As medical students are responsible for understanding vast medical content in a short amount of time, instructors have shifted their focus to include flipped classroom model and use innovative educational tools in class to facilitate stronger comprehension and critical thinking. While there are many audience response systems (ARS) available, the cost to the institution and students in the form of licenses, and installation of hardware can be a significant problem. Besides, faculty can show resistance in adopting these tools. Mentimeter is a web-based ARS that is low cost and is available on any device anytime. We wanted to inquire about its impact on learning in our medical students since course evaluations are usually retrievable at the end of course. By analyzing satisfaction surveys, this study looked at the utilization of Mentimeter in a medical physiology course. Medical students overwhelmingly agreed that Mentimeter is a useful tool for exam preparation in clarifying difficult concepts and appreciated an instructor-led readiness assessment several days before their first exam. We believe that the use of this application can help explain basic concepts, make office hours more constructive, and bring a paradigm shift in readiness assessment for medical students in both preclinical and clinical curriculum.
Nitroxyl (HNO), a reduced form of the important gasotransmitter nitric oxide, exhibits its own unique biological activity. A possible biological pathway of HNO formation is the S-thiolation reaction between thiols and S-nitrosothiols (RSNOs). Our density functional theory (DFT) calculations suggested that S-thiolation proceeds through a proton transfer from the thiol to the RSNO nitrogen atom, which increases electrophilicity of the RSNO sulfur, followed by nucleophilic attack by thiol, yielding a charge-separated zwitterionic intermediate structure RSS (R)N(H)O (Zi), which decomposes to yield HNO and disulfide RSSR. In the gas phase, the proton transfer and the S-S bond formation are asynchronous, resulting in a high activation barrier (>40 kcal mol ), making the reaction infeasible. However, the barrier can decrease below the S-N bond dissociation energy in RSNOs (≈30 kcal mol ) upon transition into an aqueous environment that stabilizes Zi and provides a proton shuttle to synchronize the proton transfer and the S-S bond formation. These mechanistic features suggest that S-thiolation can easily lend itself to enzymatic catalysis and thus can be a possible route of endogenous HNO production.
Norepinephrine exerts powerful influences on the metabolic, neuroprotective and immunoregulatory functions of astrocytes. Until recently, all effects of norepinephrine were believed to be mediated by receptors localized exclusively to the plasma membrane. However, recent studies in cardiomyocytes have identified adrenergic receptors localized to intracellular membranes, including Golgi and inner nuclear membranes, and have shown that norepinephrine can access these receptors via transporter-mediated uptake. We recently identified a high-capacity norepinephrine transporter, organic cation transporter 3 (OCT3), densely localized to outer nuclear membranes in astrocytes, suggesting that adrenergic signaling may also occur at the inner nuclear membrane in these cells. Here, we used immunofluorescence and western blot to show that β 1 -adrenergic receptors are localized to astrocyte inner nuclear membranes; that key adrenergic signaling partners are present in astrocyte nuclei; and that OCT3 and other catecholamine transporters are localized to astrocyte plasma and nuclear membranes. To test the functionality of nuclear membrane β 1 -adrenergic receptors, we monitored real-time protein kinase A (PKA) activity in astrocyte nuclei using a fluorescent biosensor. Treatment of astrocytes with norepinephrine induced rapid increases in PKA activity in the nuclear compartment.
declare that they have no conflict of interest.Abstract: Facial expressions provide a nonverbal mechanism for social communication, a core challenge for autistic people. Little is known regarding the association between arousal, selfreport of anxiety, and facial expressions among autistic adolescents. Therefore, this study investigated session-by-session facial expressions, self-report of anxiety, and physiological arousal via Electrodermal Activity (EDA), of 12 autistic male adolescents in a didactic social skills intervention setting. The goals of this study were threefold: 1) identify physiological arousal levels ("have-it"), 2) examine if autistic adolescents' facial expressions indicated arousal ("show-it"), and 3) determine whether autistic adolescents were self-aware of their anxiety ("know-it"). Our results showed that autistic adolescents' self-rated anxiety was significantly associated with peaks in EDA. Both machine learning algorithms and human participant-based methods, however, had low accuracy in predicting autistic adolescents' arousal state from facial expressions, suggesting that autistic adolescent's facial expressions did not coincide with their arousal. Implications for understanding social communication difficulties among autistic adolescents, as well as future targets for intervention, are discussed. This project is registered with ClinicalTrials.gov, Identifier: NCT02680015.
Pancreaticopleural fistula (PPF) is an uncommon complication of chronic pancreatitis. The authors describe a case of a 41-year-old male with a history of chronic alcoholic pancreatitis and pancreatic pseudocyst who presented with dyspnea and right-sided chest pain for three days. A chest radiograph showed near-complete opacification of the right hemithorax. A diagnostic thoracentesis revealed an exudative, amylase-rich pleural effusion. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a normal appearance of the ampulla of Vater and common bile duct; however, there was disruption of the pancreatic duct with leaking beyond the pancreatic neck. A sphincterotomy was performed, and a double-flanged stent was placed, which resulted in the resolution of the dyspnea and the right-sided pleural effusion.
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