Extension for Community Healthcare Outcomes (ECHO) Telementoring in the Military: Where We Are Now, Opportunities and Challenges.

INTRODUCTION: In collaboration with the ECHO (Extension for Community Healthcare Outcomes) Institute since 2012, the Army, Navy, and Air Force have developed medical teleECHO programs to address various health and safety issues affecting military personnel. This article describes and compares the current state of military teleECHOs as well as the growth and change over time. MATERIALS AND METHODS: This study evaluated continuing education units (CEUs) offered, average session attendance, and number of spoke sites for current military teleECHO programs across the service branches. RESULTS: Between 2012 and 2019, the military teleECHO initiative grew from one program to seven different teleECHO programs, covering topics from pain to diabetes to amputee care. Military ECHOs now provide training to 10 countries and 27 states in the United States. Between October 2018 and September 2019, the military ECHO programs provided a total of 51,769 continuing medical education (CME) hours to a total of 3,575 attendees from 223 spoke sites. CONCLUSIONS: The military has successfully used the ECHO model to improve the health and safety of active-duty military, retirees, and dependents.

Time-Dependent Molecular Responses Differ between Gastric Bypass and Dieting but Are Conserved Across Species.

The effectiveness of Roux-en-Y gastric bypass (RYGB) against obesity and its comorbidities has generated excitement about developing new, less invasive treatments that use the same molecular mechanisms. Although controversial, RYGB-induced improvement of metabolic function may not depend entirely upon weight loss. To elucidate the differences between RYGB and dieting, we studied several individual organ molecular responses and generated an integrative, interorgan view of organismal physiology. We also compared murine and human molecular signatures. We show that, although dieting and RYGB can bring about the same degree of weight loss, post-RYGB physiology is very different. RYGB induces distinct, organ-specific adaptations in a temporal pattern that is characterized by energetically demanding processes, which may be coordinated by HIF1a activation and the systemic repression of growth hormone receptor signaling. Many of these responses are conserved in rodents and humans and may contribute to the remarkable ability of surgery to induce and sustain metabolic improvement.

Biodistribution and Lymphatic Tracking of the Main Neurotoxin of Micrurus fulvius Venom by Molecular Imaging.

The venom of the Eastern coral snake Micrurus fulvius can cause respiratory paralysis in the bitten patient, which is attributable to ß-neurotoxins (ß-NTx). The aim of this work was to study the biodistribution and lymphatic tracking by molecular imaging of the main ß-NTx of M. fulvius venom. ß-NTx was bioconjugated with the chelator diethylenetriaminepenta-acetic acid (DTPA) and radiolabeled with the radionuclide Gallium-67. Radiolabeling efficiency was 60%-78%; radiochemical purity ≥92%; and stability at 48 h ≥ 85%. The median lethal dose (LD50) and PLA2 activity of bioconjugated ß-NTx decreased 3 and 2.5 times, respectively, in comparison with native ß-NTx. The immune recognition by polyclonal antibodies decreased 10 times. Biodistribution of ß-NTx-DTPA-(67)Ga in rats showed increased uptake in popliteal, lumbar nodes and kidneys that was not observed with (67)Ga-free. Accumulation in organs at 24 h was less than 1%, except for kidneys, where the average was 3.7%. The inoculation site works as a depot, since 10% of the initial dose of ß-NTx-DTPA-(67)Ga remains there for up to 48 h. This work clearly demonstrates the lymphatic system participation in the biodistribution of ß-NTx-DTPA-(67)Ga. Our approach could be applied to analyze the role of the lymphatic system in snakebite for a better understanding of envenoming.

Inhibition of cholinergic contractions of rat ileum by tkopane-type alkaloids present in Schizanthus hookeri.

The relative lack of specificity of atropine as a competitive antagonist of muscarinic receptors is a frequent cause of undesirable parasympathetic side effects. Consequently, new tropane alkaloids with potentially greater selectivity are usually seen with real interest. The cholinergic antagonistic effects of a purified mixture of tropane alkaloids extracted from Schizanthus hookeri were evaluated in rat ileum. For this purpose, ileal segments were obtained from randomly selected male Sprague-Dawley rats, and the effect of 1 x 10(-4), 1 x 10(-3), and 1 x 10(-2) mg/mL of the purified mixture of alkaloids on the contractile response of the ileum induced with increasing doses of carbachol (5 x 10(-8) - 10(-4) M) was determined. The results were compared with those obtained in the presence of 3.46 x 10(-7), 3.46 x 10(-6), and 3.46 x 10(-5) mg/mL atropine as an agonist. Tropane alkaloids extracted from Schizanthus hookeri competitively antagonized acetylcholine muscarinic receptors.

Oxaliplatin but not irinotecan impairs posthepatectomy liver regeneration in a murine model.

Introduction. We examined the murine hepatectomy model of liver regeneration (LR) in the setting of neoadjuvant chemotherapy. Methods. C57BL/6 mice were randomized to receive neoadjuvant intraperitoneal (IP) injections of a control, oxaliplatin (15 mg/kg), or irinotecan (100 mg/Kg or 250 mg/Kg) solution. Hepatectomy (70%) was performed 14 days after the final IP treatment. Animals were sacrificed at postoperative day (D) 0, 1, 2, 3, and 7. Liver remnants and serum were collected for analysis. T-tests for independent samples were used for statistical comparisons. Results. For oxaliplatin, percent LR did not differ at D1 or D2 but was significantly less at D3 (89.0% versus 70.0%, P = 0.048) with no difference on D7 (P = 0.21). Irinotecan-treated mice at both dose levels (100 mg/Kg and 250 mg/Kg) showed no significant differences in LR. BrdU incorporation was significantly decreased in oxaliplatin-treated animals (D1,2,3). Conclusions. Neoadjuvant oxaliplatin but not irinotecan impairs early LR in a posthepatectomy murine model which correlates with decreased DNA synthesis.

Tratamiento quirúrgico de Fracturas mandibulares en pacientes pediátricos: Revisión Bibliográfica / Surgical treatment of mandibular fractures in pediatric patients

Las fracturas faciales en niños muestran características importantes en lo que respecta a su prevalencia, diagnóstico y tratamiento, las cuales las diferencian de las fracturas en adultos. Por estas razones, el trauma infantil debe ser objeto de especial atención ya que presentan particulares características anatómicas, fisiológicas y psicológicas propias de la edad del paciente. Las fracturas mandibulares infantiles que presenten pequeños desplazamientos pueden ser tratadas conservadoramente, mientras que, aquellas que presenten desplazamientos mayores y que interfieran con la función deben ser tratadas de manera semejante a la de los adultos, esto es con reducción cruenta y estabilización, la misma que puede ser obtenida por medio de dispositivos como placas, alambres de acero, tornillos, tornillos y placas de titanio o mediante sistemas de osteosíntesis resorbibles. Estos diferentes sistemas presentan indicaciones, ventajas y desventajas, las cuales deben ser consideradas a fin de elegir la opción de tratamiento más adecuada.

The facial fractures in children show important characteristics about their prevalence, diagnosis and treatment, which differentiate them from fractures in adults. For these reasons, children trauma should be a subject of special attention to due the anatomical, physiological and psychological considerations of the patient´s age. The children jaw fractures that show little displacements can be treat in a conservative way, while those that show greater displacements and interfering with the function should be treated similarly to that in adults, this is with open reduction and stabilization, using some devices such as plaques, steel wires, screws and titanium plaques or through resorbable osteosynthesis systems. These different systems show indications, advantages and disadvantages, which must be considered in order to choose the most suitable treatment.

Liver resection using a four-prong radiofrequency transection device.

Multiple techniques are available for division of hepatic parenchyma. This is the largest United States report examining the use of the Habib 4X tissue coagulator (AngioDynamics, Queensbury, NY). The objective was to collect standard parameters associated with successful, benchmarked liver surgery outcomes using this new device, and in particular, examine the risk of margin failure. Ninety-four consecutive operations using the Habib 4X were analyzed with special attention to local failure at resection margin, blood loss/transfusion, and operative times. An institutional review board approved protocol allowed collection and analysis of demographic information and outcomes for intraoperative, perioperative, and long-term follow-up. Eighteen patients had biopsy only. Thirty-one had lobar resections and 46 had wedge or segmental resections. There were 30 primary hepatic and 46 metastatic tumor diagnoses. There were a total of 33 (43%) recurrences with a mean time to recurrence of 212 days (range 15-974). Of the 27 intrahepatic recurrences, four (15%) were at the margin. The OR time ranged from 115 to 642 minutes (average 283 min). The average recorded blood loss was 427 mL; 11 patients were transfused (average 0.43 units). The Habib 4X is a safe tool to use when evaluating the parameters of blood loss, transfusion, and margin recurrence.

Evaluación clínica y de laboratorio de las infecciones producidas por Pseudomonas aeruginosa en el Hospital Arzobispo Loayza / Clinical evaluation and of laboratory of the infections produced by aeruginosa pseudomonas in the Hospital Arzobispo Loayza

Objetivo: Evaluar las características clínicas y establecer los patrones de resistencia de la Pseudomonas aeruginosa a los antibióticos. Diseño: Estudio descriptivo de corte transversal realizado en el Hospital Arzobispo Loayza que incluyó a pacientes con cultivo positivo para P. aeruginosa desde el 1 de setiembre hasta el 30 de noviembre de 1999. Mediciones y resultados: Cumplieron con los criterios de inclusión 33 pacientes, cuyo tiempo de hospitalización promedio hasta presentar cultivo positivo fue 23 días; de estos pacientes, en 54,6 por ciento la infección se localizó en la piel; en 33,3 por ciento, en tracto urinario; y en 12,1 por ciento, en tracto respiratorio. En cuanto al patrón de resistencia antibiótica, fue elevada frente a gentamicina (87,5 por ciento), ciprofloxacina (68,8 por ciento) y amikacina (63,6 por ciento); es importante la resistencia a ceftazidima (41,4 por ciento), cefpiroma (39,3 por ciento) y cefoperazona/sulbactam (37,9 por ciento). Por otro lado, la escasa o nula resistencia a aztreonam, imipenem y meropenem los convierte en las armas más importantes para el tratamiento de las infecciones por Pseudomonas. Conclusión: Al momento de realizarse este estudio, P. aeruginosa presenta una alta resistencia frente a las quinolonas y los aminoglicósidos, 41 por ciento de resistencia a la ceftazidima y es casi completamente sensible al aztreonam, meropenem e imipenem.