Emergency Department Clinician Perceptions of Implementing High-Sensitivity Troponin T Assay in an Academic Hospital Emergency Department.

Purpose: A newly approved, high-sensitivity troponin T (hsTnT) assay may offer opportunities to more rapidly assess for acute coronary syndrome and identify lower thresholds of myocardial injury. As more emergency departments begin to use the hsTnT assay, anticipating barriers to hsTnT implementation success are critical to realizing potential benefits in rapid, accurate patient assessment.

Methods: At a tertiary health system emergency department, hsTnT was implemented along with a diagnostic algorithm and a decision tree to aid in utilization.

Patient Perceptions of Survivorship Care Plans: A Mixed-Methods Evaluation.

Purpose: To understand the perceptions of patients with cancer regarding the role and purpose of a survivorship care plan (SCP) to inform content and delivery opportunities.

Participants & Setting: A mixed-methods evaluation was conducted among patients at a survivorship clinic for high-risk survivors of sarcomas in an academic medical center.

Methodologic Approach: An electronic survey was administered, followed by qualitative telephone interviews.

Successful childhood obesity management in primary care in Canada: what are the odds?

Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed.

Synthesis and activity of the archazolid western hemisphere.

A convergent and scalable synthesis of the archazolid western hemisphere has been completed. The V-ATPase inhibitory activity of this compound along with a previously prepared eastern domain was then tested using a convenient Arabidopsis-based V-ATPase assay.

Sensorimotor cortex aspiration: a model for studying Wallerian degeneration-induced glial reactivity along the entire length of a single CNS axonal pathway.

Although there are some similarities in the molecular and cellular pattern of Wallerian degeneration in the PNS and CNS, in the CNS the removal of axonal and myelin debris by microglia and astrocytes is not very efficient and occurs over a much longer time frame than seen in a peripheral nerve. Several animal models have been used to study Wallerian degeneration-induced glial reactivity in the CNS and PNS. Although these models have clarified some aspects of the mechanisms underlying the differential glial cell responses in the PNS and CNS, they do not lend themselves easily to deciphering the mechanisms governing the location and extent of Wallerian degeneration-induced CNS glial reactivity.

Technical strategies to isolate olfactory ensheathing cells for intraspinal implantation.

Over the past few years, the idea of using intraspinal implantations of olfactory ensheathing cells (OECs) as a therapeutic strategy to enhance recovery after spinal cord injury has quickly moved from experimentation with laboratory mammals to surgical approaches for paralyzed humans. Despite this progression, several important issues have yet to be thoroughly addressed: for instance, which of the many methods currently being used best yields enriched populations of OECs, and how such purity can be empirically tested and validated among different mammalian species, including humans. Here we offer an authoritative review of those methods used to isolate OECs from the olfactory mucosa and/or olfactory bulbs of rats, mice, dogs, pigs, non-human primates, and humans.

Doublecortin-expressing cells in the ischemic penumbra of a small-vessel stroke.

A cortical lesion was induced by disrupting the medium-size pial vessels, which led to a cone-shaped cortical lesion and turned into a fluid-filled cavity surrounded by a glial acidic fibrillary protein-positive (GFAP(+)) glia limitans 21 days after injury. Therefore, it mimics conditions of lacunar infarctions, one of the most frequent human stroke pathologies. Doublecortin (DCX)-positive cells were present in the neocortex and corpus callosum at the base of the lesion.

Olfactory ensheathing cells express smooth muscle alpha-actin in vitro and in vivo.

One strategy for spinal cord repair after injury that has moved quickly from the research laboratory to the clinic is the implantation of olfactory ensheathing cells (OECs). These unique glial cells of the olfactory system have been associated with axonal remyelination and regeneration after grafting into spinalized animals. Despite these promising observations, there remains a lack of direct empirical evidence of the exact fate of OECs after intraspinal implantation, in large part because of a surprising paucity of defined biomarkers that unequivocally distinguish these cells from phenotypically similar Schwann cells.

Proteomic evaluation reveals that olfactory ensheathing cells but not Schwann cells express calponin.

Human clinical trials have begun worldwide that use olfactory ensheathing cells (OECs) to ameliorate the functional deficits following spinal cord injury. These trials have been initiated largely because numerous studies have reported that OECs transform into Schwann Cell (SC)-like cells that myelinate axons and support new growth in adult rats with spinal injury. This phenomenon is remarkable because OECs do not myelinate olfactory axons in their native environment.

Defining the role of olfactory ensheathing cells in facilitating axon remyelination following damage to the spinal cord.

Olfactory ensheathing cells (OECs) are unique cells that are responsible for the successful regeneration of olfactory axons throughout the life of adult mammals. More than a decade of research has shown that implantation of OECs may be a promising therapy for damage to the nervous system, including spinal cord injury. Based on this research, several clinical trials worldwide have been initiated that use autologous transplantation of olfactory tissue containing OECs into the damaged spinal cord of humans.

LacZ-expressing olfactory ensheathing cells do not associate with myelinated axons after implantation into the compressed spinal cord.

Studies have shown that implanting olfactory ensheathing cells (OECs) may be a promising therapeutic strategy to promote functional recovery after spinal cord injury. Several fundamental questions remain, however, regarding their in vivo interactions in the damaged spinal cord. We have induced a clip compression injury at the T10 level of the spinal cord in adult rats.

Olfactory ensheathing cells: historical perspective and therapeutic potential.

Olfactory ensheathing cells (OECs) are the glial cells that ensheath the axons of the first cranial nerve. They are attracting increasing attention from neuroscientists as potential therapeutic agents for use in the repair of spinal cord injury and as a source of myelinating glia for use in remyelinating axons in demyelinating diseases such as multiple sclerosis. This review mainly addresses the cell biological aspects of OECs pertinent to addressing two questions.

Complications associated with optical-access laparoscopic trocars.

Objective: To investigate the number and type of serious complications associated with optical-access trocars reported by sources other than the medical literature.

Methods: Optical-access trocars, first introduced in 1994, were designed to decrease the risk of injury to intra-abdominal structures by allowing the surgeon to visualize abdominal wall layers during placement. To date, very few complications with their use have been reported in the medical literature.

Challenging generally accepted contraindications to vaginal hysterectomy.

Objective: A number of preexisting clinical conditions are generally accepted as contraindications to vaginal hysterectomy. The purpose of this study was to evaluate the validity of this concept.

Study Design: The study vaginal hysterectomy group consisted of 250 consecutive patients undergoing vaginal hysterectomy.

Dyspareunia and recurrent stress urinary incontinence after laparoscopic colposuspension with mesh and staples. A case report.

Background: A laparoscopic colposuspension technique using hernia staples and polypropylene mesh has been introduced for the treatment of stress urinary incontinence but is not without hazards.

Case: A 32-year-old woman developed recurrent stress urinary incontinence and dyspareunia approximately one year after undergoing laparoscopic colposuspension with hernia staples and polypropylene mesh. Metal staples palpated vaginally corresponded with the area of maximal tenderness, and the bladder neck was hypermobile.

The role of vaginal apex excision in the management of persistent posthysterectomy dyspareunia.

Objective: The purpose of this study was to evaluate the effectiveness of vaginal apex excision in the treatment of patients with posthysterectomy dyspareunia.

Study Design: This was a case series with an independent third-party survey of patients with posthysterectomy dyspareunia managed at the University of Utah Pelvic Pain Clinic. Thirteen patients were first treated with local injections of anesthetics into localized vaginal pain foci.

Is fruit juice a "no-no" in children's diets?

In addition to milk and other beverages, juices in reasonable quantities (12 fl oz/day or less) provide nutrients infants need while keeping sugar and food energy intakes adequate.

Differential expression of Hoxa-2 protein along the dorsal-ventral axis of the developing and adult mouse spinal cord.

We have used synthetic oligopeptides derived from the coding sequence of the murine Hoxa-2 protein to produce polyclonal antibodies that specifically recognize the Hoxa-2 recombinant protein. Immunohistochemical studies reveal a distinct pattern of spatial and temporal expression of Hoxa-2 protein within the mouse spinal cord which is concomitant with the cytoarchitectural changes occurring in the developing cord. Hoxa-2 protein is predominantly detected in the nuclei of cells in the ventral mantle region of 10-day-old mouse embryos.

Managing organizational challenge and change: closing an inpatient unit.

The effects of a turbulent health care delivery market have impacted the day-to-day reality of acute care hospitals. One effect is that the supply of acute care hospital beds currently exceeds the demand, a trend that is expected to continue to the year 2000 and beyond. Nursing administrators at St.

Immunohistochemical localization of laminin, fibronectin and collagen type IV in the nerve fiber layer of the olfactory bulb.

When the olfactory nerve is injured in adult mammals, the axons grow across the PNS-CNS transitional zone and re-innervate their synaptic contacts within the olfactory bulb. Some years ago, Liesi [Liesi P. (1985) Laminin-immunoreactive glia distinguish regenerative adult CNS systems from non-regenerative ones.

Implantation of olfactory ensheathing cells in the adult rat brain following fimbria-fornix transection.

Ensheathing cells from fetal rat olfactory bulb were implanted into th e damaged adult rat brain to assess whether these cultured cells would survive in nonolfactory CNS areas and support the regrowth of nonolfactory axons. Cultures of primary ensheathing cells prelabeled with WGA-Au were embedded in a collagen matrix and implanted into a lesion cavity immediately following ablation of the fimbria-fornix in adult rats; the animals were sacrificed 4 weeks after surgery. Labeled ensheathing cells were observed only within the graft and not in the adjacent neural tissue.

Comparison of laparoscopically assisted vaginal hysterectomy with abdominal and vaginal hysterectomy.

Objective: To define the advantages and disadvantages of laparoscopically assisted vaginal hysterectomy (LAVH).

Study Design: The first 70 cases of LAVH performed in a community hospital were compared with 70 cases of abdominal and 70 cases of vaginal hysterectomy performed by the same physicians during the same period.

Results: The mean operating time was 80 minutes for LAVH, 50 for abdominal hysterectomy and 40 for vaginal hysterectomy.

Olfactory ensheathing cells do not require L-ascorbic acid in vitro to assemble a basal lamina or to myelinate dorsal root ganglion neurites.

Ensheathing cells reside within both the PNS and CNS portions of the primary olfactory pathway and provide a glial covering and support for the unmyelinated olfactory axons. In vivo, these ensheathing cells express a mixture of astrocyte-specific and Schwann cell-specific phenotypic features. When grown in vitro in the presence of DRG neurons however, these ensheathing cells were observed to myelinate DRG neurites.

Olfactory ensheathing cells: potential for glial cell transplantation into areas of CNS injury.

Ensheathing cells are the glial cells that ensheath olfactory axons within both the PNS and CNS portions of the primary olfactory pathway. These glial cells express a mixture of astrocyte-specific and Schwann cell-specific phenotypic features, support axonal growth by olfactory as well as by non-olfactory neurons, and survive transplantation into injured areas of the CNS. This review article focuses on those phenotypic features that are expressed by ensheathing cells that make them ideal candidates for transplantation into wound cavities in the damaged spinal cord of humans.