Search

Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for suspected ischemic heart disease. This working diagnosis encompasses coronary microvascular dysfunction, microvascular and epicardial spasm, myocardial bridging, and other occult coronary abnormalities. Patients with ANOCA often face a high burden of symptoms and may experience repeated presentations to multiple medical providers before receiving a diagnosis. Given the challenges of establishing a diagnosis, patients with ANOCA frequently experience invalidation and recidivism, possibly leading to anxiety and depression. Advances in scientific knowledge and diagnostic testing now allow for routine evaluation of ANOCA noninvasively and in the cardiac catheterization laboratory with coronary function testing (CFT). CFT includes diagnostic coronary angiography, assessment of coronary flow reserve and microcirculatory resistance, provocative testing for endothelial dysfunction and coronary vasospasm, and intravascular imaging for identification of myocardial bridging, with hemodynamic assessment as needed. [Display omitted] • ANOCA is a common clinical presentation that is variably recognized and managed. • Standardization is needed for the identification, diagnosis, and treatment of patients with ANOCA. • Comprehensive coronary function testing is important for identifying underlying causes of ANOCA in individual patients. [ABSTRACT FROM AUTHOR]

Objective To compare the effectiveness of teaching a pharmaceutical calculations course using a flipped versus traditional instructional method. Methods For the flipped method, students were required to watch recorded lectures before class, and class time was used for completing problems. For the traditional method, lectures were delivered in class followed by use of some class time for completing problems. The course material was divided into sections I and II. In 2011, sections I and II were taught by the flipped and traditional method, respectively. In 2012, both the sections were taught using the flipped method. Exam 1 and final exam part A tested the material covered in section I. Exam 2 and final exam part B tested the material covered in section II. Section II scores were compared between the 2011 and 2012 cohorts. Pre-admission criteria and section I scores were compared between the two cohorts to assess whether difference in section II scores could be attributed to differences in-class composition. Student perceptions about the flipped and the traditional instructional method were also examined. Results The 2012 cohort (taught by flipped method) achieved a higher score on the section II material (exam 2, p = 0.013 and final exam part B, p = 0.001) compared to the 2011 cohort (taught by traditional method). Student perception data also indicated that a majority of students preferred the flipped method over the traditional method. Conclusion This study demonstrates that a flipped classroom approach for teaching pharmaceutical calculations can improve student performance and satisfaction. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the design, implementation, and assessment of a hybrid learning molecular biology course. Design: Students were assigned to watch pre-recorded lectures (modules) prior to class. Class time was used for applying the theory in the modules to exercises designed to explore the material at a deeper level. Student perceptions of the use of modules and class exercises as a tool to enhance learning were examined using a survey with a 5-point Likert Disagree–Agree response scale. Assessment: One hundred percent of the students participating in the survey indicated that the pre-recorded modules and class exercises helped enhance their learning, and that the hybrid course design effectively combined active and passive learning methods. Over 95% of the students indicated that the course design helped them to learn the material more effectively at all levels of Bloom’s taxonomy compared to a traditional lecture-based course. Conclusion: Providing students with modules allows them to review a recorded lecture multiple times and learn the course material at their own pace. Use of the modules also frees up classroom time that can then be used for active learning exercises and detailed application of the material. Students believed that combining pre-recorded modules with class exercises allowed them to become more actively engaged in the learning process and develop better understanding of the course material. Students also perceived that the hybrid learning approach in molecular biology promoted better recall, understanding, application, analysis, and integration of the material compared to a traditional lecture-based course. [Copyright &y& Elsevier]

Abstract: To investigate the effect of docosahexaenoic acid (DHA) without other highly unsaturated fatty acids (HUFA) on n-3 and n-6 essential fatty acid (EFA) metabolism and fatty acid composition in mammals, a stable isotope tracer technique was used in adult rats fed diets with or without 1.3% of algal DHA in a base diet containing 15% of linoleic acid and 3% of alpha-linolenic acid over 8 weeks. The rats were administered orally a mixed oil containing 48 mg/kg body weight of deuterated linoleic and alpha-linolenic acids and euthanized at 4, 8, 24, 96, 168, 240, 360 and 600 h after administration of the isotopes. Fatty acid compositions and the concentrations of deuterated precursors and their respective metabolites were determined in rat liver, plasma, heart and brain as a function of time. DHA, docosapentaenoic acid and eicosapentaenoic acid in the n-3 EFA family were significantly increased in all organs tested in the DHA-fed group, ranging from 5% to 200% greater in comparison with the control group. The accumulation of the metabolites, deuterated-DHA and deuterated-docosapentaenoic acid n-6 was greatly decreased by 1.5- to 2.5-fold in the dietary DHA group. In summary, feeding preformed DHA led to a marked increase in n-3 HUFA content of rat organs at the expense of n-6 HUFA and also prevented the accumulation of newly synthesized deuterated end products. This is the first study which has isolated the effects of DHA on the de novo metabolism on both the n-6 and n-3 EFA pathways. [Copyright &y& Elsevier]

Objectives: The purpose of this study was to investigate the effect of location, coding type, and topology of KCNH2(hERG) mutations on clinical phenotype in type 2 long QT syndrome (LQTS). Background: Previous studies were limited by population size in their ability to examine phenotypic effect of location, type, and topology. Methods: Study subjects included 858 type 2 LQTS patients with 162 different KCNH2 mutations in 213 proband-identified families. The Cox proportional-hazards survivorship model was used to evaluate independent contributions of clinical and genetic factors to the first cardiac events. Results: For patients with missense mutations, the transmembrane pore (S5-loop-S6) and N-terminus regions were a significantly greater risk than the C-terminus region (hazard ratio [HR]: 2.87 and 1.86, respectively), but the transmembrane nonpore (S1–S4) region was not (HR: 1.19). Additionally, the transmembrane pore region was significantly riskier than the N-terminus or transmembrane nonpore regions (HR: 1.54 and 2.42, respectively). However, for nonmissense mutations, these other regions were no longer riskier than the C-terminus (HR: 1.13, 0.77, and 0.46, respectively). Likewise, subjects with nonmissense mutations were at significantly higher risk than were subjects with missense mutations in the C-terminus region (HR: 2.00), but that was not the case in other regions. This mutation location–type interaction was significant (p = 0.008). A significantly higher risk was found in subjects with mutations located in α-helical domains than in subjects with mutations in β-sheet domains or other locations (HR: 1.74 and 1.33, respectively). Time-dependent β-blocker use was associated with a significant 63% reduction in the risk of first cardiac events (p < 0.001). Conclusions: The KCNH2 missense mutations located in the transmembrane S5-loop-S6 region are associated with the greatest risk. [Copyright &y& Elsevier]