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An experiment was conducted to study the allelopathic potential of old orchard soils on the seedling growth of rough lemon. Soils from the root zone spheres of eight orchards of mango, aonla, peach, pomegranate, citrus, pear, ber, guava and virgin soil as a control was used for raising the seedlings. The rough lemon Jatti khatti seedlings of one and a half year old raised in aonla, ber and peach orchard soil as growing media showed the reduction in shoot length (40-50%), leaf number (46-63%), leaf area/ plant (62-69%) and shoot dry weight (79-83%). The root length was most inhibited by ber, aonla and peach orchard soils. The percent reduction in root dry weight (11.23- 34.48%) of the seedling was not in equal proportion to reduction in root volume (42.55- 55.86%). Root dry weight density varied between 0.55-0.96 g mL-1 and root: shoot ratio between 1.42-1.82. Whereas, in citrus, mango, pomegranate, ber and guava orchard soils, the percent reduction in root dry weight was in equal proportion to root volume and root dry weight density varied between 0.41-0.49 g mL-1 and root: shoot ratio between 0.44-0.72. The shoot and root growth of the seedlings was at par when raised in citrus and pomegranate orchard soil as growing media. Leaf N and P contents increased, whereas, Ca and Mg decreased in all the orchard soils except citrus and pomegranate orchard soils as growing media. Leaf Fe, Cu and Mn contents in all the orchard soils as growing media were in toxic range except citrus and pomegranate orchard soils. Overall, the orchard soils of deciduous fruit plants showed more allelopathic effect than the soils growing evergreen fruit plants in citrus cultivation. [ABSTRACT FROM AUTHOR]

An experiment was conducted to study the allelopathic potential of old orchard soils on the seedling growth of rough lemon. Soils from the root zone spheres of eight orchards of mango, aonla, peach, pomegranate, citrus, pear, ber, guava and virgin soil as a control was used for raising the seedlings. The rough lemon Jatti khatti seedlings of one and a half year old raised in aonla, ber and peach orchard soil as growing media showed the reduction in shoot length (40-50%), leaf number (46-63%), leaf area/ plant (62-69%) and shoot dry weight (79-83%). The root length was most inhibited by ber, aonla and peach orchard soils. The percent reduction in root dry weight (11.23- 34.48%) of the seedling was not in equal proportion to reduction in root volume (42.55-55.86%). Root dry weight density varied between 0.55-0.96 g mL-1 and root: shoot ratio between 1.42-1.82. Whereas, in citrus, mango, pomegranate, ber and guava orchard soils, the percent reduction in root dry weight was in equal proportion to root volume and root dry weight density varied between 0.41-0.49 g mL-1 and root: shoot ratio between 0.44-0.72. The shoot and root growth of the seedlings was at par when raised in citrus and pomegranate orchard soil as growing media. Leaf N and P contents increased, whereas, Ca and Mg decreased in all the orchard soils except citrus and pomegranate orchard soils as growing media. Leaf Fe, Cu and Mn contents in all the orchard soils as growing media were in toxic range except citrus and pomegranate orchard soils. Overall, the orchard soils of deciduous fruit plants showed more allelopathic effect than the soils growing evergreen fruit plants in citrus cultivation. [ABSTRACT FROM AUTHOR]

Provides a comprehensive review of various modelling approaches related to Just-in-Time (JIT) manufacturing. JIT is essentially a philosophy for reducing lead time as well as excessive work-in-progress inventories. Based on this concept a number of techniques have been developed for the design, planning, scheduling and control of JIT manufacturing systems. Reports on a comparative study of these approaches for JIT manufacturing along with the conventional manufacturing approaches and alternative systems for JIT manufacture. Explores future research areas. [ABSTRACT FROM AUTHOR]

Martin Strassnig,1 Jaspreet S Brar,2 Rohan Ganguli31Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, FL, USA; 2Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; 3Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, CanadaObjective: To examine adiposity and sedentary behavior in relation to health-related quality of life (QoL) in patients with early schizophrenia.Methods: A cross-sectional study was used to assess adiposity by dual-energy X-ray absorptiometry scans, habitual physical activity and idle sitting time by the Short Form International Physical Activity Questionnaire, and health-related QoL by the RAND Medical Outcomes Study SF-36. QoL scores were compared with age-adjusted Canadian normative population data.Results: There were 36 participants with early schizophrenia, average age 25.1 (±3.6). Twenty-nine (72.5%) were males. Mean illness duration was 30 (±18) months, and mean body mass index was 28.3 (±5). Females had higher body fat content than males (30.8 ± 6.9 vs 24.7 ± 10.6; t = −2.6, df = 34; P = 0.015). Total body fat (F = 14; P = 0.001), lean body mass (F = 10.2; P = 0.001), and sedentary behavior (F = 5; P = 0.013) significantly increased across body mass index categories. Total body fat was correlated with sedentary behavior (r = 0.62; P = 0.001), and total lean body mass was negatively correlated with sedentary behavior (r = 0.39; P = 0.03). Based on SF-36 scores, participants had significantly lower physical functioning (P = 0.0034), role physical (P = 0.0003), general health (P < 0.0001), vitality (P = 0.03), and physical component scores (P = 0.003) than Canadian population comparisons. Habitual sedentary behavior, more than activity or adiposity levels, was associated with health-related QoL in early schizophrenia.Conclusion: Health-related QoL is lower in early schizophrenia and is predominantly experienced in the physical domain. QoL in early schizophrenia relates to sedentary behavior more than to activity and adiposity levels.Keywords: obesity, CVD risk, activity levels, BMI

Abstract Background In clinical practice, physicians often need to change the antipsychotic medications they give to patients because of an inadequate response or the presence of unacceptable or unsafe side effects. However, there is a lack of consensus in the field as to the optimal switching strategy for antipsychotics, especially with regards to the speed at which the dose of the previous antipsychotic should be reduced. This paper assesses the short-term results of strategies for the discontinuation of olanzapine when initiating risperidone. Methods In a 6-week, randomized, open-label, rater-blinded study, patients with schizophrenia or schizoaffective disorder, on a stable drug dose for more than 30 days at entry, who were intolerant of or exhibiting a suboptimal symptom response to more than 30 days of olanzapine treatment, were randomly assigned to the following switch strategies (common risperidone initiation scheme; varying olanzapine discontinuation): (i) abrupt strategy, where olanzapine was discontinued at risperidone initiation; (ii) gradual 1 strategy, where olanzapine was given at 50% entry dose for 1 week after risperidone initiation and then discontinued; or (iii) gradual 2 strategy, where olanzapine was given at 100% entry dose for 1 week, then at 50% in the second week, and then discontinued. Results The study enrolled 123 patients on stable doses of olanzapine. Their mean age was 40.3 years and mean (± standard deviation (SD)) baseline Positive and Negative Syndrome Scale (PANSS) total score of 75.6 ± 11.5. All-cause treatment discontinuation was lowest (12%) in the group with the slowest olanzapine dose reduction (gradual 2) and occurred at half the discontinuation rate in the other two groups (25% in abrupt and 28% in gradual 1). The relative risk of early discontinuation was 0.77 (confidence interval 0.61–0.99) for the slowest dose reduction compared with the other two strategies. After the medication was changed, improvements at endpoint were seen in PANSS total score (-7.3; p < 0.0001) and in PANSS positive (-3.0; p < 0.0001), negative (-0.9; p = 0.171) and anxiety/depression (-1.4; p = 0.0005) subscale scores. Severity of movement disorders and weight changes were minimal. Conclusion When switching patients from olanzapine to risperidone, a gradual reduction in the dose of olanzapine over 2 weeks was associated with higher rates of retention compared with abrupt or less gradual discontinuation. Switching via any strategy was associated with significant improvements in positive and anxiety symptoms and was generally well tolerated. Trial registration ClinicalTrials.gov NCT00378183

Contractile myosin and cell adhesion work together to induce tissue shape changes, but how they are patterned to achieve diverse morphogenetic outcomes remains unclear. Epithelial folding occurs via apical constriction, mediated by apical contractile myosin engaged with adherens junctions, as in Drosophila ventral furrow formation. While it has been shown that a multicellular gradient of myosin contractility determines folding shape, the impact of multicellular patterning of adherens junction levels on tissue folding is unknown. We identified a novel Drosophila gene  moat essential for differential apical constriction and folding behaviors across the ventral epithelium which contains both folding ventral furrow and nonfolding ectodermal anterior midgut (ectoAMG). We show that Moat functions to downregulate polarity-dependent adherens junctions through inhibiting cortical clustering of Bazooka/Par3 proteins. Such downregulation of polarity-dependent junctions is critical for establishing a myosin-dependent pattern of adherens junctions, which in turn mediates differential apical constriction in the ventral epithelium. In  moat  mutants, abnormally high levels of polarity-dependent junctions promote ectopic apical constriction in cells with low-level contractile myosin, resulting in expansion of infolding from ventral furrow to ectoAMG, and flattening of ventral furrow constriction gradient. Our results demonstrate that tissue-scale distribution of adhesion levels patterns apical constriction and establishes morphogenetic boundaries., Competing Interests: Conflicts of interests: The authors declare no financial conflict of interest.

Competing Interests: Competing interests:: None declared.

Stroke is the most common cause of death and disability in the world, and ischemic etiology plays a major role. Atrial septal aneurysm (ASA) is a localized saccular deformity of the atrial septum, associated with ischemic stroke independently or in association with other atrial septal defects (ASD). There is a higher incidence of stroke in the population with ASD. In these patients, the presence of ASA is an important predictor of recurrent stroke. This is a case of ischemic stroke in a 44-year-old who presented with sudden-onset right-sided body weakness, expressive aphasia, and non-specific confusion for one hour, with an initial National Institutes of Health Stroke Scale (NIHSS) score of 7. CT angiogram revealed occlusion of the M3 branch of the left middle cerebral artery in the left lateral frontal lobe. Code stroke was called, and the patient was given tenecteplase (TNK), after which her right-side weakness and aphasia resolved. Trans-thoracic echo with bubble study showed ASA with positive bubble study. Lone ASA or ASA with concomitant ASD poses a higher risk of recurrent stroke in younger patients, especially those without significant risk factors for strokes. Patients with ASA and concomitant ASD are at high risk for recurrent ischemic stroke and should be kept under surveillance with continued medical therapy. We present a case of ischemic stroke caused by ASA and a review of the current literature and case reports documenting cases with similar presentations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Waqas et al.)

Cytomegalovirus (CMV) infection is often asymptomatic. However, in certain individuals, it can cause non-specific signs and symptoms that maybe hard to recognise. The condition may therefore be overlooked or misdiagnosed, leading to prolonged illness and serious sequelae. In this case report, we present a rare instance of CMV infection in an HIV-negative patient who had a remote history of splenectomy and was experiencing prolonged fever and markedly elevated white blood cell (WBC) count., Learning Points: The clinical presentation of CMV infection in a post-splenectomy patient can be intricate and deceptive, involving non-specific symptoms such as prolonged fever and a markedly elevated WBC count.The decision on treatment among individuals without apparent risk factors (such as AIDS, transplant, or cancers) led to in-depth deliberations and discussion.Post-splenectomy patients with CMV infection may exhibit prolonged illness, potentially leading to severe consequences if left untreated., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2024.)

Despite the high burden of mental disorders in low- and middle-income countries (LMICs), less than 25% of those in need have access to appropriate services, in part due to a scarcity of locally relevant, evidence-based interventions and models of care. To address this gap, researchers from India and the United States and the Indian Council of Medical Research (ICMR) collaboratively developed a "Grantathon" model to provide mentored research training to 24 new principal investigators (PIs). This included a week-long didactic training, a customized web-based data entry/analysis system and a National Coordination Unit (NCU) to support PIs and track process objectives. Outcome objectives were assessed via scholarly output including publications, awards received and subsequent grants that were leveraged. Multiple mentorship strategies including collaborative problem-solving approaches were used to foster single-centre and multicentre research. Flexible, approachable and engaged support from mentors helped PIs overcome research barriers, and the NCU addressed local policy and day-to-day challenges through informal monthly review meetings. Bi-annual formal review presentations by all PIs continued through the COVID-19 pandemic, enabling interim results reporting and scientific review, also serving to reinforce accountability. To date, more than 33 publications, 47 scientific presentations, 12 awards, two measurement tools, five intervention manuals and eight research grants have been generated in an open-access environment. The Grantathon is a successful model for building research capacity and improving mental health research in India that could be adopted for use in other LMICs., (© 2023. The Author(s).)

Current knowledge creation and mobilization efforts are concentrated in academic institutions. A community-engaged knowledge hub (CEKH) has the potential for transdisciplinary and cross-sectorial collaboration between knowledge producers, mobilizers, and users to develop more relevant and effective research practices as well as to increase community capacity in terms of knowledge production. Objective: To summarize existing original research articles on knowledge hubs or platforms and to identify the benefits, challenges, and ways to address challenges when developing a CEKH. Methods: This study followed a systematic integrative review design. Following a comprehensive search of academic and grey literature databases, we screened 9030 unique articles using predetermined inclusion criteria and identified 20 studies for the final synthesis. We employed thematic analysis to summarize the results. Results: The focus of the majority of these knowledge mobilization hubs was related to health and wellness. Knowledge hubs have a multitude of benefits for the key stakeholders including academics, communities, service providers, and policymakers, including improving dissemination processes, providing more effective community interventions, ensuring informed care, and creating policy assessment tools. Challenges in creating knowledge hubs are generally consistent for all stakeholders, rather than for individual stakeholders, and typically pertain to funding, resources, and conflicting perspectives. As such, strategies to address challenges are also emphasized and should be executed in unison. Conclusions: This study informs the development of a future CEKH through the identification of the benefits, challenges, and strategies to mitigate challenges when developing knowledge hubs. This study addresses a literature gap regarding the comparisons of knowledge hubs and stakeholder experiences.

With the growing prevalence of obesity in the pediatric population, reports of its severe complications are increasing. Obesity hypoventilation syndrome is an uncommon disorder in children with altered respiratory mechanics, sleep-disordered breathing, and impaired ventilatory responses leading to persistent hypercapnia. Presentation is varied, and children may remain relatively asymptomatic until challenged with a respiratory infection, when they may present with acute respiratory failure. With increasing use of genetic testing in pediatric patients, our knowledge of potential contributors to hypoventilation syndromes is growing. Although mutations in the paired-like homeobox 2B gene are known to be causative of congenital central hypoventilation syndrome, other genes may also contribute to hypoventilation phenotypes. We report one of the youngest reported patients with obesity hypoventilation syndrome in pediatrics, with a proposed congenital predisposition for central hypoventilation derived from a deletion in the brain-derived neurotrophic factor gene., Citation: McCoy J, Karp N, Brar J, Amin R, St-Laurent A. A novel case of central hypoventilation syndrome or just heavy breathing? J Clin Sleep Med. 2022;18(9):2321-2325., (© 2022 American Academy of Sleep Medicine.)

Background: Obsessive-compulsive disorder (OCD) is associated with poor quality of life (QoL) and functionality. Treatment leads to improvement in QoL and better functioning., Aim: To assess the effect of treatment with SSRIs on QoL and disability in first-episode, drug-naïve patients with OCD., Materials and Methods: Fifty first-episode, drug-naïve patients with a diagnosis of OCD according to the Diagnostic and Statistical Manual 5 were assessed for severity of illness (Y-BOCS), World Health Organization QoL (WHO-QoL Bref), and disability (WHODAS 2.0) at baseline and at 12 weeks after receiving treatment with either sertraline or fluvoxamine., Results: The scores for QoL were low and for disability were high at baseline, and the scores for WHO-QoL-Bref and WHODAS 2.0 improved significantly after 12 weeks of treatment compared to baseline. This improvement correlated with reduction in the illness severity scores on Yale-Brown Obsessive-Compulsive Scale. The responders to treatment had better QoL and lower disability compared to nonresponders., Conclusion: There is an impairment in QoL and disability in first-episode, drug-naïve patients with OCD, and QoL improves and disability decreases with adequate treatment with SSRIs, and this improvement correlates with improvement in the illness severity., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Industrial Psychiatry Journal.)

Background  Migraine auras are transient neurological symptoms, usually lasting for approximately 5 to 30 minutes before the onset of migraine pain. Out of various types of auras, visual aura is the commonest and has variable manifestations, forming approximately 90% of auras. These visual auras may be of particular interest to the ophthalmologist as well as to the neurologist. We planned to conduct this study to look for the prevalence of visual aura in our population and make a descriptive analysis of the same. Materials and Methods  It was an observational, questionnaire-based cross-sectional study, enrolling all the consenting patients of migraine. Migraine was classified by International Classification of Headache Disorders (ICHD)-III β version, Third edition of International Classification of Headache Disorders. Patients in whom aura was present, detailed profile of visual aura was made regarding its type, duration, relation with migraine as per its laterality, etc. Observations and Results  Out of 1,245 migraine patients, 165 (13.25%) patients reported to have visual aura, 127 females and 38 males. Scintillating scotoma was the commonest type of visual aura, then zigzag lines, blurred vision, and tunnel vision. Majority of patients had aura between 5 and 35 minutes, none had more than 60 minutes. A total of 142 patients out of 165 had unilateral aura, out of which 64 (38.78%) patients had aura ipsilateral to the side of headache, and 78 (47.27%) patients had aura contralateral to the side of headache. Twenty-three (13.93%) patients had bilateral aura. Discussion  The frequency of visual aura was found to be 13.25% in our study, which is high compared with previously published Indian data. We did a descriptive analysis of visual aura symptoms. Conclusion  Visual aura is the commonest type of aura, more frequent in females. Scintillating scotoma was found to be the commonest type of visual aura, followed by zigzag lines in study. Our study is unique of its type as its shows a descriptive visual analysis in a larger number of patients., Competing Interests: NoteConflict of Interest The study primarily carried out at Guru Gobind Singh Medical College, Faridkot None declared., (Association for Helping Neurosurgical Sick People. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Traumatic brain injury (TBI) is an insult to the brain from an external mechanical force, leading to temporary/permanent secondary injuries, i.e. impairment of cognitive, physical, and psycho-social functions with altered consciousness. The leading mechanism responsible for neuronal damage following TBI is an increase in oxidative reactions initiated by free radicals generated by the injury along with various other mechanisms. Nerolidol is reported to have potent antioxidant and anti-neuroinflammatory properties. The present study was designed to explore the neuroprotective effect of nerolidol in weight-drop-induced TBI in rats. Animals were injured on the 1st day by dropping a free-falling weight of 200 gm from a height of 1 m through a guide pipe onto the exposed skull. After 14 days of injury, nerolidol (25, 50, and 100 mg/kg, i.p. ) treatment was given for the next 14 days. Locomotor activity and motor coordination were evaluated using an actophotometer and rotarod, respectively. Cognitive impairment was observed through the Morris Water Maze and Object Recognition Test. On the 29th day, animals were sacrificed, and their brains were collected for the biochemical estimation. The weight drop model significantly decreased locomotor activity, motor coordination, increased Acetylcholinesterase (AChE) activity, oxidative stress, and induced cognitive deficits in TBI rats. Nerolidol significantly improved locomotor activity, reversed motor incoordination and cognitive impairment, and reduced the AChE activity and oxidative/nitrosative stress. The present study demonstrates the promising neuroprotective effects of nerolidol, which might improve the quality of life of TBI patients., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background and Objective: Migraine is one of the most common types of headache leading to significant disability; still people do not seek early help in developing countries. Therefore, we planned to conduct a study to assess the clinical profile of migraine, its triggers, comorbidities, and related disability in rural India., Design: An observational study in which 1,245 men and women suffering from migraine were recruited at a tertiary care hospital and were asked to complete a questionnaire related to migraine, its triggers, comorbidities, and disability., Results: Out of 1245 patients, females constituted 75% (937) of the patient pool and rest 25% were males (308). Fatigability (52.7%), nausea/vomiting (42.7%), phonophobia (33.57%), numbness (28.2%), and vertiginous sensation (20.8%) were accompanying features. Stress was the most common trigger impacting 44.9% of the patient population, followed by noise in 44.3% of cases. Exertion and sleep disturbance acted as triggers in 36.1%, smells in 20.5%, hormonal factors in 11.5%, and visual stimuli in 5.1% of patients. Anxiety was identified as the most common comorbidity affecting 542 patients (43.5%), followed by depression in 25.7%of patients. Around 103 patients (8.2%) had other psychiatric illnesses such as panic disorder and bipolar mood disorder., Conclusion: The migraine-related disability is high; therefore we conducted a study to understand its triggers and clinical profile. This was the first observational study conducted in a tertiary care hospital on migraine in north India catering to a sizeable rural population however, larger population studies are required to understand migraine more exhaustively., Competing Interests: There are no conflicts of interest., (Copyright: © 2006 - 2020 Annals of Indian Academy of Neurology.)

Abstract: Salmonella is one of the top causes for bacterial foodborne infections in the United States, emphasizing the importance of controlling this pathogen for protecting public health. Poultry and poultry products are commonly associated with Salmonella, and interventions during production and processing are necessary to manage the risk of infection due to consumption of poultry products. In recent times, the demand for organic and antibiotic-free poultry has increased owing to consumer perceptions and concerns of increasing prevalence of antimicrobial-resistant (AMR) pathogens. However, the microbiological effect of these management practices is not clear. This study was conducted to determine the difference in the AMR of Salmonella isolated from poultry processed conventionally and organically. Fecal samples, carcass rinses, and environmental samples were collected over 1 year and analyzed for the prevalence of Salmonella and AMR. Results of this experiment showed that organic chickens were associated with statistically higher levels of Salmonella during early processing steps. However, no difference in Salmonella prevalence was observed between organic and conventional carcasses postchill. In addition, for most antimicrobial agents tested, prevalence of AMR Salmonella in conventional processing was lower in this study than was reported by the National Antimicrobial Resistance Monitoring System for chickens at slaughter. These observations indicate that organic methods may introduce greater risk of Salmonella contamination; however, proper interventions during processing can abate this risk. In addition, this study supports the assertion that raising chickens without the use of antibiotics may result in lower prevalence of AMR Salmonella., (Copyright ©, International Association for Food Protection.)

Background/objective: Various strategies have been implemented to reduce acute stroke treatment times. Recent studies have shown a significant benefit of acute endovascular therapy. The JFK Comprehensive Stroke Center instituted Code Neurointervention (NI) on May 1, 2014 for the purpose of rapidly assembling the NI team and rapidly providing acute endovascular therapy., Design/methods: We performed a retrospective analysis of all patients who had Code NI (Code NI group) called from May 1, 2014 to July 30, 2018 and compared them to patients who underwent acute endovascular treatment prior to initiation of the code (pre-Code NI group) between January 2012 and April 30, 2014. The following parameters were compared: door to puncture (DTP) and door to recanalization (DTR) times, as well as preprocedure NIHSS, 24-hour postprocedure NIHSS, and 90-day modified Rankin scores., Results: There were 67 pre-Code NI patients compared to 193 Code NI patients. Mean and median DTP times for pre-code NI vs Code NI patients were 161 minutes(mins) vs 115mins (p<0.0001, 31.76-58.86) and 153mins vs 112mins ( p <0.0001), respectively. Mean and median DTR times were 220 mins vs 167mins ( p <0.0001, 37.76-69.97) and 225mins vs 171mins ( p <0.0001). Mean pre-procedure NIHSS was 16 for both groups while 24 hours post procedure NIHSS was 10.6 vs 10.8 ( p =.078, 1.8-2.38). Mean 90 day mRS was 2.15 vs 1.65 ( p =0.036, 0.32-0.96)., Conclusion: Institution of Code NI significantly improved DTP and DTR times as well as mRS at 3-months postprocedure. Rapid assembly of the NI team, rapid availability of imaging and angiography suite, and streamlining of processes, likely contribute to these differences. These lessons and more widespread institution of such codes will further aid in improving acute stroke care for patients., (All Rights Reserved by JVIN. Unauthorized reproduction of this article is prohibited.)

Rationale: Evidence from cadaveric studies note that the sympathetic nerves from the second and third thoracic ganglia bypass the stellate ganglion in 20% of the population. We present a novel alternative technique for sympathetic blockade of upper extremity via thoracic epidural approach., Patient Concerns: The patient-reported anxiety about "the placement of the needle in the front of the neck" and severe pain secondary to complex regional pain syndrome., Diagnoses: Complex regional pain syndrome type-1 with involvement of upper extremity., Interventions: A patient with upper extremity complex regional pain syndrome underwent sympathetic blockade of the upper extremity via thoracic epidural approach with advancement of a catheter through neural foramen and positioning the catheter tip in the upper thoracic paravertebral space., Outcomes: Clinical signs of successful sympathetic blockade of upper extremity were consistently observed after each block utilizing this alternative technique multiple times in a single patient., Lessons: Thoracic paravertebral block via thoracic epidural approach and catheter use may be an alternative technique for upper extremity sympathetic blockade. Potential advantages of this technique include complete sympathetic blockade of upper extremity for both diagnostic and therapeutic purposes, patient comfort with more effective local anesthetic administration for needle entry site, and potentially reduced risk of pneumothorax and inadvertent intravascular injection.

Preclinical research shows that compounds acting at α7 nicotinic receptors (nAChRs) can reduce nicotine self-administration, suggesting that a positive allosteric modulator (PAM) of α7 receptors, JNJ-39393406, may aid smoking cessation. Moreover, individuals with schizophrenia, who have very high rates of smoking, have reduced expression of α7 nAChRs and may particularly benefit from this compound. In two parallel studies using a within-subject cross-over design, 36 healthy smokers (Study 1) and 62 smokers with schizophrenia (Study 2), both groups high in quit interest, attempted to initiate quitting temporarily during each of two 3-week phases. Treatments were the α7 nicotinic receptor PAM JNJ-39393406 (100 mg b.i.d.) or placebo (double-blind, counter-balanced). In each phase, all smoked ad lib with no drug on week 1 or during dose run-up on week 2, and then tried to quit every day during week 3. Abstinence (confirmed by CO <5 p.p.m.) and smoking reduction (CO <8), as well as cigarettes/day (in Study 1), were assessed daily (Monday-Friday) each quit week and compared between conditions. Secondary outcomes included abstinence symptoms (withdrawal and craving) and cognitive test responding (N-back; continuous performance task). In both studies, compared with placebo, active JNJ-39393406 did not increase the number of abstinent days nor reduce total smoking exposure. We also found no significant improvements in craving, withdrawal, or cognitive function. With this dose and study duration, our findings do not support further testing of this α7 nAChR PAM compound for possible efficacy in smoking cessation, in smokers with or without schizophrenia.

Background: Interest in global health during postgraduate residency training is increasing across medical specialties, and multiple disciplines have categorized global health training opportunities in their arena. No such cataloging exists for anesthesiology residency programs. The aim of this study was to assess and characterize global health opportunities and the attitudes of program directors (PDs) in U.S. anesthesiology residency programs towards this training., Methods: A cross-sectional 20-question survey on global health opportunities was distributed to 128 ACGME accredited anesthesiology residency program directors via email between October 2015 and January 2016. Descriptive statistics and exploratory inferential analyses were applied. Maximal nonresponse selection bias was estimated., Results: The overall response rate was 44%. Of those who responded, 61% reported that their residency program had a global health elective, with a maximal bias estimate of 6.5%. 45% of program directors with no global health elective reported wanting to offer one. 77% of electives have articulated educational goals, but there is substantial heterogeneity in curricula offered. Program director attitudes regarding the value of global health programs differed significantly between those with and without existing programs., Conclusions: The proportion of U.S. anesthesiology residency programs offering global health electives is similar to that in other medical specialties. There is inconsistency in program structure, goals, curriculum, and funding. Attitudes of program directors differ between programs with and without electives, which may reflect bidirectional influence to be investigated further. Further studies are needed to codify curricula, assess effectiveness, and validate methodologies.

Metastases to breast accounts for 0.5-1.3% of all breast malignancies, with the exclusion of leukaemia and lymphoma. These have a wide range of clinical and radiological manifestations and their diagnosis is difficult. There is a need to distinguish them from primary breast carcinoma to prevent unnecessary mastectomy. Imaging and immunohistological correlation plays a vital role in distinguishing this. Our case series review describes the clinical presentation, radiological and histopathological appearances of three patients who presented to our institution.