The molecular basis to autoimmune arthritis is unclear. To identify candidate molecules that may be involved in the development and progression of collagen-induced arthritis (CIA), an animal model for human rheumatoid arthritis, we used microarray and real-time PCR assays to examine the gene expression profiles at the onset, peak and decline phase of CIA. Our results showed that, of the 514 immune-related genes assayed in microarrays, fifty-eight genes showed differential expression with thirty-one up-regulated and twenty-seven down-regulated in CIA joints, in comparison to normal joint tissue. By real-time PCR, expression of some chemokines/chemokine receptors, such as CCR1, CXCR4, CXCL13 and MCP1, showed significantly elevated in the inflamed joints. Quite a few genes were significantly up- or down-regulated at the peak time point, which indicates their roles in the progression of the disease. In addition, the expression levels of some genes remained significantly elevated at all stages of the disease. These gene expression profiles may help understand the pathogenesis of the disease.
This is a comprehensive review of the literature regarding the use of ketamine as a treatment for treatment-resistant depression (TRD). It covers the epidemiology, risk factors, pathophysiology, and current treatment modalities regarding Major Depressive Disorder (MDD) and TRD. It provides background on the mechanism of action of ketamine, its history, current approved and off-label indications in the field of psychiatry, and then provides an overview of the existing evidence for the use of ketamine in the treatment of TRD. Recent findingsMDD is a mental illness that puts an enormous strain on the affected and a high socio-economic burden on society. The illness is complex and combines genetic, pathophysiologic, and environmental factors that combine to negatively affect neurotransmitter balance in the brain. Additional evidence suggests dysregulation of the hypothalamic-pituitary (HPA) axis, brain-derived neurotrophic factor (BDNF), vitamin D levels, and involvement of pro-inflammatory markers. Core symptoms include depressed mood or anhedonia, combined with neurovegetative symptoms such as sleep impairment, changes in appetite, feelings of worthlessness and guilt, and psychomotor retardation. Current first-line treatment options are antidepressants of the selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) class. Failure to respond to two adequate trials of treatment meets the criteria for TRD. Esketamine (Spravato) is an NMDA-receptor antagonist with additional AMPA-receptor agonist properties, which the FDA approved in 2019 to treat adult TRD in conjunction with an oral antidepressant. It can be administered intranasally, providing a rapid response and proven effective and safe. Additional research suggests that oral ketamine might be effective for PTSD and anxiety disorders. Intravenous administration of ketamine has also shown benefits for acute suicidal ideation and depression and substance use to reduce relapse rates.
Background and aims The consultant of the week (COW) model of inpatient care means the consultants' primary focus is to deliver ward-based care daily. At Sandwell and West Birmingham Hospitals NHS Trust, a COW model has been successfully used for cardiology and stroke services. This has improved continuity of care and developed a 7-day working week. Our aim was to extend this model to all general medical consultants who manage inpatients. Methods We introduced the COW model to the unselected general medical take. Restructuring of consultant job plans allowed daily ward presence, 5 days per week. Outcome measures included length of stay (LOS) and accuracy of expected date of discharge (EDD). Results LOS over a 12-month period improved from an average of 9.17 days to 6.61 days. The number of EDD changes reduced, from a previous average of 3.0 changes to 1.8 changes. Consultant feedback showed there was an improvement in collaboration between teams, improved training of junior doctors and higher job satisfaction. Conclusions Improved 5-day consultant presence is associated with reduced LOS. Learning points included the delay in implementation due to the complexity of consultant job planning. We plan to extend COW to 7-days for all general medical wards.
A new species of the freshwater cyclopine copepod genus Diacyclops is described from a North American cave system in SE New Mexico, U.S.A. The new species, D. nikolasarburni n. sp., differs from its congeners by its having of a unique combination of characters including: 17-segmented antennules, three-segmented rami in legs 1-4, a basic 2333 spinal formula with a highly variable pattern, naked inner margin of caudal rami, but dorsal surface with spinules, subequal terminal spines of leg 4 endopod, and inner spine of fifth leg about as long as bearing segment. This species has also a variable length/width ratio of the caudal ramus (4.6-6.0, average 5.0); the lateral caudal seta is inserted on the distal one-quarter of ramus. The 2333 spinal formula was dominant (55%) in the population but other patterns were also present. The new species belongs to Group 1 species of Diacyclops (sensu Reid & Strayer, 1994). The local population of this stygobiotic species probably resulted from radiation-stranding processes of epigean forms of widely distributed Diacyclops and is probably endemic to this cave system.
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