Characteristics and optical properties of atmospheric aerosols based on long-term AERONET investigations in an urban environment of Pakistan.

Radiative balance, local climate, and human health are all significantly influenced by aerosol. Recent severe air pollution over Lahore, a city in Pakistan calls for more thorough research to determine the negative impacts brought on by too many aerosols. To study regional aerosol characteristics and their differences from various aspects, in-depth and long-term (2007-2020) investigations of the columnar aerosol properties over the urban environment of Lahore were carried out by using AERONET data. The Aerosol Optical Depth (AOD400) and Angstrom Exponent (AE400-870) vary from low values of 0.10 to a maximum value of 4.51 and from 0.03 to 1.81, respectively. The huge differences in the amount of AOD440 as well as AE440-870 show the large fluctuation of aerosol classes because of various sources of their emission. During the autumn and winter seasons, the decreasing trend of the optical parameters of aerosols like Single Scattering Albedo (SSA) and Asymmetry Parameter (ASY) with increasing wavelength from 675 to 1020 nm indicates the dominance of light-absorbing aerosols (biomass burning (BB) and industrial/urban (UI). Due to the long-distance dust movement during spring, summer, and autumn, coarse mode particles predominated in Lahore during the study period. Dust type (DD) aerosols are found to be the dominant one during spring (46.92%), summer (54.31%), and autumn (57.46%) while urban industry (BB/UI) was dominant during the winter season (53.21%). During each season, the clean continental (CC) aerosols are found to be in negligible amounts, indicating terrible air quality in Lahore City. The present research work fills up the study gap in the optical properties of aerosols in Lahore and will help us understand more fully how local aerosol fluctuation affects regional climate change over the urban environment of Lahore.

The Role of Fish Skin Xenografts in Healing Complex Wounds: A Brief Case Report.

Non-healing wounds profoundly impact patient quality of life and present a significant financial burden. The Kerecis™ fish skin xenograft is a decellularized skin matrix that has been introduced to treat complicated wounds. The objective of this presentation is to highlight the use of fish skin xenograft in the treatment of a complex right flank wound with stool contamination, necrotizing soft tissue infection due to perforated colon cancer, and sepsis. This presentation follows the wound healing for 28 days following the operation and demonstrates the efficacy of fish skin xenografts in improved wound healing. A 61-year-old female with a past medical history of colon cancer and recent chemotherapy treatment presented with colon perforation causing right flank cellulitis and sepsis with necrotic abdominal wall tissue extending into the hip joint. She was taken for an emergent exploratory laparotomy, drainage of abdominal and retroperitoneal abscesses, open right hemicolectomy, diverting ileostomy, abdominal washout, intra-abdominal omental patch, placement of Strattice mesh, and debridement of necrotizing soft tissue infection of the right flank. After extensive debridement of her 15x10cmx5cm deep wound and placement of a Kerecis™ fish skin xenograft, the wound had completely healed with excellent granulation tissue, and the patient was scheduled for placement of a skin graft 28 days following the initial procedure. The results after xenograft application were outstanding, supporting the use of polyunsaturated fatty acid (PUFA) based xenografts in wound treatment due to their anti-inflammatory and angiogenic properties. This is definitely an option that needs to be considered in expediting the healing process for complex wounds.

Wintertime investigation of PM10 concentrations, sources, and relationship with different meteorological parameters.

Meteorological factors play a crucial role in affecting air quality in the urban environment. Peshawar is the capital city of the Khyber Pakhtunkhwa province in Pakistan and is a pollution hotspot. Sources of PM10 and the influence of meteorological factors on PM10 in this megacity have yet to be studied. The current study aims to investigate PM10 mass concentration levels and composition, identify PM10 sources, and quantify links between PM10 and various meteorological parameters like temperature, relative humidity (RH), wind speed (WS), and rainfall (RF) during the winter months from December 2017 to February 2018. PM10 mass concentrations vary from 180 - 1071 µg m-3, with a mean value of 586 ± 217 µg m-3. The highest concentration is observed in December, followed by January and February. The average values of the mass concentration of carbonaceous species (i.e., total carbon, organic carbon, and elemental carbon) are 102.41, 91.56, and 6.72 µgm-3, respectively. Water-soluble ions adhere to the following concentration order: Ca2+ > Na+ > K+ > NH4+ > Mg2+. Twenty-four elements (Al, Si, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Co, Zn, Ga, Ge, As, Se, Kr, Ag, Pb, Cu, and Cd) are detected in the current study by PIXE analysis. Five sources based on Positive Matrix Factorization (PMF) modeling include industrial emissions, soil and re-suspended dust, household combustion, metallurgic industries, and vehicular emission. A positive relationship of PM10 with temperature and relative humidity is observed (r = 0.46 and r = 0.56, respectively). A negative correlation of PM10 is recorded with WS (r = - 0.27) and RF (r = - 0.46). This study's results motivate routine air quality monitoring owing to the high levels of pollution in this region. For this purpose, the establishment of air monitoring stations is highly suggested for both PM and meteorology. Air quality standards and legislation need to be revised and implemented. Moreover, the development of effective control strategies for air pollution is highly suggested.

The use of Multispectral Radio-Meter (MSR5) data for wheat crop genotypes identification using machine learning models.

Satellite remote sensing is widely being used by the researchers and geospatial scientists due to its free data access for land observation and agricultural activities monitoring. The world is suffering from food shortages due to the dramatic increase in population and climate change. Various crop genotypes can survive in harsh climatic conditions and give more production with less disease infection. Remote sensing can play an essential role in crop genotype identification using computer vision. In many studies, different objects, crops, and land cover classification is done successfully, while crop genotypes classification is still a gray area. Despite the importance of genotype identification for production planning, a significant method has yet to be developed to detect the genotypes varieties of crop yield using multispectral radiometer data. In this study, three genotypes of wheat crop (Aas-'2011', 'Miraj-'08', and 'Punjnad-1) fields are prepared for the investigation of multispectral radio meter band properties. Temporal data (every 15 days from the height of 10 feet covering 5 feet in the circle in one scan) is collected using an efficient multispectral Radio Meter (MSR5 five bands). Two hundred yield samples of each wheat genotype are acquired and manually labeled accordingly for the training of supervised machine learning models. To find the strength of features (five bands), Principle Component Analysis (PCA), Linear Discriminant Analysis (LDA), and Nonlinear Discernment Analysis (NDA) are performed besides the machine learning models of the Extra Tree Classifier (ETC), Random Forest (RF), Support Vector Machine (SVM), Decision Tree (DT), Logistic Regression (LR), k Nearest Neighbor (KNN) and Artificial Neural Network (ANN) with detailed of configuration settings. ANN and random forest algorithm have achieved approximately maximum accuracy of 97% and 96% on the test dataset. It is recommended that digital policymakers from the agriculture department can use ANN and RF to identify the different genotypes at farmer's fields and research centers. These findings can be used for precision identification and management of the crop specific genotypes for optimized resource use efficiency.

Maternal Epidermal Growth Factor Promotes Neonatal Claudin-2 Dependent Increases in Small Intestinal Calcium Permeability.

A higher concentration of calcium in breast milk than blood favors paracellular calcium absorption enabling growth during postnatal development. We aimed to determine whether suckling animals have greater intestinal calcium permeability to maximize absorption and to identify the underlying molecular mechanism. We examined intestinal claudin expression at different ages in mice and in human intestinal epithelial (Caco-2) cells in response to hormones or human milk. We also measured intestinal calcium permeability in wildtype, Cldn2 and Cldn12 KO mice and Caco-2 cells in response to hormones or human milk. Bone mineralization in mice was assessed by µCT. Calcium permeability across the jejunum and ileum of mice were 2-fold greater at 2 wk than 2 mo postnatal age. At 2 wk, Cldn2 and Cldn12 expression were greater, but only Cldn2 KO mice had decreased calcium permeability compared to wildtype. This translated to decreased bone volume, cross-sectional thickness, and tissue mineral density of femurs. Weaning from breast milk led to a 50% decrease in Cldn2 expression in the jejunum and ileum. Epidermal growth factor (EGF) in breast milk specifically increased only CLDN2 expression and calcium permeability in Caco-2 cells. These data support intestinal permeability to calcium, conferred by claudin-2, being greater in suckling mice and being driven by EGF in breast milk. Loss of the CLDN2 pathway leads to suboptimal bone mineralization at 2 wk of life. Overall, EGF-mediated control of intestinal claudin-2 expression contributes to maximal intestinal calcium absorption in suckling animals.

Intra-pituitary follicle-stimulating hormone signaling regulates hepatic lipid metabolism in mice.

Inter-organ communication is a major hallmark of health and is often orchestrated by hormones released by the anterior pituitary gland. Pituitary gonadotropes secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to regulate gonadal function and control fertility. Whether FSH and LH also act on organs other than the gonads is debated. Here, we find that gonadotrope depletion in adult female mice triggers profound hypogonadism, obesity, glucose intolerance, fatty liver, and bone loss. The absence of sex steroids precipitates these phenotypes, with the notable exception of fatty liver, which results from ovary-independent actions of FSH. We uncover paracrine FSH action on pituitary corticotropes as a mechanism to restrain the production of corticosterone and prevent hepatic steatosis. Our data demonstrate that functional communication of two distinct hormone-secreting cell populations in the pituitary regulates hepatic lipid metabolism.

Robotic Sigmoidectomy With Natural Orifice Specimen Extraction: A Single-Center Experience.

Background Natural orifice specimen extraction (NOSE) involves the removal of specimens through a naturally occurring orifice, such as the anus, rather than trans-abdominal extraction. NOSE procedures have been shown to significantly reduce postoperative complications and improve healing.  Objective The purpose of this case series is to report the outcomes of 27 patients undergoing sigmoidectomies through natural orifice specimen extraction. Materials and methods We carefully recorded demographic data on age and BMI, as well as operative data on surgical indication, and length of stay. We also collected data on postoperative complications, including infection, hernia, wound dehiscence, urinary tract infections (UTIs), or anastomotic leaks. Results Our patients were majority female (n = 21, 77.8%) with a median age of 53.5 (range: 25-79) and median BMI of 33.2 kg/m2 (range: 16.7 - 48.3 kg/m2). Thirteen patients (48.1%) were obese (BMI > 30.0 kg/m2). The majority of these patients underwent sigmoidectomies for benign conditions such as recurrent diverticulitis (n = 9, 33.3%), rectal prolapse (n = 8, 29.6%), perforated diverticulitis (n = 3, 11.1%), colovesical fistula (n = 3, 11.1%), and abdominal abscess (n = 3, 11.1%) (Table 1). One patient was receiving treatment for sigmoid cancer. The average estimated blood loss was 63.26 mL. The average hospital stay was 3.61 days. Three patients (11.1%) developed a fever postoperatively (temperature >= 100.4 F), which resolved the day after. One patient completed a post-operative hospital stay of 19 days for dialysis and rehab placement. No patients (0.0%) experienced any postoperative complications, including wound infection, hernia, dehiscence, UTIs, or anastomotic leakages. There was no postoperative mortality. Conclusions Our study demonstrates the practicality and safety of NOSE procedures for sigmoidectomies as an alternative to transabdominal approaches to treat benign colon diseases.

Robotic Single-Site Cholecystectomy: A Single-Center Retrospective Study.

Objective Our goal is to describe and report the outcomes of patients undergoing robotic single-site cholecystectomy at a single institution. Background Cholecystectomy is a common procedure performed to remove the gallbladder. Robotic single-site cholecystectomy (RSSC) is rapidly emerging as a safe and feasible alternative to conventional 4-port laparoscopic techniques. Patients who undergo RSSC procedures may also have a decreased need for postoperative analgesics and a lower postoperative pain score. Methods From September 2020 to August 2023, there were 33 cases of RSSC performed by a single surgeon at a single institution. We recorded demographic data including sex, age, and BMI as well as postoperative outcome data including wound dehiscence, postoperative infection, biliary leakage, wound herniation, blood loss, and conversion to open procedure. Results The patient group included 24 females (72.7%) and nine males (27.3%) with a median age of 32 (Range: 9-70) and a median BMI of 24.2 kg/m2 (Range: 18.1-30.7). The majority of these patients were receiving cholecystectomies for benign conditions such as symptomatic cholelithiasis (n = 18, 54.5%), biliary dyskinesia (n = 13, 39.4%), acute cholecystitis (n = 1, 0.03%), and biliary colic (n = 1, 0.03%). The average estimated blood loss was 5.91 mL. Thirty-two patients (96.9%) were discharged home the same day of surgery. One patient was admitted overnight for observation due to severe biliary dyskinesia diagnosed preoperatively. The patient had no complications and was discharged the following day. One patient presented with acute abdominal wall cellulitis and omphalitis with no underlying abscess four weeks after the operation. They were treated with therapeutic antibiotics. No patients underwent conversion to an open procedure. There were no incidences of postoperative wound dehiscence or biliary leakages. One patient was admitted overnight for observation of biliary dyskinesia and another experienced abdominal wall cellulitis four weeks post-operation. Conclusions Although conventional multi-incision laparoscopic cholecystectomy remains the gold standard treatment for benign gallbladder disease, our study demonstrates the practicality and safety of Robotic Single-Site Cholecystectomy procedures.

Impact of climate change on agricultural production; Issues, challenges, and opportunities in Asia.

Agricultural production is under threat due to climate change in food insecure regions, especially in Asian countries. Various climate-driven extremes, i.e., drought, heat waves, erratic and intense rainfall patterns, storms, floods, and emerging insect pests have adversely affected the livelihood of the farmers. Future climatic predictions showed a significant increase in temperature, and erratic rainfall with higher intensity while variability exists in climatic patterns for climate extremes prediction. For mid-century (2040-2069), it is projected that there will be a rise of 2.8°C in maximum temperature and a 2.2°C in minimum temperature in Pakistan. To respond to the adverse effects of climate change scenarios, there is a need to optimize the climate-smart and resilient agricultural practices and technology for sustainable productivity. Therefore, a case study was carried out to quantify climate change effects on rice and wheat crops and to develop adaptation strategies for the rice-wheat cropping system during the mid-century (2040-2069) as these two crops have significant contributions to food production. For the quantification of adverse impacts of climate change in farmer fields, a multidisciplinary approach consisted of five climate models (GCMs), two crop models (DSSAT and APSIM) and an economic model [Trade-off Analysis, Minimum Data Model Approach (TOAMD)] was used in this case study. DSSAT predicted that there would be a yield reduction of 15.2% in rice and 14.1% in wheat and APSIM showed that there would be a yield reduction of 17.2% in rice and 12% in wheat. Adaptation technology, by modification in crop management like sowing time and density, nitrogen, and irrigation application have the potential to enhance the overall productivity and profitability of the rice-wheat cropping system under climate change scenarios. Moreover, this paper reviews current literature regarding adverse climate change impacts on agricultural productivity, associated main issues, challenges, and opportunities for sustainable productivity of agriculture to ensure food security in Asia. Flowing opportunities such as altering sowing time and planting density of crops, crop rotation with legumes, agroforestry, mixed livestock systems, climate resilient plants, livestock and fish breeds, farming of monogastric livestock, early warning systems and decision support systems, carbon sequestration, climate, water, energy, and soil smart technologies, and promotion of biodiversity have the potential to reduce the negative effects of climate change.

Subunit composition, molecular environment, and activation of native TRPC channels encoded by their interactomes.

In the mammalian brain TRPC channels, a family of Ca2+-permeable cation channels, are involved in a variety of processes from neuronal growth and synapse formation to transmitter release, synaptic transmission and plasticity. The molecular appearance and operation of native TRPC channels, however, remained poorly understood. Here, we used high-resolution proteomics to show that TRPC channels in the rodent brain are macro-molecular complexes of more than 1 MDa in size that result from the co-assembly of the tetrameric channel core with an ensemble of interacting proteins (interactome). The core(s) of TRPC1-, C4-, and C5-containing channels are mostly heteromers with defined stoichiometries for each subtype, whereas TRPC3, C6, and C7 preferentially form homomers. In addition, TRPC1/C4/C5 channels may co-assemble with the metabotropic glutamate receptor mGluR1, thus guaranteeing both specificity and reliability of channel activation via the phospholipase-Ca2+ pathway. Our results unveil the subunit composition of native TRPC channels and resolve the molecular details underlying their activation.

Using the Taguchi experimental design for assessing within-field variability of surface run-off and soil erosion risk.

Water erosion is one of the soil degradation processes driven by environmental and field factors such as rainfall intensity, slope gradient, dynamics of vegetation cover, soil characteristics, and management practices. Most of the studies assess the separate contribution of these factors under controlled conditions. However, there is a lack of adequate knowledge regarding the complex interactions between prevailing factors and soil erosion processes under heterogeneous field conditions. This study investigated 16 combinations of 5 factors at 4 levels of each factor on the soil erosion process using Taguchi's fractional factorial experiment design, identifying the factor combinations resulting in maximum sediment yield, runoff, organic carbon, and nitrogen losses. We considered the factors: Soil organic matter and silt content (SiltOM), vegetation cover (VC), slope steepness (SS), rainfall intensity (RI), and depth to a loamy layer (DLL). The interactive effects of these factors and their combinations were visualized from the analysis of signal-to-noise (S/N) responses. Results indicated that interactions between the selected factors and soil erosion processes exist and multiple linear regression models were developed to predict sediment yields, runoff, carbon, and nitrogen losses at the sub-field scale. Results revealed that 1) RI with 40.6% showed the highest contribution to sediment yield followed by SS (23.8%), VC (17.74%), SiltOM (14.77%), and DLL (3.17%), indicating a strong rainfall-erosion relationship; 2) the combination of levels of factors generating highest sediment yield was determined; 3) A simple multiple linear regression model developed for predicting local sediment yield showed the highest agreement with field observations (R2 = 82.5%). The findings suggest that Taguchi design could be used reliably for modeling soil erosion at field and sub-field scales. Using local calibration data such models have great potential for soil erosion risk assessments at the field scale, especially in areas where contributing factors and factor levels change at small spatial scales.

Establishment of a Reliable Model to Study the Failure of Fracture Healing in Aged Mice.

The failure of fracture healing represents a substantial clinical problem. Moreover, aged patients demonstrate an elevated risk for failed bone healing. However, murine models to study the failure of fracture healing are established only in young adult animals. Therefore, the aim of this study was to develop a reliable model to study failed fracture healing in aged mice. After creation of a 1.8-mm segmental defect and periosteal resection, femora of aged mice (18-20 months) and young adult control mice (3-4 months) were stabilized by pin-clip fixation. Segmental defects were analyzed by means of biomechanics, x-ray, and micro-computed tomography, as well as histomorphometric, immunohistochemical, and Western blot analysis. After 10 weeks, all animals showed a complete lack of osseous bridging, resulting in fracture healing failure. Segmental defects in aged mice revealed a reduced bone formation and vascularization when compared to young adult mice. This was associated with a decreased expression of bone formation markers. In addition, we detected a reduced number of tartrate-resistant acid phosphatase-positive osteoclasts and an elevated osteoprotegerin/receptor activator of NF-ĸB ligand ratio in aged animals, indicating a reduced osteoclast activity. Moreover, aged animals showed also an enhanced inflammatory response, characterized by an increased infiltration of macrophages within the callus tissue. Taken together, we herein report for the first time a reliable model to study fracture healing failure in aged mice. In the future, the use of this model enables us to study novel therapeutic strategies and molecular mechanics of failed fracture healing during aging.

TRPV6 and Cav1.3 Mediate Distal Small Intestine Calcium Absorption Before Weaning.

BACKGROUND & AIMS: Intestinal Ca2+ absorption early in life is vital to achieving optimal bone mineralization. The molecular details of intestinal Ca2+ absorption have been defined in adults after peak bone mass is obtained, but they are largely unexplored during development. We sought to delineate the molecular details of transcellular Ca2+ absorption during this critical period. METHODS: Expression of small intestinal and renal calcium transport genes was assessed by using quantitative polymerase chain reaction. Net calcium flux across small intestinal segments was measured in Ussing chambers, including after pharmacologic inhibition or genetic manipulation of TRPV6 or Cav1.3 calcium channels. Femurs were analyzed by using micro-computed tomography and histology. RESULTS: Net TRPV6-mediated Ca2+ flux across the duodenum was absent in pre-weaned (P14) mice but present after weaning. In contrast, we found significant transcellular Ca2+ absorption in the jejunum at 2 weeks but not 2 months of age. Net jejunal Ca2+ absorption observed at P14 was not present in either Trpv6 mutant (D541A) mice or Cav1.3 knockout mice. We observed significant nifedipine-sensitive transcellular absorption across the ileum at P14 but not 2 months. Cav1.3 knockout pups exhibited delayed bone mineral accrual, compensatory nifedipine-insensitive Ca2+ absorption in the ileum, and increased expression of renal Ca2+ reabsorption mediators at P14. Moreover, weaning pups at 2 weeks reduced jejunal and ileal Cav1.3 expression. CONCLUSIONS: We have detailed novel pathways contributing to transcellular Ca2+ transport across the distal small intestine of mice during development, highlighting the complexity of the multiple mechanisms involved in achieving a positive Ca2+ balance early in life.

Maternal Transient Receptor Potential Vanilloid 6 (Trpv6) Is Involved In Offspring Bone Development.

Embryonic growth and bone development depend on placental Ca2+ transport across the feto-maternal barrier to supply minerals to the fetus. The individual factors and cellular mechanisms that regulate placental Ca2+ transfer, however, are only beginning to emerge. We find that the Ca2+ -selective transient receptor potential vanilloid 6 (TRPV6) channel is expressed in trophoblasts of the fetal labyrinth, in the yolk sac, and in the maternal part of the placenta. Lack of functional TRPV6 channels in the mother leads to a reduced Ca2+ content in both placenta and embryo. Ca2+ uptake in trophoblasts is impaired in the absence of Trpv6. Trpv6-deficient embryos are smaller, have a lower body weight, and shorter and less calcified femurs. The altered cortical bone microarchitecture persists in adulthood. We show that TRPV6's Ca2+ -conducting property causes this embryonic and bone phenotype. Our results show that TRPV6 is necessary for the Ca2+ uptake in trophoblasts and that TRPV6 deficiency in the placenta leads to reduced embryo growth, minor bone calcification, and impaired bone development. © 2019 American Society for Bone and Mineral Research.

Some neck swellings are serious; a case of Lemierre's Syndrome.

Lemierre's syndrome also termed post-anginal septicemia, is a disease characterized by internal jugular septic thrombophlebitis leading to Fusobacterium septicemia with multiple metastatic foci following an oropharyngeal infection. Diagnosis and management is challenging and can result in fatal consequences due to potential multisystem involvement and multiple complications. We describe here a case of Lemierre's syndrome with multifocal pneumonia, acute renal failure and protracted course of illness over forty days with successful recovery. A brief overview of literature is also presented.

The Novel Use of Resuscitative Endovascular Balloon Occlusion of the Aorta to Explore a Retroperitoneal Hematoma in a Hemodynamically Unstable Patient.

Balloon occlusion of the aorta was first described by C.W. Hughes in 1954, when it was used as a tamponade device for three wounded soldiers during the Korean War suffering from intra-abdominal hemorrhage. Currently, the device is indicated in trauma patients as a surrogate for resuscitative thoracotomy. Brenner et al. reported a case series describing the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in advanced hemorrhagic shock. Their conclusion was that "it is a feasible method for proximal aortic control." We describe the novel use of REBOA before retroperitoneal hematoma exploration in a hemodynamically unstable patient. Reported is a 19-year-old blunt trauma victim where REBOA was successfully deployed as a means for proximal arterial control before a Zone 1 retroperitoneal hematoma exploration. The source of the patient's hemorrhagic shock was multifactorial: grade V hepatic injury, retrohepatic inferior vena cava laceration, and right renal vein avulsion with Zone 1 retroperitoneal hematoma. Immediate return of perfusion pressure, as systolic pressures increased from 50 to 150 mm Hg. Hemodynamic improvements were accompanied by decreased transfusion and vasopressor requirements. In addition, the surgeons were able to enter the retroperitoneal hematoma under controlled conditions. REBOA is an attractive new tool to gain proximal aortic control in select patients with hemorrhagic shock. It is less morbid, possibly more efficient, and appears to be more effective than resuscitative thoracotomy. REBOA is certainly feasible for proximal aortic control before retroperitoneal exploration, and should be considered in select patients.

Cost Effectiveness of a Novel Attempt to Reduce Readmission after Ileostomy Creation.

BACKGROUND AND OBJECTIVES: Dehydration is a common complication after ileostomy creation and is the most frequent reason for postoperative readmission to the hospital. We sought to determine the clinical and economic impact of an outpatient intervention to decrease readmissions for dehydration after ileostomy creation. METHODS: All new ileostomates from 09/2011 through 10/2012 at the University of Florida were enrolled to receive an ileostomy education and management protocol and a daily telephone call for 3 weeks after discharge. Counseling and medication adjustments were provided, with a satisfaction survey at the end. Outcomes of these patients were compared to those in a historical control cohort. A cost analysis was conducted to calculate the savings to the hospital. RESULTS: Thirty-eight patients were enrolled. All patients required telephone counseling, and the mean satisfaction score rating was 4.69, on a scale of 1 to 5. The readmission rate for dehydration within 30 days of discharge decreased significantly from 65% before intervention to 16% (5/32 patients) after intervention (P = .002). The length of readmission hospital stay decreased from a mean of 4.2 days before the introduction of the intervention to 3 days after. Cost analysis revealed that the actual total hospital cost of dehydration-specific readmission decreased from $88,858 to $25,037, a saving of $63,821. CONCLUSION: A standardized ileostomy pathway with comprehensive patient education and outpatient telephone follow-up is cost effective, has a positive influence on patient satisfaction, and reduces dehydration-related readmission rates.

Identification of Parvalbumin Interneurons as Cellular Substrate of Fear Memory Persistence.

Parvalbumin-positive (PV) basket cells provide perisomatic inhibition in the cortex and hippocampus and control generation of memory-related network activity patterns, such as sharp wave ripples (SPW-R). Deterioration of this class of fast-spiking interneurons has been observed in neuropsychiatric disorders and evidence from animal models suggests their involvement in the acquisition and extinction of fear memories. Here, we used mice with neuron type-targeted expression of the presynaptic gain-of-function glycine receptor RNA variant GlyR α3L(185L)to genetically enhance the network activity of PV interneurons. These mice showed reduced extinction of contextual fear memory but normal auditory cued fear memory. They furthermore displayed increase of SPW-R activity in area CA3 and CA1 and facilitated propagation of this particular network activity pattern, as determined in ventral hippocampal slice preparations. Individual freezing levels during extinction and SPW-R propagation were correlated across genotypes. The same was true for parvalbumin immunoreactivity in the ventral hippocampus, which was generally augmented in the GlyR mutant mice and correlated with individual freezing levels. Together, these results identify PV interneurons as critical cellular substrate of fear memory persistence and associated SPW-R activity in the hippocampus. Our findings may be relevant for the identification and characterization of physiological correlates for posttraumatic stress and anxiety disorders.