Lactate is an energy substrate for rodent cortical neurons and enhances their firing activity.

Glucose is the mandatory fuel for the brain, yet the relative contribution of glucose and lactate for neuronal energy metabolism is unclear. We found that increased lactate, but not glucose concentration, enhances the spiking activity of neurons of the cerebral cortex. Enhanced spiking was dependent on ATP-sensitive potassium (KATP) channels formed with KCNJ11 and ABCC8 subunits, which we show are functionally expressed in most neocortical neuronal types. We also demonstrate the ability of cortical neurons to take-up and metabolize lactate. We further reveal that ATP is produced by cortical neurons largely via oxidative phosphorylation and only modestly by glycolysis. Our data demonstrate that in active neurons, lactate is preferred to glucose as an energy substrate, and that lactate metabolism shapes neuronal activity in the neocortex through KATP channels. Our results highlight the importance of metabolic crosstalk between neurons and astrocytes for brain function.

In vivo functional diversity of midbrain dopamine neurons within identified axonal projections.

Functional diversity of midbrain dopamine (DA) neurons ranges across multiple scales, from differences in intrinsic properties and connectivity to selective task engagement in behaving animals. Distinct in vitro biophysical features of DA neurons have been associated with different axonal projection targets. However, it is unknown how this translates to different firing patterns of projection-defined DA subpopulations in the intact brain. We combined retrograde tracing with single-unit recording and labelling in mouse brain to create an in vivo functional topography of the midbrain DA system. We identified differences in burst firing among DA neurons projecting to dorsolateral striatum. Bursting also differentiated DA neurons in the medial substantia nigra (SN) projecting either to dorsal or ventral striatum. We found differences in mean firing rates and pause durations among ventral tegmental area (VTA) DA neurons projecting to lateral or medial shell of nucleus accumbens. Our data establishes a high-resolution functional in vivo landscape of midbrain DA neurons.

Implementation of an IT-guided checklist to improve the quality of medication history records at hospital admission.

Background Medication discrepancies often occur at transition of care such as hospital admission and discharge. Obtaining a complete and accurate medication history on admission is essential as further treatment is based on it. Objective The goal of this study was to reduce the proportion of patients with at least one medication discrepancy in the medication history at admission by implementing an IT-guided checklist. Setting Surgery ward focused on vascular and visceral surgery at a Swiss Cantonal Hospital. Method The study was divided into two phases, before and after implementation of an IT-guided checklist. For both phases a pharmacist collected and compared the medication history (defined as gold standard) with that of the admitting physician. Medication discrepancies were subdivided in omissions and commissions, incorrect medications or dose changes, and incorrect dosage forms or strength. Main outcome measure The proportion of patients with at least one medication discrepancy in the medication history before and after intervention was assessed. Results Out of 415 admissions, 228 patients that met the inclusion criteria were enrolled in the study, 113 before and 115 patients after intervention. After intervention, medication discrepancies declined from 69.9 to 29.6% (p < 0.0001) of patients, the mean medication discrepancy per patient was reduced from 2.3 to 0.6 (p < 0.0001), and the most common error, omission of a regularly used medication, was reduced from 76.4 to 44.1% (p < 0.001). Conclusion The implementation of the IT-guided checklist is associated with a significant reduction of medication discrepancies at admission and potentially improves the medication safety for the patient.

Norovirus outbreak in a district general hospital--new strain identified.

INTRODUCTION: Media reports about Norovirus outbreaks, especially in hospitals and nursing homes, have accumulated in the past years. The reasons for this increasing problem are manifold: resistance against common disinfectants, a high level of contagion (a dose of less than 100 particles may be infective); variability of the virus-genome documented by polymerase chain reaction-studies, as well as further factors concerning modern life-style. The following study describes and analyses a Norovirus outbreak in the SRO-Hospital Langenthal from November 25, 2003, to December 31, 2003. PATIENTS AND METHODS: The case definition included sudden vomiting and diarrhoea, abdominal cramps, fever below 38.5 degrees C and recovery after 48 hours. Stool cultures were taken and tested for bacteria (Campylobacter jejuni, salmonella and shigella species) and rotaviruses. Stool and vomit specimens were then tested using Real Time Polymerase Chain Reaction (RT-PCR) for noroviruses using different primer sets. Epidemiological data were gained such as transmission modus from person-to-person or food-borne. RESULTS: A total of 77 persons were affected by the viral disease. Two incidence-peaks of gastroenteritis were noted. The first peak happened in the geriatric ward and the second in the geographically distinct department of internal medicine. The existence of a new norovirus strain of genogroup II/4 has been confirmed by the CDC Enteric Viruses Branch in Atlanta, GA. The measures to be taken are pointed out. CONCLUSIONS: A norovirus gastroenteritis outbreak of such intensity and extent as described had not thus far occurred in the hospital's history. The strains newly found by sequencing are associated with genogroup II/4. This genogroup caused a striking increase of gastroenteritis outbreaks in Europe in the year 2002 including atypical spring and summer peaks. This new variant is supposed to be more virulent and environmentally more stable than previous strains [21]. Preventive measures that are in agreement with the published guidelines were taken before the viral pathogen was identified by RT-PCR. The obvious emerging problem of norovirus infections in our society and the economic data analysing the costs caused by lost bed days and staff absence make epidemiological investigation of outbreaks and application of molecular tests more important. They are the basis for determining transmission routes and characterising the different strains in order to improve preventive strategies.