Rogersjenkins5491

Contrary to guidelines, magnetic resonance imaging (MRI) is often ordered in the first 6 weeks of new episodes of uncomplicated non-specific low back pain.

To determine the downstream consequences of early imaging.

Retrospective matched cohort study using data from electronic health records of primary care clinics of the U.S. Department of Veterans Affairs.

Patients seeking primary care for non-specific low back pain without a red flag condition or an encounter for low back pain in the prior 6 months (N = 405,965).

MRI of the lumbar spine within 6 weeks of the initial primary care visit.

Covariates included patient demographics, health history in the prior year, and baseline pain. Outcomes were lumbar surgery, prescription opioid use, acute health care costs, and last pain score recorded within 1 year of the index visit.

Early MRI was associated with more back surgery (1.48% vs. 0.12% in episodes without early MRI), greater use of prescription opioids (35.1% vs. 28.6%), a higher final pain scoreother care, and worse outcomes, including potential harms from prescription opioids.

The use of simulators in medical education is critical for developing procedural competence prior to treating patients. Current training of emergency physicians to perform distal radius fracture reduction is inconsistent and inadequate.

We developed a3Dprinted distal radius fracture simulation training model that is easy to assemble and relatively inexpensive. We present step-by-step instructions to reproduce the model.

The model was found to have high fidelity for training by both instructors and participants in asimulation-based mastery learning course.

We successfully designed alow cost, easy to reproduce, high fidelity model for use in asimulation-based mastery learning course to teach distal radius fracture reduction.

We successfully designed a low cost, easy to reproduce, high fidelity model for use in a simulation-based mastery learning course to teach distal radius fracture reduction.Few data regarding popliteal artery entrapment syndrome (PAES) is available in Japan. In this study, we investigated incidence, diagnosis and treatment of PAES in current vascular practice. A retrospective analysis of all patients with PAES visiting 31 participating institutes between 2003 and 2015 was conducted. Thirty-five limbs (28 patients) were identified during the 13-year study period, and the incidence of PAES was 0.12% of all peripheral artery disease cases revascularized. Mean age was 32.0 ± 16.9 years old, and 60 and more years old was 10.7%. Also, 92.9% were male and 39.3% were athletes. Most frequent initial symptoms were intermittent claudication in 23 limbs (65.7%); 4 limbs (11.4%) had chronic limb-threatening ischemia. CT scan was most frequently (94.3%) used for the diagnostic imaging followed by MRI (45.7%) and duplex ultrasound (45.7%). Stress test such as dorsal flexion during duplex ultrasound was used only in 28.6%. Thirty-two limbs (91.4%) received surgical treatment, including 23 arterial reconstructions (71.9%); there were no major perioperative complications. All patients achieved improvement of their symptoms, and the average ankle brachial index increased from 0.69 ± 0.22 to 1.00 ± 0.14 post-surgery. The average postoperative follow-up period was 26.0 months with only one reintervention during the follow-up. In conclusion, PAES was a rare condition and traditional surgical treatment was solid. However, given a broad spectrum of clinical feature of PAES and less usage of diagnostic duplex ultrasound with stress test, there might be a miss- or delayed diagnosis of PAES even in the current vascular practice.Cognitive impairment is highly prevalent in the population with spinal cord injury (SCI) and exerts a significant impact on functional independence and quality of life in this population. A number of neuroscientists have conducted preliminary investigations of cognitive deficits after SCI, but achieved marginally contradictory results due to some limitations such as the heterogeneity in the sample population, sample size, types of tests utilized, study design, and time since SCI. Therefore, this review mainly focuses on the characteristics, assessments, potential causality and treatment of cognitive impairment for better understanding such deficits in the SCI population.Gap junction (GJ) research has entered a new stage focusing the concerted dynamic behavior of multiple isoforms of connexin (Cx) in the cell membrane, cytosolic vesicles, and space between them. To proceed with this research, imaging technologies are important. Here we describe two novel protocols for this purpose. At first, the adoption of a small motif of Cys-Cys-X-X-Cys-Cys as a visualization tag is described. An As complex, FlAsH, can bind to this tetra-Cys (TC) tag to form a fluorescent conjugate. Its introduction into the C-terminal of Cx43 is demonstrated. Next, a novel triangle chip for the accurate x-y registration is described. Target single cells of HeLa marked with a fluorescent dye can be easily recognized by electron microscopy based on this chip.The world is increasingly getting urbanized and globalized, and the increase in natural resource exploration could have a far-reaching impact on environmental quality. Since most Latin American and Caribbean countries (LACCs) have proximity to the Amazon, they, therefore, rely heavily on agriculture and mining which develop via deforestation which could exacerbate the already increasing carbon dioxide emissions (CO2 emissions). Therefore, to the best of our knowledge, this study becomes the first to investigate the link between natural resources, globalization, urbanization, and environmental degradation in LACCs countries from 1990 to 2017 with advanced panel data econometric techniques. The unit root tests affirm all the variables to be stationary at first difference, and the Westerlund (Oxf Bull Econ Stat 69(6)709-748, 2007) cointegration test confirms the long-run relationship among the variables. The augmented mean group (AMG) and the common correlated effects mean group (CCEMG) results affirm that the aforementioned variables add to CO2 emissions, while human capital mitigates it. Further findings reveal that human capital performs a moderating role in promoting urbanization sustainability. The country-specific results confirm that economic growth adds to emissions in all the countries, except in the Dominican Republic. A feedback causality exists between economic growth, globalization, urbanization, and CO2 emissions. This study argues for the development of human capital, a gradual transition to sustainable growth-driven and knowledge-based industries, and the introduction of sustainability practices in the natural resource sector to mitigate CO2 emissions in LACCs.Arsenic (As) exposure is associated with adverse health outcomes to the living organisms. In the present study, the hepato-protective ability of thymoquinone (TQ), the active principle of Nigella sativa seed, or ebselen (Eb), an organoselenium compound, against As intoxication in female rats was investigated. For this purpose, animals were allocated randomly into control, As (20 mg/kg), TQ (10 mg/kg), Eb (5 mg/kg), As+TQ, and As+Eb groups that were orally administered for 28 consecutive days. Arsenic exposure resulted in hepatic oxidative damage which was evidenced by marked decreases in antioxidant parameters (superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione (GSH)) concomitant with high malondialdehyde (MDA) level. Furthermore, As toxicity induced significant elevations in liver accumulation of As, serum hepatic indices (aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (TB)), and apoptotic marker (B cell lymphoma 2(Bcl2), Bcl-2-associated X protein (Bax), and caspase 3) levels. Additionally, notable increments in hepatic fibrotic markers (epidermal growth factor (EFG) and transforming growth factor beta 1 (TGF-β1)) associated with high nitric oxide, interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and myeloperoxidase (MPO) levels were noticed following As intoxication. Biochemical findings were well-supported by hepatic histopathological screening. The co-treatment of As-exposed rats with TQ or Eb considerably improved liver function and antioxidant status together with lessened hepatic As content, inflammation, apoptosis, and fibrosis. The overall outcomes demonstrated that TQ or Eb ameliorates As-induced liver injury through their favorable antioxidant, anti-inflammatory, anti-apoptotic, and fibrolytic properties.The research was designed to examine oxidative stress of the liver of turtle Mauremys reevesii caused by cadmium (Cd). Turtles were injected intraperitoneally with cadmium at the concentration of 7.5, 15, and 30 mg/kg, and 5 turtles were taken from each group after exposure for 1 week (1 w), 2 weeks (2 w), and 3 weeks (3 w). The activities of SOD and CAT as well as the contents of GSH and MDA in liver tissues were detected by using a kit. The results showed that the difference between the control group and the Cd-treated group was statistically significant with the increase of Cd concentration and the prolongation of exposure time, which suggested that Cd caused oxidative stress on the liver of turtles.Green innovation (GI) is an important means of achieving a win-win outcome in the form of both economic development and environmental protection. Using a unique Chinese Patent Census Database to identify the quantity and quality of GI in each province and panel data for Chinese industrial sector in 30 provinces from 2002 to 2015, we investigated the impact of environmental regulation (ER) on GI in China. This study presents the first attempt to identify green innovation quality in China. Empirical results show that there is an inverted-U relationship between ER and GI. The heterogenous effects are further investigated in order to obtain more accurate policy implications. The results indicate that the impact of ER on GI is insignificant in the central and western regions, implying the necessity of adjusting ER policies in these regions. Second, the inverted U-shaped relationship between ER and GI only occurred in provinces with high state-owned enterprise (SOE) ratio, figuring out the special role of Chinese SOEs in promoting GI. Third, the impact of ER on GI is insignificant in regions with high levels of pollution, indicating high potential of green innovation and policy adjustments there.Plant- and/or microbe-based systems can provide a cost-effective, sustainable means to remove contaminants from soil. Microbe-assisted phytoremediation has potential utility for polycyclic aromatic hydrocarbons such as fluoranthene (Flu) removal from soils; however, the efficiency varies with the plant and microbes used. This study evaluated the Flu removal efficiency in a system with ryegrass (Lolium multiflorum), an IAA-producing Arthrobacter pascens strain (ZZ21), and/or a Flu-degrading Bacillus cereus strain (Z21). Strain ZZ21 significantly enhanced the growth of ryegrass. Ryegrass in combination with both strains (FIP) was the most effective method for Flu removal. By day 60, 74.9% of the Flu was depleted in the FIP treatment, compared with 21.1% in the control (CK), 63.7% with ryegrass alone (P), 69.0% for ryegrass with ZZ21 (IP), and 72.6% for ryegrass with Z21 (FP). FIP treatment promoted ryegrass growth, accelerated Flu accumulation in plants, and increased soil microbial counts. Microbial carbon utilization was significantly higher in soil in the FIP than with the CK treatment.