Rapid actions of aldosterone revisited: receptors in the limelight

Publication date: Available online 23 January 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Martin Wehling
Steroid hormones like aldosterone have been conclusively shown to elicit both late genomic and rapid, nongenomically initiated responses. Aldosterone was among the first for which rapid, clinically relevant effects were even shown in humans. Yet, after over 30 years of research, the nature of receptors involved in rapid actions of aldosterone is still unclear. Such effects may be assigned to the classical, intracellular steroid receptors, in this case mineralocorticoid receptors (MR, class IIa action Mannheim classification). They typically disappear in knockout models and are blocked by MR-antagonists such as spironolactone, as shown for several cellular and physiological, e.g. renal or cardiovascular effects. In contrast, there is also consistent evidence suggesting type IIb effects involving structurally different receptors ("membrane receptors") being insensitive to classic antagonists and persistent in knockout models; IIb effects have lately even been confirmed by atomic force detection of surface receptors which bind aldosterone but not spironolactone. Type IIa and b may coexist in the same cell with IIa often augmenting early IIb effects. So far cloning of IIb receptors was unsuccessful; therefore results on G-protein coupled estrogen receptor 1 (GPER1) being potentially involved in rapid aldosterone action raised considerable interest. Surprisingly, GPER1 does not bind aldosterone. Though under these circumstances GPER1 should not yet be considered as IIb-receptor, it might be an intermediary signaling enhancer of mineralocorticoid action as shown for epithelial growth factor receptors reconciling those results. We still seem to be left without IIb-receptors whose identification would however be highly desirable and essential for clinical translation.



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Impact of vitamin D supplementation on endothelial and inflammatory markers in adults: A systematic review

Publication date: Available online 23 January 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Tari Agbalalah, Stephen F. Hughes, Ellen J. Freeborn, Sohail Mushtaq
This systematic review aims to evaluate randomised controlled trials (RCTs) investigating the effect of vitamin D supplementation on endothelial function and inflammation in adults. An electronic search of published randomised controlled trials, using Cochrane, Pubmed and Medline databases was conducted, with the search terms related to vitamin D and endothelial function. Inclusion criteria were RCTs in adult humans with a measure of vitamin D status using serum/plasma 25(OH)D and studies which administered the intervention through the oral route. Among the 1107 studies retrieved, 29 studies met the full inclusion criteria for this systematic review. Overall, 8 studies reported significant improvements in the endothelial/inflammatory biomarkers/parameters measured. However, in 2 out of the 8 studies, improvements were reported at interim time points, but improvements were absent post-intervention. The remaining 21 trial studies did not show significant improvements in the markers of interest measured. Evidence from the studies included in this systematic review did not demonstrate that vitamin D supplementation in adults, results in an improvement in circulating inflammatory and endothelial function biomarkers/parameters. This systematic review does not therefore support the use of vitamin D supplementation as a therapeutic or preventative measure for CVD in this respect.



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Effects on respiratory system due to exposure to wheat flour

Publication date: Available online 23 January 2017
Source:Egyptian Journal of Chest Diseases and Tuberculosis
Author(s): Adel Mohammed Said, Eman Badawy AbdelFattah, Abd-Almonem Mohsen Almawardi
BackgroundThere is growing consensus on the deleterious effects of organic dust on respiratory symptoms and function of industrial workers. Flour dust is widely incriminated to cause impairment of lung function. Exposure to flour dust occurs across a range of food industries including grain mills, flour mills and bakeries.Aim of workTo assess the effects of exposure to flour dust on respiratory symptoms and lung function of bakery workers at a number of bakeries in Cairo.Subjects and methodsThe study was conducted on 30 bakery workers working at bakeries in Cairo state, the cases matched for age, sex, and height. All bakery workers participated in this study were subjected to following: Full medical history taking, Thorough clinical examination, Routine laboratory investigation, BMI was calculated, Chest X-ray, Spirometric lung function test, Diffusion capacity for carbon monoxide (DLCO), Further proper radiological assessment using CT scan for cases that show abnormalities in their chest X-ray or DLCOSB.ResultsAll workers included in the study were males. The age of the flour milling workers ranged between 14 and 56years. They worked at least for 10h per day for 6days per week for total working years ranged between 2 and 30years. This study reported that there was an increase in respiratory symptoms among bakery workers due to exposure to wheat flour. Also, 16.6% of the studied population had abnormal spirometry compared to the reference value, 30% had abnormal diffusion capacity of lung to carbon mono-oxide compared to reference value. Nine participants underwent HRCT chest as their DLCOSB has shown diffusion defect, 5 (55.6%) of them have normal HRCT chest and 4 (44.4%) of them have interstitial changes.ConclusionsExposure to wheat flour increases the risk of developing respiratory symptoms; it also causes reduction in the pulmonary function parameters, as regards spirometry and DLCOSB. Exposure to wheat flour causes interstitial lung disease as detected by HRCT chest. Smoking augments the wheat flour induced lung disease.



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Effects on respiratory system due to exposure to wheat flour

Publication date: Available online 23 January 2017
Source:Egyptian Journal of Chest Diseases and Tuberculosis
Author(s): Adel Mohammed Said, Eman Badawy AbdelFattah, Abd-Almonem Mohsen Almawardi
BackgroundThere is growing consensus on the deleterious effects of organic dust on respiratory symptoms and function of industrial workers. Flour dust is widely incriminated to cause impairment of lung function. Exposure to flour dust occurs across a range of food industries including grain mills, flour mills and bakeries.Aim of workTo assess the effects of exposure to flour dust on respiratory symptoms and lung function of bakery workers at a number of bakeries in Cairo.Subjects and methodsThe study was conducted on 30 bakery workers working at bakeries in Cairo state, the cases matched for age, sex, and height. All bakery workers participated in this study were subjected to following: Full medical history taking, Thorough clinical examination, Routine laboratory investigation, BMI was calculated, Chest X-ray, Spirometric lung function test, Diffusion capacity for carbon monoxide (DLCO), Further proper radiological assessment using CT scan for cases that show abnormalities in their chest X-ray or DLCOSB.ResultsAll workers included in the study were males. The age of the flour milling workers ranged between 14 and 56years. They worked at least for 10h per day for 6days per week for total working years ranged between 2 and 30years. This study reported that there was an increase in respiratory symptoms among bakery workers due to exposure to wheat flour. Also, 16.6% of the studied population had abnormal spirometry compared to the reference value, 30% had abnormal diffusion capacity of lung to carbon mono-oxide compared to reference value. Nine participants underwent HRCT chest as their DLCOSB has shown diffusion defect, 5 (55.6%) of them have normal HRCT chest and 4 (44.4%) of them have interstitial changes.ConclusionsExposure to wheat flour increases the risk of developing respiratory symptoms; it also causes reduction in the pulmonary function parameters, as regards spirometry and DLCOSB. Exposure to wheat flour causes interstitial lung disease as detected by HRCT chest. Smoking augments the wheat flour induced lung disease.



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Procedural Skills of the Entrustable Professional Activities: Are Graduating US Medical Students Prepared to Perform Procedures in Residency?

Publication date: Available online 23 January 2017
Source:Journal of Surgical Education
Author(s): Adrienne N. Bruce, Anagha Kumar, Sonya Malekzadeh
PurposeCompetency-based medical education has been successfully instituted in graduate medical education through the development of Milestones. Consequently, the Association of American Medical Colleges implemented the core entrustable professional activities initiative to complement this framework in undergraduate medical education. We sought to determine its efficacy by examining the experiences and confidence of recent medical school graduates with general procedural skills (entrustable professional activities 12).MethodWe administered an electronic survey to the MedStar Georgetown University Hospital intern class assessing their experiences with learning and evaluation as well as their confidence with procedural skills training during medical school. Simple linear regression was used to compare respondent confidence and the presence of formal evaluation in medical school.ResultsWe received 28 complete responses, resulting in a 33% response rate, whereas most respondents indicated that basic cardiopulmonary resuscitation, bag/mask ventilation, and universal precautions were important to and evaluated by their medical school, this emphasis was not present for venipuncture, intravenous catheter placement, and arterial puncture. Mean summed scores of confidence for each skill indicated a statistically significant effect between confidence and evaluation of universal precaution skills.ConclusionsMore advanced procedural skills are not considered as important for graduating medical students and are less likely to be taught and formally evaluated before graduation. Formal evaluation of some procedural skills is associated with increased confidence of the learner.



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The Role of Letters of Recommendation in the Selection Process of Surgical Residents in Canada: A National Survey of Program Directors

Publication date: Available online 23 January 2017
Source:Journal of Surgical Education
Author(s): Yousef Marwan, Feras Waly, Nizar Algarni, Abdullah Addar, Neil Saran, Linda Snell
ObjectiveLetters of recommendation (LOR) provide valuable information that help in selecting new residents. In this study, we aim to investigate the perceptions of surgical residency program directors (PDs) in Canada on the elements that can affect the strength and value of LOR.DesignCross-sectional; survey.SettingA national survey was conducted using an online questionnaire consisting of 2 main sections to collect data from PDs from all surgical subspecialties. The first section included basic background questions about the participant, such as the specialty and experience in selecting resident candidates, whereas the second section was about the elements and characteristics of LOR. Participants were asked to rate the importance of 34 different variables using a Likert scale.ParticipantsSurgical PDs in Canada.ResultsOf 122 PDs, 65 (53.3%) participated in the survey. Work ethic (57; 87.7%), interpersonal skills (52; 80.0%), and teamwork (49; 75.4%) were considered very important parts of the LOR by more than three-quarters of the PDs. Thirty-three (50.8%) PDs reported that a familiar author of LOR would always affect their impression regarding the letter. Additionally, 57 (87.7%) and 35 (53.8%) directors thought that LOR are important in evaluating the candidates and can help in predicting the residents' performance during their residency training.ConclusionsLOR are important for the selection of new surgical residents in Canada. Information about the candidate's work ethic, interpersonal skills, and teamwork is essential for a good LOR. Familiarity of PDs with authors of LOR could increase the value of the letter.



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Use of Eye Tracking as an Innovative Instructional Method in Surgical Human Anatomy

Publication date: Available online 24 January 2017
Source:Journal of Surgical Education
Author(s): María Luísa Sánchez-Ferrer, María Dolores Grima-Murcia, Francisco Sánchez-Ferrer, Ana Isabel Hernández-Peñalver, Eduardo Fernández-Jover, Francisco Sánchez del Campo
ObjectiveTobii glasses can record corneal infrared light reflection to track pupil position and to map gaze focusing in the video recording. Eye tracking has been proposed for use in training and coaching as a visually guided control interface. The aim of our study was to test the potential use of these glasses in various situations: explanations of anatomical structures on tablet-type electronic devices, explanations of anatomical models and dissected cadavers, and during the prosection thereof. An additional aim of the study was to test the use of the glasses during laparoscopies performed on Thiel-embalmed cadavers (that allows pneumoinsufflation and exact reproduction of the laparoscopic surgical technique). The device was also tried out in actual surgery (both laparoscopy and open surgery).DesignWe performed a pilot study using the Tobii glasses.SettingDissection room at our School of Medicine and in the operating room at our Hospital.ParticipantsTo evaluate usefulness, a survey was designed for use among students, instructors, and practicing physicians.ResultsThe results were satisfactory, with the usefulness of this tool supported by more than 80% positive responses to most questions. There was no inconvenience for surgeons and that patient safety was ensured in the real laparoscopy.ConclusionTo our knowledge, this is the first publication to demonstrate the usefulness of eye tracking in practical instruction of human anatomy, as well as in teaching clinical anatomy and surgical techniques in the dissection and operating rooms.



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