Implications of Compression Race Suit on Forced Vital Capacity: Assessment Considerations for Paradoxical Vocal Fold Motion in Competitive Female Swimmers.

Purpose The purpose of this investigation was to quantify the extent to which forced vital capacity (FVC) in competitive swimmers may differ from nonswimmers and determine if compression race suits reduced FVC when compared to practice swimsuits. Identification of the differences in FVC between swimmers and nonswimmers as well as pulmonary function differences secondary to swimsuit construction may inform assessment of the competitive swimmer with paradoxical vocal fold motion (PVFM). Method Using a prospective, mixed within- and between-groups, repeated measures design with 10 female competitive swimmers and 13 female nonswimmers, FVC was measured and compared between the two groups. Further FVC assessment was completed with the swimmers to identify FVC differences between a practice suit and a compression racing suit. Results FVC in swimmers was significantly larger than FVC in nonswimmers by over 1 L. The predicted FVC volumes were significantly smaller than the actual FVC volumes for swimmers. No significant differences were identified between the practice swimsuit and the compression race suit or between the predicted and actual FVCs for the nonswimmer group. Conclusions Swimmers have unique pulmonary function and physiology that require consideration during the assessment for PVFM to ascertain the extent to which the pulmonary system may be compromised from PVFM, reduced exercise intensity, or both. Knowledge of differential diagnoses and adequate characterization of pulmonary volumes in swimmers will improve assessment processes.

Emergency Medicine Residents on Electronic Medical Records: Perspectives and Advice.

Given the near-universal implementation of electronic medical records (EMRs) in emergency departments (EDs), emergency medicine (EM) residents spend significant time interfacing with EMRs without any established national curriculum to learn best practices. While EMRs have the potential to increase physician efficiency and improve the quality of documentation, they have also been cited as a factor in physician burnout. Understanding the target audience of the EMR, knowing what and when to chart, and practicing time-saving strategies can streamline the process of charting. We review the literature on the current state of EMR documentation by residents and provide recommendations for best practices.

Delayed Diagnosis of Acromegaly in the Context of Post-Traumatic Stress Disorder due to Symptoms Mimicking Known Psychotropic Medication Side Effects.

BACKGROUND: Acromegaly is caused by elevated secretion of human growth hormone, which is frequently because of intracranial tumors. This diagnosis is fairly uncommon with an incidence of 3 to 4 cases per million patients per year. We are presenting a case of acromegaly diagnosed in an active duty Chief Petty Officer. MATERIALS AND METHODS: A 38-year-old male Chief Petty Officer with no previous mental health diagnosis experienced post-traumatic stress disorder (PTSD)-like symptoms in early 2012 after deploying to Iraq and Afghanistan from 2010 to 2011. Initially he self-managed his symptoms, but in July 2012 he required a reduction mammoplasty because of gynecomastia. The metabolic workup revealed elevated prolactin, but this was not further investigated. His recovery from anesthesia was complicated by intensified PTSD-like symptoms, which continued to worsen after the surgery. On self-referral to mental health, he was diagnosed with PTSD and managed for 6 months with cognitive behavioral therapy. Because of persistent and worsening symptoms, his therapy was augmented to include continued cognitive behavioral therapy, alpha-blockers, antidepressants, antihistamines, and sleep aids. Because of night sweats, the selective serotonin reuptake inhibitors doses were modified. Night sweats persisted, and the patient was re-evaluated for other potential etiologies. On evaluation, the patient endorsed a history of obstructive sleep apnea, cervicalgia, visual changes, depressed mood, as well as multiple physical symptoms including coarsened facial features, large hands/feet, and increased interdental distance. On laboratory analysis, insulin-like growth factor 1 was noted to be 3 times the upper limit of normal, and a prolactin level was five times the upper limit of normal. A brain magnetic resonance imaging revealed a cystic pituitary lesion with suprasellar extension, compression of the infundibulum without invasion of the cavernous sinus, or displacement of the optic chiasm. Based on clinical history, physical examination, laboratory data, and the pituitary lesion, this patient was diagnosed with acromegaly. He was referred to neurosurgery for further evaluation and management. RESULTS AND CONCLUSION: This case shows that side effects of medications can easily mimic some medical conditions. The possibility of unrecognized disease should not be overlooked simply because a patient's symptoms that develop after starting a medication correspond well the side effect profile of the prescribed medications. This is especially true if side effects do not stop with alteration of medication dose, cessation of the medication, or changing to another medication. Pituitary adenomas are rare in patients treated for PTSD. However, attribution of PTSD patient's symptoms to the side effects of selective serotonin reuptake inhibitors therapy without considering a broader differential may lead to a missed diagnosis of an endocrine disease. In this case, the presence of an undiagnosed pituitary lesion resulted in ineffective medical management of PTSD in the patient. Mental health providers should remain allied with their primary care counterparts and consider directing patients to primary care for periodic physical re-evaluation to provide the most effective approach to symptom evaluation and management.

Diagnosis and treatment of seborrheic dermatitis.

Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis.

Midbrain dopamine neurons associated with reward processing innervate the neurogenic subventricular zone.

Coordinated regulation of the adult neurogenic subventricular zone (SVZ) is accomplished by a myriad of intrinsic and extrinsic factors. The neurotransmitter dopamine is one regulatory molecule implicated in SVZ function. Nigrostriatal and ventral tegmental area (VTA) midbrain dopamine neurons innervate regions adjacent to the SVZ, and dopamine synapses are found on SVZ cells. Cell division within the SVZ is decreased in humans with Parkinson's disease and in animal models of Parkinson's disease following exposure to toxins that selectively remove nigrostriatal neurons, suggesting that dopamine is critical for SVZ function and nigrostriatal neurons are the main suppliers of SVZ dopamine. However, when we examined the aphakia mouse, which is deficient in nigrostriatal neurons, we found no detrimental effect to SVZ proliferation or organization. Instead, dopamine innervation of the SVZ tracked to neurons at the ventrolateral boundary of the VTA. This same dopaminergic neuron population also innervated the SVZ of control mice. Characterization of these neurons revealed expression of proteins indicative of VTA neurons. Furthermore, exposure to the neurotoxin MPTP depleted neurons in the ventrolateral VTA and resulted in decreased SVZ proliferation. Together, these results reveal that dopamine signaling in the SVZ originates from a population of midbrain neurons more typically associated with motivational and reward processing.

Fitness epistasis among 6 biosynthetic loci in the budding yeast Saccharomyces cerevisiae.

We generated all possible haploid and homozygous diploid genotypes at 6 biosynthetic loci in yeast and scored their fitness to examine whether there was any pattern of weak synergistic epistasis, which is a requirement of the deterministic mutation model for the evolution of sex. We measured 4 components of fitness: haploid growth rate, haploid mating efficiency, diploid growth rate, and diploid sporulation efficiency. We found that in agreement with previous work in yeast, epistasis tended to be small in magnitude and variable in sign, regardless of the fitness component measured. The number of background mutations had either no effect or no consistent effect on epistasis distributions. For every combination of 2 loci in a mutation-free background, we also generated all heterozygous genotypes so that we could partition diploid epistasis into additive x additive, additive x dominance, and dominance x dominance epistasis. Our main interest was in determining whether dominance by dominance epistasis was large and negative, which is a requirement of diploid models with inbreeding to explain high levels of recombination. Dominance by dominance epistasis estimates obtained by partitioning diploid epistasis for growth rates were both positive and negative. With the caveat that our results are based on only 6 biosynthetic loci, epistasis for fitness is not supported as an explanation for the maintenance of sex or the high rate of meiotic recombination in yeast.

Growth of primary embryo cells in a microculture system.

We present optimal perfusion conditions for the growth of primary mouse embryonic fibroblasts (mEFs) and mouse embryonic stem cells (mESCs) using a microfluidic perfusion culture system. In an effort to balance nutrient renewal while ensuring the presence of cell secreted factors, we found that the optimal perfusion rate for culturing primary embryonic fibroblasts (mEFs) in our experimental setting is 10 nL/min with an average flow velocity 0.55 microm/s in the microchannel. Primary mEFs may have a greater dependence on cell secreted factors when compared to their immortalized counterpart 3T3 fibroblasts cultured under similar conditions. Both the seeding density and the perfusion rate are critical for the proliferation of primary cells. A week long cultivation of mEFs and mESCs using the microculture system exhibited similar morphology and viability to those grown in a petri dish. Both mEFs and mESCs were analyzed using fluorescence immunoassays to determine their proliferative status and protein expression. Our results demonstrate that a perfusion-based microculture environment is capable of supporting the highly proliferative status of pluripotent embryonic stem cells.