Medical Aid in Dying.

As the nation's 75 million baby boomers enter into a new phase of their life, care for their aging parents, and contemplate their own mortality, many have come to realize that our end-of-life care system is hamstrung by outdated modes of dying. This chapter discusses the current status of medical aid in dying in the United States as a legal and medically recognized medical option for supporting patients at life's end.

Insulin use in chronic kidney disease and the risk of hypoglycemic events.

Background: We examined in persons with type 2 diabetes (T2D) whether the use of insulin and the risk of serious hypoglycemic events with insulin is higher in persons with more advanced CKD.

Methods: In a national cohort of 855,133 veterans with T2D seen at Veteran Affairs clinics between Jan 1, 2008 and December 31, 2010 with at least two serum creatinine measurements, we defined insulin use from pharmacy records and serious hypoglycemic events by ICD-9/10 codes from emergency room visits or hospitalizations that occurred until December 31, 2016.

Results: Mean age was 66 ± 11 years and 97% were men.

The Relationship Between Cognition and Sensorimotor Behavior in an F1 Driving Simulation: An Explorative Study.

Sensorimotor control simultaneously engages multiple cognitive processes, like decision making, intention, processing, and the integration of multisensory signals. The reciprocal relationship of cognition and sensorimotor learning is well documented. However, little is known if the status of cognitive skills relates to immediate sensorimotor performance of performing a novel skill.

Auditory Stimulation Training With Technically Manipulated Musical Material in Preschool Children With Specific Language Impairments: An Explorative Study.

Auditory stimulation training (AST) has been proposed as a potential treatment for children with specific language impairments (SLI). The current study was designed to test this assumption by using an AST with technically modulated musical material (ASTM) in a randomized control group design. A total of 101 preschool children (62 male, 39 females; mean age = 4.

High-Resolution High Kinetic Energy Ion Mobility Spectrometer Based on a Low-Discrimination Tristate Ion Shutter.

High kinetic energy ion mobility spectrometry (HiKE-IMS) allows for sensitive trace gas analysis within seconds, mitigating many disadvantages of standard ion mobility spectrometers through operation at reduced pressure and high electric field strengths. However, these advantages usually come at the cost of reduced resolving power, ranging from a maximum of 75 down to 50 at a reduced field strength of 120 Td for the original device. In this work, we present an extended theory for HiKE-IMS resolving power and a novel tristate ion shutter principle able to achieve initial ion packet widths of 1 μs without significant mobility discrimination.

Does prior domain-specific content knowledge influence students' recall of arguments surrounding interdisciplinary topics?

Awareness of various arguments can help interactants present opinions, stress points, and build counterarguments during discussions. At school, some topics are taught in a way that students learn to accumulate knowledge and gather arguments, and later employ them during debates. Prior knowledge may facilitate recalling information on well structured, fact-based topics, but does it facilitate recalling arguments during discussions on complex, interdisciplinary topics? We assessed the prior knowledge in domains related to a bioethical topic of 277 students from Germany (approximately 15 years old), their interest in the topic, and their general knowledge.

Prior knowledge in recalling arguments in bioethical dilemmas.

Prior knowledge is known to facilitate learning new information. Normally in studies confirming this outcome the relationship between prior knowledge and the topic to be learned is obvious: the information to be acquired is part of the domain or topic to which the prior knowledge belongs. This raises the question as to whether prior knowledge of various domains facilitates recalling information.

Constants and variables in immunohistochemistry.

Many efforts have been made to develop reliable methods for the quantification of immunohistochemical reaction products. Most of the corresponding studies have dealt with problems related to the development of adequate hardware and software, while fewer investigations have focused on variables of histotechnical or immunohistochemical methods. The present paper summarizes findings and experience obtained over many years in this latter field, and a total of 14 corresponding parameters were considered.

Engineering of a glucose-responsive surrogate cell for insulin replacement therapy of experimental insulin-dependent diabetes.

Glucose responsiveness in the millimolar concentration range is a crucial requirement of a surrogate pancreatic beta cell for insulin replacement therapy of insulin-dependent diabetes. Novel insulin-secreting GK cell clones with millimolar glucose responsiveness were generated from an early-passage glucose-unresponsive RINm5F cell line. This line expressed constitutively both the K(ATP) channel and the GLUT2 glucose transporter; but it had a relative lack of glucokinase.

Specific progesterone binding to a membrane protein and related nongenomic effects on Ca2+-fluxes in sperm.

Rapid, nongenomic effects of steroids are supposed to be transmitted by membrane receptors unrelated to the classic intracellular steroid receptors. In this context, a putative progesterone membrane binding protein (mPR) has been identified, recently. Here we show that expression of mPR-cDNA in CHO cells leads to increased microsomal progesterone binding.

Munc-18-1 and cysteine string protein (csp) in pinealocytes of the gerbil pineal gland.

Mammalian pinealocytes contain several synaptic membrane proteins which probably play a role in the targeting and exocytosis of secretory vesicles, in particular of synaptic-like microvesicles (SLMVs). The latter are considered as the endocrine equivalent of neuronal synaptic vesicles. By means of immunocytochemical techniques and immunoblot analyses, we now show that two further key components of the molecular apparatus regulating neurotransmitter release are present in the gerbil pineal gland, i.

Immunocytochemical localization of chromogranin A and secretogranin II in female rat gonadotropes.

Ultrastructures of pituitary gonadotropes are known to show a prominent sex-related difference: typical male rat gonadotropes contain both large- and small-sized granules, whereas typical female rat gonadotropes appear to exhibit uniformly small-sized granules. Our preceding studies have demonstrated that two representative granins, chromogranin A (CgA) and secretogranin II (SgII), are separately localized to each type of granule in male rat gonadotropes. To clarify whether or not there is a certain relationship between granin proteins and characteristic features of secretory granules in female rat gonadotropes, we examined the expression levels and immunocytochemical localizations of CgA and SgII in the cells.

Effects of sex steroids on secretory granule formation in gonadotropes of castrated male rats with respect to granin expression.

Pituitary gonadotropes show sex-related differences in their ultrastructure. Typical gonadotropes of male rats exhibit both large granules, which contain chromogranin A (CgA), and small granules, which contain secretogranin II (SgII). In contrast, typical female rat gonadotropes show only a very few large granules among the numerous small granules.

Heterogeneity of pituitary gonadotrope cells in male rats.

Mammalian gonadotrope (Gn-) cells producing FSH and LH show great variability in their cytological characteristics. To gain a closer view of the corresponding phenotypes, Gn-cells of male rats were investigated by various methods including immunocytochemistry on serial semithin sections, quantitative immunocytochemistry, three-dimensional reconstructions, sequential semithin-/thin-section technique, routine electron microscopy, and immuno-electron microscopy. Gn-cells were immunostained with FSH and LH antisera and with antibodies raised against synthetic N- and C-terminal sequences of chromogranin A (CgA) and secretogranin II (SgII), and four phenotypes of Gn-cells could be identified.

Rat and gerbil pinealocytes contain the synaptosomal-associated protein 25 (SNAP-25).

It has recently been established that the neuroendocrine pinealocytes of mammals contain several synaptic membrane proteins that are involved in the regulation of vesicle trafficking in the nerve terminal. In the present study, we have conducted immunoblot and immunocytochemical analyses to demonstrate that another key component of the presynaptic plasmalemma, i.e.

[Processing acoustically presented time intervals of seconds duration: an expression of the phonological loop of the working memory?].

Working memory has been proposed to contribute to the processing of time, rhythm and music; the question which component of working memory is involved is under discussion. The present study tests the hypothesis that the phonological loop component (Baddeley, 1986) is involved in the processing of auditorily presented time intervals of a few seconds' duration. Typical effects well known with short-term retention of verbal material could be replicated with short-term retention of temporal intervals: The immediate reproduction of time intervals was impaired under conditions of background music and articulatory suppression.

Differential distribution of synaptotagmin I and rab3 in the anterior pituitary of four mammalian species.

In the anterior pituitary of rat, gerbil, hamster and guinea pig, the presence and cellular distribution of the synaptic vesicle-associated proteins synaptotagmin I and rab3 were analyzed by immunoblotting and by immunocytochemical staining of serial semithin sections. Our results show that rab3 proteins are ubiquitously expressed in all endocrine cell types of both the anterior and intermediate lobe. In many cells, rab3 immunoreactivity was concentrated beneath the plasmalemma.

Bronchiolar nonciliated secretory (Clara) cells: source of guanylin in the mammalian lung.

The peptide guanylin, which has recently been isolated from the intestine, is involved in the regulation of fluid secretion in the intestinal epithelium by activation of guanylate cyclase C, the putative guanylin receptor. Since the latter protein is also expressed in airway epithelia, we investigated the lung of three mammalian species for the presence and cellular localization of guanylin by immunoblot (Western blot) analyses and light and electron microscopical immunocytochemistry. In Western blots of bovine, guinea pig, and rat lung extracts, three different guanylin antisera directed against the midportion and against the C terminus of the precursor molecule identified a peptide band corresponding to the apparent molecular mass of guanylin.

Enterochromaffin cells of the digestive system: cellular source of guanylin, a guanylate cyclase-activating peptide.

Guanylin, a bioactive peptide, has recently been isolated from the intestine; this peptide activates intestinal guanylate cyclase (i.e., guanylate cyclase C) and thus is potentially involved in the regulation of water/electrolyte transport in the gastrointestinal mucosa.

Secretory granules and granins in hyperstimulated male rat gonadotropes.

Granins are acidic proteins co-localized with peptides in secretory granules of many endocrine cells. They are thought to participate in certain steps of the regulated secretory pathway. This is of particular interest in rat pituitary gonadotropes, which in most cases contain both gonadotropins (follicle-stimulating hormone, FSH and luteinizing hormone, LH) and two granins (chromogranin A, CgA and secretogranin II, Sg II).

Chromostatin, a chromogranin A-derived bioactive peptide, is present in human pancreatic insulin (beta) cells.

Chromogranin A (CGA) is a secretory protein present in the adrenal medulla and in a variety of endocrine organs. This protein may serve as precursor for pancreastatin (PST) and for other biologically active peptides. Recently, chromostatin (CST), a CGA derivative, has been identified that possesses high biological activity.

Serotonin storage and chromogranins: an experimental study in rat gastric endocrine cells.

Chromogranins (Cg) and secretogranins (Sg) are acidic proteins localized in the secretory granules of a large variety of endocrine cells collectively named APUD cells (amine precursor uptake and decarboxylation). To examine the possible function of Cg/Sg as amine storage proteins, enteroendocrine cells of the rat gastric antral mucosa, i.e.