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Objectives: Peripheral intravenous (IV) cannulation is the most common procedure performed in the emergency department (ED). Elastic tourniquets (ETs) and blood pressure cuffs (BPCs) are frequently used for venodilation. Although BPCs lead to increased venodilation and decreased compressibility, it is unclear whether this translates into a meaningful patient-centered outcome. This study aimed to determine whether one method is superior for success on the first attempt.Methods: This was a prospective, single-blinded, randomized controlled trial in the ED of a tertiary care center. A convenience sample of adult patients was randomly assigned to an ET or BPC with a cover concealing the type of tourniquet. The primary outcome was success rate on the first attempt. Secondary outcomes were number of attempts, number of providers, and rate of rescue techniques.Results: Of the 121 patients enrolled, 119 qualified for analysis. In the ET group, 42 of 59 patients (71%) had successful IV cannulation on first attempt compared with 43 of 60 (72%) in the BPC group (P = .95). The number of attempts (P = .87), number of nurses (P = .67), and use of rescue techniques (P = .32) did not differ significantly. A history of difficult IV access and site other than the antecubital vein were associated with decreased success.Conclusions: ETs and BPCs performed similarly in providing venodilation for successful peripheral IV cannulation. History of difficult IV access and IV site are important factors in determining the likelihood of success. [ABSTRACT FROM AUTHOR]

There is currently renewed interest in farming triploid Atlantic salmon. Improving farming requires identifying triploid specific phenotypic and physiological traits that are uniquely derived from ploidy per se and developed under optimal growing conditions. This study investigated firstly, the impact of ploidy on growth performance and whole body composition of Atlantic salmon at different early freshwater stages [34 dph (days post-hatching) alevin, 109 dph fry, and 162 dph parr] and secondly, whether phenotypic differences at these stages were reflected in protein samples collected from whole fish, white muscle or liver tissue. Female diploid and triploid Atlantic salmon (n = 3) were first fed at 35 dph and then maintained by feeding to satiation on commercial feeds. Triploids were significantly lower in weight at the late alevin and fry stages but matched diploid weight at the parr stage. The whole-body lipid content was significantly higher for triploids at the parr stage, while the whole-body lipid class profile was broadly similar and was largely not affected by ploidy. Comparative label-free shotgun proteomic analysis did not detect significant alterations in protein expression between diploids and triploids at any growth stage. The present results indicate that ploidy under optimal growing conditions and during early freshwater stages only result in small phenotypic differences in weight and whole body lipid content that were not reflected at the proteome level. These findings suggest that optimal husbandry conditions for freshwater Atlantic salmon are similar between ploidies, at least for all-female populations. [ABSTRACT FROM AUTHOR]

Thraustochytrids can produce high amounts of docosahexaenoic acid (DHA, 22:6ω3). Glycerol, a by-product of biodiesel production from vegetable oil and animal fats, is becoming increasingly available. We investigated the potential of Australian thraustochytrids to use crude glycerol as the main carbon source for production of long-chain (LC, ≥C 20 ) omega 3-oils. Crude glycerol content was analysed, and the growth kinetics of eight thraustochytrid strains was examined with crude glycerol. Aurantiochytrium sp. strains achieved higher biomass (20 g/L dry cell weight; DCW) and lipid yield (389 mg/g total fatty acids; TFA) compared to Schizochytrium , Thraustochytrium and Ulkenia spp. Impurities in the crude glycerol hindered growth of thraustochytrids, with maximum yield of 9 g/L DCW and 48% DHA TFA at 4-days. Our research shows the potential of heterotrophic thraustochytrids to provide the growing global population with a secure, environmentally sustainable alternative source of health-benefitting LC omega-3 oils for use in feeds and foods. [ABSTRACT FROM AUTHOR]

Objectives: We compared pain perception and procedure time in abortions performed by residents and faculty using a manual vacuum aspirator and electric vacuum curettage devices.Study Design: We conducted a randomized trial of 114 women undergoing first-trimester abortions. Patients assessed the level of pain with visual analog scales.Results: The mean procedure times were 5.7 and 6.9 minutes, respectively, with electric vacuum curettage and manual vacuum aspirator. Faculty took less time than residents to perform both procedures. Patients reported a higher pain level with cervical dilatation before resident electric vacuum curettage procedures. Patients undergoing electric vacuum curettage thought that the procedure noise increased their pain.Conclusions: First-trimester abortion procedures can be performed more quickly by experienced surgeons. The procedure time for the manual vacuum aspirator is greater than that for the electric vacuum curettage. Patient pain perception with aspiration by these two techniques is not different. The level of pain after aspiration did not vary significantly in patients who had abortions performed by residents or faculty. [ABSTRACT FROM AUTHOR]

Abstract: Our purpose was to analyse the demographics, prevalence and pattern of visual field defects in patients with pituitary adenoma. We prospectively recruited 103 consecutive patients (206 eyes) presenting to a neurosurgical unit with pituitary adenoma. Ophthalmological examination and standard automated perimetry (Humphrey, 24-2 threshold) was performed. Severity of visual field defects was also assessed. The mean population age was 53.9years (standard deviation=15). Visual loss was the most common reason for presentation (39%) followed by endocrine abnormality (21%) and headache (15%). Patients with endocrine abnormality on presentation were 10.9years younger than those presenting with visual loss (p =0.001). Bitemporal defects were the most prevalent pattern (n=22, 41%) followed by homonymous defects (n=7, 13%). Of the patients with visual field loss, 33% had unilateral visual field defects. The mean visual acuity in those with bitemporal defects was 6/7.5 with half of these patients having 6/6 vision in both eyes. In conclusion, the majority of patients with pituitary adenoma have visual acuity better than 6/7.5 despite having visual field defects. While a bitemporal pattern of visual field loss is the most common, a significant proportion of patients had unilateral and altitudinal defects. Assessment of the visual field is essential to rule out chiasmal compression. [Copyright &y& Elsevier]

Abstract: The Sp-family of transcription factors is comprised by nine members, Sp1-9, that share a highly conserved DNA-binding domain. Sp2 is a poorly characterized member of this transcription factor family that is widely expressed in murine and human cell lines yet exhibits little DNA-binding or trans-activation activity in these settings. As a prelude to the generation of a “knock-out” mouse strain, we isolated a mouse Sp2 cDNA and performed a detailed analysis of Sp2 transcription in embryonic and adult mouse tissues. We report that (1) the 5′ untranslated region of Sp2 is subject to alternative splicing, (2) Sp2 transcription is regulated by at least two promoters that differ in their cell-type specificity, (3) one Sp2 promoter is highly active in nine mammalian cell lines and strains and is regulated by at least five discrete stimulatory and inhibitory elements, (4) a variety of sub-genomic messages are synthesized from the Sp2 locus in a tissue- and cell-type-specific fashion and these transcripts have the capacity to encode a novel partial-Sp2 protein, and (5) RNA in situ hybridization assays indicate that Sp2 is widely expressed during mouse embryogenesis, particularly in the embryonic brain, and robust Sp2 expression occurs in neurogenic regions of the post-natal and adult brain. [Copyright &y& Elsevier]

Abstract: Modular, bioactive, macroporous scaffolds were formed by crosslinking poly(ethylene glycol) (PEG) microspheres around living cells. Hydrogel microspheres were produced from reactive PEG derivatives in aqueous sodium sulfate solutions without the use of surfactants or copolymers. Microspheres were formed following thermally induced phase separation if the gel point was reached prior to extensive coarsening of the PEG-rich domains. Three types of PEG microspheres with different functionalities were used to form scaffolds: one type provided mechanical support, the second type provided controlled delivery of the angiogenesis-promoting molecule, sphingosine 1-phosphate (S1P) and the third type served as a slowly dissolving non-cytotoxic porogen. Scaffolds were formed by centrifuging microspheres in the presence of HepG2 hepatoma cells, resulting in a homogenous distribution of cells. During overnight incubation at 37°C, the microspheres reacted with serum proteins in cell culture medium to stabilize the scaffolds. Within 2days in culture, macropores formed due to the dissolution of the porogenic PEG microspheres, without affecting cell viability. Gradients in porosity were produced by varying the buoyancy of the porogenic microspheres. Conjugated RGD cell adhesion peptides and the delivery of S1P promoted endothelial cell infiltration through macropores in the scaffolds. The scaffolds presented here differ from previous hydrogel scaffolds in that: (i) cells are not encapsulated in hydrogel; (ii) macropores form in the presence of cells; and (iii) scaffold properties are controlled by the modular assembly of different microspheres that perform distinct functions. [Copyright &y& Elsevier]

Objective: This study was undertaken to determine whether buccal misoprostol improves cervical preparation achieved with laminaria before second-trimester dilation and evacuation procedures. Study design: A randomized, double blind, placebo-controlled trial of preoperative cervical preparation with overnight laminaria and either buccal placebo or 400 μg buccal misoprostol approximately 90 minutes before second-trimester surgical abortion. Block randomization was used to provide balanced enrollment into 2 separate gestational age study groups: early (13–156/7) and mid (16–206/7) second trimester. Surgeons tested maximal cervical dilation by inserting the largest dilator that could be passed through the cervical os without force. Subject demographics and preprocedure symptoms were tracked. Results: Groups were similar in regard to age, gravity, parity, delivery type, and gestational age. Data were analyzed from 125 women in the 13 to 156/7 (30 misoprostol, 32 placebo) and 16 to 206/7 (31 misoprostol, 32 placebo) gestational age groups. Overall, misoprostol treatment did not improve the initial mean dilation achieved with laminaria alone in either the 13 to 156/7 (46.0 ƒr ± 5.0; placebo 45.0 ƒr ± 6.2, P = .68) or 16 to 206/7 (50.9 ƒr ± 5.6, placebo 48.9 ƒr ± 5.2, P = .16) groups. However, a subanalysis of gestations 19 weeks or more demonstrated significantly greater dilation in the misoprostol group (53.6 ƒr ƒr ± 5.3, placebo 48.5 ƒr ± 5.0, P = .01). Subjects receiving misoprostol reported significantly more cramping than those receiving placebo (13–156/7 weeks misoprostol 25/30, 83%; placebo 17/32, 53%, P = .02; 16–206/7 week misoprostol 25/31, 81%, placebo 16/32, 50%, P = .02). Conclusion: Cervical dilation with laminaria is augmented by 400 μg buccal misoprostol in gestations 19 weeks or more, but not in earlier gestations. Misoprostol causes more abdominal cramping. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to determine whether an interactive medical student contraceptive teaching session results in improved knowledge gain or satisfaction when compared with a standard, didactic lecture. Study design: An interactive lecture was compared with a standard lecture among third-year medical students at Oregon Health and Science University School of Medicine and Medical College of Georgia. Knowledge gain was assessed by comparing correct responses to a posttest with the students' own responses to the same questions given as a pretest before the lecture. Satisfaction with the lecture was assessed on a visual analog scale. Scores and satisfaction ratings were compared within and between lecture groups. Results: A total of 150 students participated. There was a significant increase in test scores within both the interactive and standard groups (P < .0001 for both groups). The change in scores did not differ significantly between the groups (P = .087). Although overall satisfaction was significantly greater with the standard lecture (P = .004), it was high with both lectures. Conclusion: Knowledge gain with the interactive lecture was equivalent to that with the standard lecture. Satisfaction with both learning formats was high. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to assess the effect on pain and patient satisfaction of waiting between paracervical block and dilation during first-trimester abortions.Study Design: One hundred ninety-nine women seeking pregnancy termination were randomly assigned to a no-wait group (group 1) and a 3- to 5-minute wait between injection and dilation group (group 2). Subjects rated their pain on a visual analog scale at four times: prior to procedure, with dilation, with aspiration, and 30 to 45 minutes after procedure.Results: No significant differences were observed in pain or satisfaction ratings reported by group 1 (n = 93) and group 2 (n = 101). A significant decrease in pain with dilation (1.21 cm decrease, P =.009) and aspiration (1.15 cm decrease, P =.0015) was observed among patients who received fentanyl.Conclusion: Delay between paracervical injection and dilation during first-trimester abortion does not have an impact on patient pain or satisfaction. Fentanyl decreased pain scores by 20% to 25% during the procedure. [ABSTRACT FROM AUTHOR]

The performance and survival of macroalgae is largely determined by their ability to adjust to varying environmental conditions. In this study, we investigated the short-term response of the giant kelp Macrocystis pyrifera to varying temperatures (6, 17 and 24 °C) and low and high nitrate conditions (5 μM and 80 μM nitrate) on lipid and fatty acid levels. Results revealed that M. pyrifera was able to rapidly adjust to varying temperatures by changing the saturation level of the fatty acid composition at low and high nitrate conditions. On a lipid level, we observed interactive effects of temperature and nutrient conditions. Under high nitrate conditions, M. pyrifera maintained the same lipid profile. However, under low nitrate and high temperature conditions, an increase in free fatty acids (FFA) was observed, indicative of lipid degeneration at high temperatures. Results show that low nitrogen concentrations can magnify the negative effects of short term temperature stress in the giant kelp M. pyrifera. Our findings indicate that under rapid warming events, local nitrate availability might be a decisive factor for the acclimation potential of M. pyrifera. • M. pyrifera acclimates to short term exposure to a wide temperature range by rapidly adjusting the fatty acid composition. • The lipid profile shows interactive effects of both nitrogen and temperature. • Under high nitrogen concentrations, M. pyrifera maintains high levels of polar lipids. • Low nitrogen and high temperature lead to decrease in polar lipids and an increase of free fatty acids and sterols • High nitrogen concentrations appear to improve the biochemical adjustments in M. pyrifera to high temperatures. [ABSTRACT FROM AUTHOR]

In asymptomatic patients with an early gestation located in a noncommunicating rudimentary horn, methotrexate may provide another treatment option or act as a useful adjunct to surgical intervention. We present a case of a successful pregnancy termination of a gestation located in a noncommunicating rudimentary horn with subsequent elective laparoscopic resection. [ABSTRACT FROM AUTHOR]

Objective: Oregon and federal laws prohibit giving informed consent for permanent contraception when presenting for an abortion. The primary objective of this study was to estimate the number of unintended pregnancies associated with this barrier to obtaining concurrent tubal occlusion and abortion, compared with the current policy, which limits women to obtaining interval tubal occlusion after abortion. The secondary objectives were to compare the financial costs, quality-adjusted life years, and the cost-effectiveness of these policies. Study Design: We designed a decision-analytic model examining a theoretical population of women who requested tubal occlusion at time of abortion. Model inputs came from the literature. We examined the primary and secondary outcomes stratified by maternal age (>30 and <30 years). A Markov model incorporated the possibility of multiple pregnancies. Sensitivity analyses were performed on all variables and a Monte Carlo simulation was conducted. Results: For every 1000 women age <30 years in Oregon who did not receive requested tubal occlusion at the time of abortion, over 5 years there would be 1274 additional unintended pregnancies and an additional $4,152,373 in direct medical costs. Allowing women to receive tubal occlusion at time of abortion was the dominant strategy. It resulted in both lower costs and greater quality-adjusted life years compared to allowing only interval tubal occlusion after abortion. Conclusion: Prohibiting tubal occlusion at time of abortion resulted in an increased incidence of unintended pregnancy and increased public costs. [Copyright &y& Elsevier]