Assessment of the reliability of virtual preanesthetic airway evaluation compared to traditional in-person airway evaluation: a prospective observational study.

PURPOSE: Airway evaluation is a fundamental component of the preanesthetic examination. Virtual care has increased during the COVID-19 pandemic. We aimed to assess the reliability of a virtual preanesthetic airway evaluation compared with a traditional in-person airway evaluation. METHODS: This prospective observational study compared the inter-rater agreement of an in-person airway evaluation performed by a consultant anesthesiologist with a virtual airway evaluation (VAE) performed by consultant anesthesiologists and medical students. The airway evaluation was completed using a comprehensive airway evaluation and scoring tool. The primary outcome was the inter-rater agreement of total scores between in-person anesthesiologist airway evaluations and the VAEs of both the anesthesiologists and medical students, assessed using Cohen's Kappa (CK). Secondary outcomes included the inter-rater agreement for each airway evaluation component between the in-person anesthesiologists and both the anesthesiologist and medical student VAEs, assessed using prevalence-adjusted and bias-adjusted Kappa. RESULTS: One hundred out of 111 participants completed all three evaluations. The in-person anesthesiologist airway evaluations had fair and good levels of agreement of total scores with the VAEs of the anesthesiologists (CK, 0.21; 97.5% confidence interval [CI], 0.07 to 0.34) and the medical students (CK, 0.74; 97.5% CI, 0.62 to 0.86), respectively. One participant was reported to have a difficult intubation. CONCLUSION: Virtual airway evaluations performed by anesthesiologists and medical students had fair and good inter-rater agreement, respectively, with in-person anesthesiologist airway evaluations. Further study with a focus on patients with difficult airways is required to define the predictive value of VAEs regarding difficult intubations.

RéSUMé: OBJECTIF: L'évaluation des voies aériennes constitue un élément fondamental de l'examen préanesthésique. Les soins prodigués virtuellement ont augmenté pendant la pandémie de COVID-19. Nous avons tenté d'évaluer la fiabilité d'une évaluation préanesthésique virtuelle des voies aériennes par rapport à une évaluation traditionnelle en personne. MéTHODE: Cette étude observationnelle prospective a comparé la concordance inter-observateurs d'une évaluation des voies aériennes en personne effectuée par un anesthésiologiste avec une évaluation virtuelle des voies aériennes (EVVA) réalisée par des anesthésiologistes et des étudiants en médecine. L'évaluation des voies aériennes a été réalisée à l'aide d'un outil d'évaluation et de notation des voies aériennes. Le critère d'évaluation principal était la concordance inter-observateurs des scores totaux entre les évaluations des voies aériennes réalisées par des anesthésiologistes en personne et les EVVA effectuées par des anesthésiologistes et des étudiants en médecine, évaluée à l'aide du coefficient Kappa de Cohen (CK). Les critères d'évaluation secondaires comprenaient la concordance inter-observateurs pour chaque composante de l'évaluation des voies aériennes entre les anesthésiologistes en personne et les anesthésiologistes et étudiants en médecine ayant réalisé les EVVA, évaluée à l'aide d'un coefficient de Kappa ajusté pour la prévalence et les biais. RéSULTATS: Cent des 111 participants ont complété les trois évaluations. Les évaluations des voies aériennes par des anesthésiologistes en personne présentaient des niveaux de concordance des scores totaux fidèles et bons par rapport aux EVVA réalisées par les anesthésiologistes (CK, 0,21; intervalle de confiance [IC] à 97,5 %, 0,07 à 0,34) et les étudiants en médecine (CK, 0,74; IC 97,5 %, 0,62 à 0,86), respectivement. Une intubation difficile a été rapportée pour un participant. CONCLUSION: Les évaluations virtuelles des voies aériennes réalisées par des anesthésiologistes et des étudiants en médecine avaient une concordance inter-observateurs fidèle et bonne avec les évaluations des voies aériennes réalisées en personne par des anesthésiologistes. Des recherches plus approfondies axées sur les patients présentant une prise en charge difficile des voies aériennes sont nécessaires pour définir la valeur prédictive des EVVA dans un contexte d'intubations difficiles.

Determining residual gastric volume in healthy children using ultrasound.

PURPOSE: Fasting guidelines for children recommend restricting clear fluids for one or two hours before a procedure to reduce pulmonary aspiration. Gastric volumes < 1.5 mL·kg-1 do not seem to present an increased risk of pulmonary aspiration. Our aim was to quantify the time to achieve a gastric volume < 1.5 mL·kg-1 after clear fluid ingestion in children. METHODS: We conducted a prospective observational study in healthy volunteers aged 1-14 yr. Participants followed American Society of Anesthesiologists fasting guidelines prior to data collection. Gastric ultrasound (US) was performed in the right lateral decubitus (RLD) position to determine the antral cross-sectional area (CSA). Following baseline measurements, participants consumed 250 mL of a clear fluid. We then performed gastric US at four time intervals: 30, 60, 90, and 120 min. Data were collected following a predictive model for gastric volume estimation using the formula: volume (mL) = -7.8 + (3.5 × RLD CSA) + (0.127) × age (months). RESULTS: We recruited 33 healthy children aged 2-14 yr. The mean gastric volume per weight (mL·kg-1) at baseline was 0.51 mL·kg-1 (95% confidence interval [CI], 0.46 to 0.57). The mean gastric volume was 1.55 mL·kg-1 (95% CI, 1.36 to 1.75) at 30 min, 1.17 mL·kg-1 (95% CI, 1.01 to 1.33) at 60 min, 0.76 mL·kg-1 (95% CI, 0.67 to 0.85) at 90 min, and 0.58 mL·kg-1 (95% CI, 0.52 to 0.65) at 120 min. CONCLUSION: Our results show that total gastric fluid volume was < 1.5 mL·kg-1 after 60 min, suggesting that current fasting guidelines for children could be liberalized.

RéSUMé: OBJECTIF: Les directives de jeûne pour les enfants recommandent de restreindre les liquides clairs pendant une ou deux heures avant une intervention pour réduire l'aspiration pulmonaire. Des volumes gastriques < 1,5 mL·kg−1 ne semblent pas présenter un risque accru d'aspiration pulmonaire. Notre objectif était de quantifier le temps nécessaire pour atteindre un volume gastrique < 1,5 mL·kg−1 après ingestion de liquides clairs chez les enfants. MéTHODE: Nous avons mené une étude observationnelle prospective chez des volontaires en bonne santé âgé·es de 1 à 14 ans. Les participant·es ont suivi les directives de jeûne de l'American Society of Anesthesiologists avant la collecte de données. L'échographie gastrique a été réalisée en décubitus latéral droit (DLD) pour déterminer la section transversale antrale. Après les mesures initiales, les participant·es ont consommé 250 mL d'un liquide clair. Nous avons ensuite réalisé une échographie gastrique à quatre intervalles de temps : 30, 60, 90 et 120 minutes. Les données ont été recueillies selon un modèle prédictif pour l'estimation du volume gastrique à l'aide de la formule : volume (mL) = −7,8 + (3,5 × section transversale antrale en DLD) + (0,127) × âge (mois). RéSULTATS: Nous avons recruté 33 enfants en bonne santé âgé·es de 2 à 14 ans. Le volume gastrique moyen par poids (mL·kg−1) au début de l'intervention était de 0,51 mL·kg−1 (intervalle de confiance [IC] à 95 %, 0,46 à 0,57). Le volume gastrique moyen était de 1,55 mL·kg−1 (IC 95 %, 1,36 à 1,75) à 30 min, 1,17 mL·kg−1 (IC 95 %, 1,01 à 1,33) à 60 min, 0,76 mL·kg−1 (IC 95 %, 0,67 à 0,85) à 90 min, et 0,58 mL·kg−1 (IC 95 %, 0,52 à 0,65) à 120 min. CONCLUSION: Nos résultats montrent que le volume total de liquide gastrique était < 1,5 mL·kg−1 après 60 min, suggérant que les directives actuelles de jeûne pour les enfants pourraient être libéralisées.

Effect of fluoride varnish in combination with simulated oral environment on enamel-bracket shear bond strength.

To determine the effect of fluoride varnish application combined with a simulated oral environment prior to bracket bonding on the shear bond strength (SBS) between brackets and tooth enamel. Sixty de-identified, extracted teeth were grouped to either receive or not receive fluoride varnish and then stored for 7 days at 37 °C in phosphate-buffered saline (PBS) solution or PBS combined with three 15-min cycles/day in a demineralizing solution to simulate pH variation following meals. Subsequently, brackets were bonded and after 24-h dark cure at 37 °C, debonded using shear forces in a simulated oral environment. The maximum shear force was used to calculate SBS, and the adhesive remnant index (ARI) was determined by image analysis of photos of the bracket mesh pad after debonding. A statistically higher SBS (10.16 MPa) was observed when fluoride varnish was applied prior to storage in PBS + demineralizing solution compared to SBS (6.38 MPa) following storage in the same solution without varnish application. Based on 37% effect size, this difference is also clinically relevant. In contrast, no significant differences in SBS were observed with varnish application combined with PBS with no demineralizing solution or between storage solution alone. Moreover, there was no significant difference in ARI due to varnish combined with either storage method or storage solution only. Results suggest varnish application prior to bracket bonding in combination with simulated oral environment that included acid exposure is beneficial in maintaining higher SBS between bracket and enamel. Despite higher SBS, adhesive remaining on enamel did not increase.

Ethical and regulatory issues of stem cell-derived 3-dimensional organoid and tissue therapy for personalised regenerative medicine.

BACKGROUND: Regenerative medicine has the potential to treat genetic disorders and replace damaged or missing tissue. The use of donor or animal tissue raises many well-known issues, including limited tissue availability, the possibility of rejection and patient infection. Stem cell therapy raised hope of overcoming these issues, but created new risks including tumour formation and limited benefit if the desired target tissue does not form. The recent development of 3-dimensional tissues, including organoids, allows the creation of more complex tissues for personalised regenerative medicine. METHODS: This article details the potential health risks of 3-dimensional organoid and tissue therapy versus dissociated stem cell therapy. The current ethical and regulatory issues surrounding 3-dimensional organoid and tissue therapy are presented with a focus on the highly influential FDA and International Society of Stem Cell Research (ISSCR) guidelines. CONCLUSIONS: The potential use of 3-dimensional organoid and tissue therapy may deliver greater patient benefits than other regenerative medicine approaches, but raises new health and ethical risks. Preclinical testing of these therapies will not mitigate some of their risks; they may only be understood after first-in-human trials. The potential irreversibility and high risk of these therapies affects how clinical trials should be structured, including post-trial care for participants.

Vision Therapy Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.

Binasal Occlusion Intervention to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of binasal occlusion interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.

Vestibulo-Ocular Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of vestibulo-ocular interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.

Filter Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of filter interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.

Effectiveness of digital impressions in a predoctoral clinical curriculum.

AIM: The purpose of the present study was to investigate the effectiveness of digital impressions made by 3rd and 4th year dental students using a retrospective record review at one USA dental school during a 1-year period. MATERIALS AND METHODS: After reviewing patient records related to quality assurance, 125 digital impressions and the produced restorations were evaluated. Effectiveness and acceptability of digital impressions and restorations were associated with students' educational level, number of prepared teeth scanned, type of produced restoration, and restorative material used. Fisher's exact and chi-square tests were used for the statistical analysis. All dental students had previous experience of the digital curriculum in their preclinical education. RESULTS: A total of 91% of the digital impressions were acceptable, and 80% of the produced restorations had clinically acceptable margins. Impression approval and restoration acceptance were not affected by students' educational level, number of preparations or restoration type. Restoration acceptance was significantly affected by restorative material (P = 0.039), with higher rates of acceptable marginal integrity found with glass-ceramic and zirconia materials. CONCLUSIONS: Within the parameters of the present study, 3rd and 4th year dental students, after having extensive education in the preclinical curriculum, can utilize digital impressions effectively for clinical practice. The results show that with adequate educational experiences, dental students can use digital impressions effectively for clinically acceptable restorations. Dental schools can and should educate students in digital dentistry.

A songbird strategically modifies its blinking behavior when viewing human faces.

Even though blinking is necessary to maintain clear vision in many species, blinking is likely costly because it temporarily impairs vision. Given this cost, individuals can strategically modify their blinking behavior to minimize information loss. We tested whether a songbird species modifies its blinking behavior when viewing potential threats (human faces). We recorded the blinking behavior of captive great-tailed grackles (Quiscalus mexicanus) before, during, and after they viewed human face stimuli or control stimuli (tree bark as well as scrambled versions of human faces and tree bark). We found that the birds inhibited their blinking behavior the most when viewing human faces versus controls. In addition, they inhibited their blinking behavior more when viewing human faces that were directed rather than averted. Furthermore, when viewing the human faces, their blinking behavior was modified based on reactivity. These results suggest that a songbird can strategically modify its blinking behavior based on its perceived level of risk.

The influence of welfare spending on national immunization outcomes: A scoping review.

Background: National policies influence the environments in which people live, but the ways in which these national policies influence people's health are not well understood. Welfare spending is one national policy that may influence population health. While some research indicates higher levels of welfare investment may positively influence health, mixed findings contradict this conclusion. These mixed results examining the link between welfare policies and health may be better understood by investigating the relationship between welfare spending and preventative health interventions, such as immunization. Objective: This article's purpose is to summarize the literature studying the relationship between national welfare spending and immunization outcomes. Design: This scoping review used the Joanna Briggs scoping review method. Data sources: The scoping review utilized scholarly databases and a focused gray literature search to find research articles that explored relationships between welfare spending and immunization outcomes. Review methods: Data was extracted from articles, including themes, aims, populations, years of study, methods, and findings. The articles' themes were further analyzed with a word cloud and principal component analysis to determine which themes were more likely to coincide in the literature. Results: Seven articles were included in the review. Most of these articles did not address the relationship between welfare spending or policy and immunizations directly or with rigorous methods. Conclusions: Ultimately, the results of the scoping review suggest a lack of literature regarding the relationship between welfare spending and immunization outcomes. Further research is needed to understand the impacts of national welfare spending on immunization outcomes.

A survey of US dental schools on predoctoral implant curricula with emphasis on diagnosing and treating implant complications.

STATEMENT OF PROBLEM: Implant complications have been reported to occur at high rates and frequencies. Whether these high rates are observed in predoctoral implant programs and whether future dentists are educated to diagnose and treat implant complications is unknown. PURPOSE: The purpose of this study was to analyze and report the results of a survey on US predoctoral curricula related to implant treatment and with an emphasis on diagnosing and treating implant complications. MATERIAL AND METHODS: A 26-question survey was distributed to all (66) US dental schools. In addition to 3 questions regarding descriptive information about each school, 13 questions were used to calculate a curriculum composite score that was used to assess the quality of the school's implant curriculum. The remaining survey topics and number of questions included frequency of complications (2), tracking and types of complications (6), and school-reported student preparedness to identify or treat implant complications (2). A Kruskal-Wallis test was used to evaluate the relationship between the curriculum composite scores and student preparedness to diagnose and treat implant complications. RESULTS: Twenty-eight schools responded to the survey for a response rate of 42.4%, and 23 schools completed the entire survey (completion rate 34.8%). Fifteen schools (65.2%) reported methods of recording implant complications, and 8 of 23 schools (34.8%) reported methods of assessing student knowledge in recognizing implant complications. Only 2 schools reported methods of assessing student preparedness to treat implant complications. Most implant complications were mechanical (64.3%), followed by biological (28.6%) and esthetic (7.1%). The prostheses associated with the most complications were implant overdentures (39.1%), followed by single crowns (34.8%) and fixed partial dentures (4.3%). A positive relational trend was observed between reported student preparedness to recognize and treat implant complications and curriculum composite scores. CONCLUSIONS: Within the limitation of this survey-based study, implant curricula in US dental schools should consider improving the scope of teaching the diagnosis and treatment of implant complications. The implant complications observed at US dental schools showed similar trends to those reported in the literature.

Faculty perspectives on transitioning public health nursing clinical to virtual in response to COVID-19.

The COVID-19 pandemic has highlighted the need for public health nursing as an integral part of a strong public health workforce. However, it has also created challenges in preparing future nurses as much of nursing instruction, including clinical experiences, needed to urgently transition learning to a virtual environment. This paper describes the process faculty experienced during spring 2020 to quickly transition public health nursing clinicals from in-person to virtual learning in response to COVID-19. Further, faculty lessons learned are shared and include the importance of creating a supportive team dynamic, embracing innovation, continuing to engage with community partners, and adapting to meet emerging student needs during the evolving pandemic. The process and lessons learned may act as a guide for other nursing programs as we continue to navigate nursing education during this and future pandemics.

Leukocytes from obese individuals exhibit an impaired SPM signature.

Specialized proresolving mediators (SPMs) biosynthesized from docosahexaenoic acids (DHAs) including resolvins (Rvs), protectins, and maresins are potent endogenous autacoids that actively resolve inflammation, protect organs, and stimulate tissue regeneration. Our hypothesis was that failure of resolution programs may lead to unremitting inflammation in obesity, contributing to the development of metabolic comorbidities in this condition. Obese individuals with persistent low-grade systemic inflammation showed reduced leukocyte production of the DHA-derived monohydroxy fatty acid 17-hydroxy-DHA (HDHA) and unbalanced formation of SPMs (in particular D-series Rvs) accompanied by enhanced production of proinflammatory lipid mediators such as leukotriene B4. Mechanistic studies attributed this impairment to reduced 15-lipoxygenase (LOX) activity rather than altered DHA cellular uptake. Moreover, leukocytes from obese individuals exhibited decreased 5-LOX levels and reduced 5-LOX Ser271 phosphorylation and distinct intracellular 5-LOX redistribution. However, 15-LOX appears to be the most critical factor for the deficient production of SPMs by obese leukocytes because the formation of D-series Rvs was completely rescued by incubation with the intermediate precursor 17-HDHA. These data provide proof of concept that administration of intermediate precursors of SPM biosynthesis (e.g., 17-HDHA) could be more efficient in overriding impaired formation of these proresolving lipid mediators in conditions characterized by dysfunctional LOX activity, such as obesity.-López-Vicario, C., Titos, E., Walker, M. E., Alcaraz-Quiles, J., Casulleras, M., Durán-Güell, M., Flores-Costa, R., Pérez-Romero, N., Forné, M., Dalli, J., Clària, J. Leukocytes from obese individuals exhibit an impaired SPM signature.

Impaired Production and Diurnal Regulation of Vascular RvDn-3 DPA Increase Systemic Inflammation and Cardiovascular Disease.

RATIONALE: Diurnal mechanisms are central to regulating host responses. Recent studies uncovered a novel family of mediators termed as specialized proresolving mediators that terminate inflammation without interfering with the immune response. OBJECTIVE: Herein, we investigated the diurnal regulation of specialized proresolving mediators in humans and their role in controlling peripheral blood leukocyte and platelet activation. METHODS AND RESULTS: Using lipid mediator profiling and healthy volunteers, we found that plasma concentrations of n-3 docosapentaenoic acid-derived D-series resolvins (RvDn-3 DPA) were regulated in a diurnal manner. The production and regulation of these mediators was markedly altered in patients at risk of myocardial infarct. These changes were associated with decreased 5-lipoxygenase expression and activity, as well as increased systemic adenosine concentrations. We also found a significant negative correlation between plasma RvDn-3 DPA and markers of platelet, monocyte, and neutrophil activation, including CD63 and CD11b. Incubation of RvDn-3 DPA with peripheral blood from healthy volunteers and patients with cardiovascular disease significantly and dose-dependently decreased platelet and leukocyte activation. Furthermore, administration of RvD5n-3 DPA to ApoE-/- (apolipoprotein E deficient) mice significantly reduced platelet-leukocyte aggregates, vascular thromboxane B2 concentrations, and aortic lesions. CONCLUSIONS: These results demonstrate that peripheral blood RvDn-3 DPA are diurnally regulated in humans, and dysregulation in the production of these mediators may lead to cardiovascular disease.

Towards Including End-Users in the Design of Prosthetic Hands: Ethical Analysis of a Survey of Australians with Upper-Limb Difference.

Advances in prosthetic design should benefit people with limb difference. But empirical evidence demonstrates a lack of uptake of prosthetics among those with limb difference, including of advanced designs. Non-use is often framed as a problem of prosthetic design or a user's response to prosthetics. Few studies investigate user experience and preferences, and those that do tend to address satisfaction or dissatisfaction with functional aspects of particular designs. This results in limited data to improve designs and, we argue, this is pragmatically and ethically problematic. This paper presents results of a survey we conducted in 2017 with people with upper limb difference in Australia. The survey sought to further knowledge about preferences surrounding prosthetics and understanding of how preferences relate to user experience, perspective, and context. Survey responses demonstrated variety in the uptake, use and type of prosthetic-and that use of, preferences about, and impacts of prosthetics rely not just on design factors but on various contextual factors bearing on identity and social understandings of disability and prosthetic use. From these results, we argue that non-use of prosthetics could be usefully reframed as an issue of understanding how prosthetics can best support users' autonomy. This supports the claim that there is a need to incorporate user engagement into design processes for prosthetic limbs, though further work is needed on methods for doing so.

ERV1/ChemR23 Signaling Protects Against Atherosclerosis by Modifying Oxidized Low-Density Lipoprotein Uptake and Phagocytosis in Macrophages.

BACKGROUND: In addition to enhanced proinflammatory signaling, impaired resolution of vascular inflammation plays a key role in atherosclerosis. Proresolving lipid mediators formed through the 12/15 lipoxygenase pathways exert protective effects against murine atherosclerosis. n-3 Polyunsaturated fatty acids, including eicosapentaenoic acid (EPA), serve as the substrate for the formation of lipid mediators, which transduce potent anti-inflammatory and proresolving actions through their cognate G-protein-coupled receptors. The aim of this study was to identify signaling pathways associated with EPA supplementation and lipid mediator formation that mediate atherosclerotic disease progression. METHODS: Lipidomic plasma analysis were performed after EPA supplementation in Apoe-/- mice. Erv1/Chemr23-/- xApoe-/- mice were generated for the evaluation of atherosclerosis, phagocytosis, and oxidized low-density lipoprotein uptake. Histological and mRNA analyses were done on human atherosclerotic lesions. RESULTS: Here, we show that EPA supplementation significantly attenuated atherosclerotic lesion growth induced by Western diet in Apoe-/- mice and was associated with local cardiovascular n-3 enrichment and altered lipoprotein metabolism. Our systematic plasma lipidomic analysis identified the resolvin E1 precursor 18-monohydroxy EPA as a central molecule formed during EPA supplementation. Targeted deletion of the resolvin E1 receptor Erv1/Chemr23 in 2 independent hyperlipidemic murine models was associated with proatherogenic signaling in macrophages, increased oxidized low-density lipoprotein uptake, reduced phagocytosis, and increased atherosclerotic plaque size and necrotic core formation. We also demonstrate that in macrophages the resolvin E1-mediated effects in oxidized low-density lipoprotein uptake and phagocytosis were dependent on Erv1/Chemr23. When analyzing human atherosclerotic specimens, we identified ERV1/ChemR23 expression in a population of macrophages located in the proximity of the necrotic core and demonstrated augmented ERV1/ChemR23 mRNA levels in plaques derived from statin users. CONCLUSIONS: This study identifies 18-monohydroxy EPA as a major plasma marker after EPA supplementation and demonstrates that the ERV1/ChemR23 receptor for its downstream mediator resolvin E1 transduces protective effects in atherosclerosis. ERV1/ChemR23 signaling may represent a previously unrecognized therapeutic pathway to reduce atherosclerotic cardiovascular disease.

Novel n-3 Docosapentaneoic Acid-Derived Pro-resolving Mediators Are Vasculoprotective and Mediate the Actions of Statins in Controlling Inflammation.

Inflammation is a fundamentally protective process that guards the host from invading pathogens and is central in the repair and regeneration of damaged tissue. However, when uncontrolled, the overzealous response leads to tissue damage and malaise. Indeed, this process is now appreciated to be at the center of many chronic inflammatory diseases including vascular disease and arthritis. Studies investigating the mechanisms through which acute inflammation is actively turned off allowing tissues to regain function demonstrated that the essential fatty acids, arachidonic acid (AA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are enzymatically converted to bioactive mediators. These autacoids carry distinct structures and biological actions, actively reprogramming the inflammatory reaction to promote its termination by counter-regulating the production of pro-inflammatory mediators and regulate leukocyte trafficking as well as phenotype. Recently we found that n-3 docosapentaenoic acid (DPA), which was until then only regarded as a biosynthetic intermediate in the formation of DHA from EPA, is also converted to structurally distinct bioactive mediators that reprogram the host immune response. In the present review we will discuss the evidence underpinning the biological actions of these novel n-3 DPA-derived autacoids in particular as they pertain to the vascular system.