Embryonic stem cells are derived from the epiblast. A subpopulation of epiblast cells expresses MyoD mRNA and the G8 antigen in vivo. G8 positive (G8pos) and G8 negative (G8neg) populations were isolated by magnetic cell sorting. Nearly all G8pos cells switched from E- to N-cadherin and differentiated into skeletal muscle in culture. G8neg cells were impaired in their ability to switch cadherins and few formed skeletal muscle. Medium conditioned by G8pos cells stimulated skeletal myogenesis and N-cadherin synthesis in G8neg cultures. The effect of conditioned medium from G8pos cultures was inhibited by bone morphogenetic protein (BMP) 4. Treatment of G8neg cells with a soluble form of the BMP receptor-IA or Noggin promoted N-cadherin synthesis and skeletal myogenesis. These results demonstrate that MyoD-positive epiblast cells recruit pluripotent cells to the skeletal muscle lineage. The mechanism of recruitment involves blocking the BMP signaling pathway.

No abstract

No abstract

Jail-based student-run clinics, though uncommon, have the potential to impact the future health workforce. We evaluated, via a survey of student attitudes and a collection of lessons learned, a student–faculty collaborative clinic that was implemented in a jail in 2015. Clinic participation led to significantly greater student volunteer ratings of the importance of collaborating with oral health providers and of comfort in providing care to incarcerated populations. We report lessons learned regarding logistical considerations, volunteer behavior, and common issues arising in clinic visits. The clinic proved feasible and sustainable over several years, offering a new model for the involvement of trainees in correctional health care.

The innovative vascular unloading technology (VUT) allows continuous noninvasive arterial blood pressure (AP) monitoring. We aimed to investigate whether the VUT enables AP changes to be detected earlier compared with intermittent AP monitoring in patients undergoing gastrointestinal endoscopy. In this prospective observational study, we recorded continuous AP measurements with the VUT (CNAP system; CNSystems Medizintechnik AG, Graz, Austria) and intermittent AP measurements with upper arm cuff oscillometry in 90 patients undergoing complex gastrointestinal endoscopy (Department of Interventional Endoscopy at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany). A "hypotensive phase" was defined as a time period of at least 30 s during which ≥ 50% of the VUT-AP values were in a predefined range of hypotension, i.e., AP value a) ≥ 10% below the last oscillometric value and b) ≤ 65 mmHg for mean AP or ≤ 90 mmHg for systolic AP. In the 5-min-interval between two oscillometric measurements, one or more hypotensive phases were detected in 26 patients (29%) for mean AP and in 27 patients (30%) for systolic AP. Hypotensive phases had a mean duration of 195 ± 99 s for mean AP and 197 ± 97 s for systolic AP with a mean procedure duration of 36 (± 21) min. Continuous noninvasive AP monitoring using the VUT enables hypotensive phases to be detected earlier compared with intermittent AP monitoring during complex gastrointestinal endoscopy. These hypotensive phases may be missed or only belatedly recognized with intermittent AP monitoring. Continuous noninvasive AP measurement facilitates detecting hemodynamic instability more rapidly and therefore may improve patient safety.

Little is known about the experiences of correctional health care providers and how their experiences impact the correctional health care system. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines, multiple databases were searched. Each abstract was read by two reviewers with a third for consensus as needed. Full-text articles were selected through a second round of review. Of 4,467 citations, 61 were selected for full-text evaluation and 23 were ultimately included. Major themes identified were the distinctive working environment, burnout, and the presence of ethical dilemmas, including the tension between security and clinical considerations. This scoping review identified a limited number of articles centered on the health care provider experience in the correctional setting.

Correctional populations are disproportionately affected by conditions that affect cognition, such as psychiatric illness and head trauma. Honoring bioethical principles in the care of such patients can be particularly difficult in the correctional setting. However, the approach should not change markedly because a patient is incarcerated. That is, the same standards of respecting patient autonomy and confidentiality should be maintained, and the fact that correctional populations are already marginalized makes it all the more important for clinicians to honor these principles. Physicians should act in the best interest of their patients; in jails this might include disclosing information to and consulting with a patient's legal defense. However, this step should only be taken with a patient's consent or, in cases in which the patient does not have decision-making capacity, when it seems consistent with a patient's wishes. CaseDr. Obaje is a primary care physician who works at a county jail, where most of her patients are undergoing court processes. This afternoon, Jonathan, a 52-year-old man with a known history of poorly controlled type II diabetes and a 20-year history of opioid use, is brought to the jail's medical ward for a routine chronic care visit. This is the first time that Dr. Obaje has met Jonathan since his incarceration four weeks ago. Jonathan's blood sugars have ranged between 80 and 150 since his incarceration, and he does not currently seem to be experiencing any withdrawal symptoms. However, during the appointment, Jonathan struggles to provide a health history, shares tangential information, and repeats some information several times. After Dr. Obaje briefly leaves the room to answer a nurse's question, Jonathan does not appear to remember having met her when she returns.Based on this memory lapse and Jonathan's history, Dr. Obaje worries that Jonathan could be exhibiting cognitive impairment. Jonathan reports that he has been transiently homeless during the past decade and that during several periods of homelessness he experienced violence, including blows to the head. She asks Jonathan about his mood, www.amajournalofethics.org 878 and he confirms that he "often feels down" and states that "sometimes I get so angry, and I'm not sure why." On the Mini-Mental State Examination, Jonathan receives a score of 21 out of 30, and Dr. Obaje diagnoses him with mild cognitive impairment (MCI) [1].Dr. Obaje refers Jonathan for mental health care not only for treatment but also to rule out reversible causes of cognitive decline. She also asks her mental health colleagues to evaluate how Jonathan's cognitive impairment influences his decision-making capacity and judgment. Dr. Obaje wonders whether information about Jonathan's cognitive symptoms could be important for his legal defense. CommentaryMedical and mental health clinicians working in the correctional setting are likely to encounter scenarios similar to Dr. Obaje's encounter with Jonathan. Conditions that might be associated with cogniti...

No abstract