study, nursing students were introduced to the flipped classroom. They were instructed to listen to narrated PowerPoint presentations before class and be ready to participate in case studies that would enhance their understanding of important concepts. When comparing student test scores before and after flipping the classroom, we found a statistically significant increase of 8.04 points after the change in instruction. Results support the hypothesis that a flipped classroom may improve learning outcomes.

The stability and activity of respiratory Complex II is cardiolipin-dependent.

Respiratory Complex II of the mitochondrial inner membrane serves as a link between the tricarboxylic acid cycle and the electron transport chain. Complex II dysfunction has been implicated in a wide range of heritable mitochondrial diseases, including cancer, by a mechanism that likely involves the production of reactive oxygen species (ROS). Using Complex II enzymes reconstituted into nanoscale lipid bilayers (nanodiscs) with varying lipid composition, we demonstrate for the first time that the phospholipid environment, specifically the presence of cardiolipin, is critical for the assembly and enzymatic activity of the complex, as well as in the curtailment of ROS production.

Immunisation coverage in children with cerebral palsy compared with the general population.

AIM: To compare immunisation coverage of a cerebral palsy (CP) cohort with the known general population vaccination coverage statistics. METHODS: A cohort of children with CP aged less than 7 years was extracted from the Victorian Cerebral Palsy Register. The vaccination status of these children was compared with the general population using the Australian Childhood Immunisation Register (ACIR). Details that were audited included overall 'up-to-date' status of immunisations and individual vaccines missed. RESULTS: The CP cohort consisted of 449 children. Eighty-six or 19.2% (95% confidence intervals 15.6-23.1%) of these children were not 'up to date' (NUTD) with the Australian immunisation schedule at the time of the ACIR data link (13 March 2009). This NUTD result is well above the general population percentage (range 6.4-8%). This group was divided into subgroups based on age, with all groups having significantly lower rates of immunisation, varying from 100% NUTD in the youngest subgroup to 18.6% in the oldest subgroup. The most common vaccine NUTD was MMR (measles, mumps and rubella), followed by polio and DTaP (diphtheria-tetanus-acellular pertussis). CONCLUSION: This study demonstrates that children with CP are at high risk of incomplete and delayed immunisation, a significant problem given the increased health-care needs of this patient group and their increased vulnerability to the complications of vaccine-preventable diseases.

Embryonic caffeine exposure acts via A1 adenosine receptors to alter adult cardiac function and DNA methylation in mice.

Evidence indicates that disruption of normal prenatal development influences an individual's risk of developing obesity and cardiovascular disease as an adult. Thus, understanding how in utero exposure to chemical agents leads to increased susceptibility to adult diseases is a critical health related issue. Our aim was to determine whether adenosine A1 receptors (A1ARs) mediate the long-term effects of in utero caffeine exposure on cardiac function and whether these long-term effects are the result of changes in DNA methylation patterns in adult hearts. Pregnant A1AR knockout mice were treated with caffeine (20 mg/kg) or vehicle (0.09% NaCl) i.p. at embryonic day 8.5. This caffeine treatment results in serum levels equivalent to the consumption of 2-4 cups of coffee in humans. After dams gave birth, offspring were examined at 8-10 weeks of age. A1AR+/+ offspring treated in utero with caffeine were 10% heavier than vehicle controls. Using echocardiography, we observed altered cardiac function and morphology in adult mice exposed to caffeine in utero. Caffeine treatment decreased cardiac output by 11% and increased left ventricular wall thickness by 29% during diastole. Using DNA methylation arrays, we identified altered DNA methylation patterns in A1AR+/+ caffeine treated hearts, including 7719 differentially methylated regions (DMRs) within the genome and an overall decrease in DNA methylation of 26%. Analysis of genes associated with DMRs revealed that many are associated with cardiac hypertrophy. These data demonstrate that A1ARs mediate in utero caffeine effects on cardiac function and growth and that caffeine exposure leads to changes in DNA methylation.