Clinical Physiology Research Articles

Factors affecting mortality following necrotizing soft-tissue infections: Randomized prospective study

Background and Aim:Necrotizing soft-tissue infections (NSTIs) are common in the Indian subcontinent and are associated with high morbidity and mortality. The aim of this paper was to correlate clinical factors and Acute Physiology Health and Chronic Health Evaluation (APACHE) II score with mortality following NSTI.Methodology:Patients presenting to our tertiary-care center between November 1, 2014, and December 1, 2016, with NSTI and between the age of 15 and 90 years were included and entered into a prospectively maintained database. Fifty random patients were selected from the database and were divided according to the survival outcome into two groups: Group 1-survivors and Group 2-nonsurvivors. The two groups were compared for clinical factors and APACHE II score to identify the variable which correlated with the survival.Results:Mean age of the study cohort (n = 50, 44 males) was 50.8 ± 17.1 years. Fournier's gangrene was the most common manifestation (64%), followed by lower limb (14%). Infection was leading cause (34%) followed by trauma (16%) and prior surgery (14%). There were 16 in-hospital deaths (32%). Two groups were similar regarding age and sex. At presentation, nonsurvival group had significantly higher body surface area involvement (P = 0.001), anemia (P = 0.023), metabolic acidosis (P < 0.0001), serum creatinine (P = 0.007), and mean APACHE II score (P < 0.001). There was no difference between time from presentation to the first debridement.Conclusions:We found that APACHE II is a significant predictor of mortality. Early diagnosis and prompt aggressive treatment is the only way to improve outcome. Further studies with larger sample size are warranted.

Proceso formativo por competencias y enfoques complejos, sustentado en el Ciclo de Kolb, desde la enseñanza de la Fisiología Médica.

Introducción: El diseño curricular por competencias para la formación médica en Ecuador incorpora créditos y ciclos propedéuticos con reflexiones, aspectos conceptuales y lineamientos metodológicos. El enfoque complejo dentro del diseño por competencias da una gran prioridad a la formación de personas integrales con compromiso ético, que busquen su autorrealización, en estrecha vinculación con la sociedad, profesionales médicos idóneos y emprendedores. Kolb desarrolla un modelo de enseñanza aplicable para cada estilo de aprendizaje y de esta forma guía al profesor, bajo un esquema de confort pedagógico, de acuerdo a las necesidades del que aprende. La aplicación a la enseñanza de la Fisiología redundará en elevar la calidad del proceso formativo y la adquisición de los resultados de aprendizaje.&#x0D; Objetivo: Aplicar el enfoque complejo y el Ciclo de Kolb en la enseñanza de fisiología Médica&#x0D; Metodología: Se realizó un estudio explicativo de corte transversal que permite evidenciar la aplicación del enfoque complejo y el Ciclo de Kolb en la enseñanza de Fisiología Médica a los estudiantes de la Carrera de Medicina de la Universidad Técnica de Ambato durante el periodo académico marzo-agosto 2018. Se utilizaron métodos estadísticos descriptivos.&#x0D; Resultados: Los procesos complejos de desempeño con idoneidad en la formación médica integran diferentes saberes (saber ser, saber hacer, saber conocer y saber convivir), para realizar actividades y/o resolver problemas con sentido de reto, motivación, flexibilidad, creatividad, comprensión y emprendimiento, dentro de una perspectiva de procesamiento metacognitivo, mejoramiento continuo y compromiso ético, con la meta de contribuir al desarrollo profesional, la construcción y afianzamiento de la vinculación con la sociedad, la búsqueda continua del desarrollo académico y científico y el cuidado y protección del ambiente. Se evidenció una elevación de los resultados académicos en la asignatura, con impacto en los aspectos cognitivos, procedimentales y actitudinales.&#x0D; Conclusiones: La aplicación del enfoque complejo y el Ciclo de Kolb a la enseñanza de la Fisiología contribuye a elevar la calidad del proceso formativo y al logro de los resultados de aprendizaje con vistas a la adquisición de las competencias generales y específicas declaradas en el diseño curricular.

SELECTION OF TERMINOLOGICAL UNITS FOR TEACHING LOGOPEDICS BILINGUAL GLOSSARIES (ENGLISH-BULGARIAN)

The speech of the language pathologist may serve as a linguistic model in terms of application of language norms, unambiguous use of lexis and register for the achievement of effective professional communication. The aim of the present survey was to integrate the lexical and the corpus-based approach and to compile a collection of terminological units for the purposes of teaching English as a specialized language in the domain of Logopedics.The ESP syllabus brings together a broad range of subjects such as linguistics, phonetics, and medical sciences anatomy and physiology, psychology, neurology, and speech and language pathology. To introduce the core vocabulary and the main issues in several fields and to compensate for the lack of bilingual reference materials available to students in Logopedics, the creation of a bilingual glossary is naturally justified.On the one hand are the key components of speech production such as phonation; resonance; fluency; intonation, voice, and the components of language (phonology, morphology, syntax, semantics, and pragmatics). On the other hand, the focus on doctor-patient communication, history taking, voice, mechanics of breathing, syndromes of communicative disorders, should be introduced in accordance with the academic style conventions. For the achievement of such complex the teaching and learning goals a series of ESP language practice materials were developed, incorporating the listening, reading and speaking skills. Terminological units were extracted from authentic publications, grouped thematically in bilingual glossaries and published as an educational resource on the university platform. Key lexical items were incorporated into learning tasks and specially designed exercises for practicing pronunciation, vocabulary, and extensive oral practice through audio visuals, discussions, simulation and role-play activities, students’ Power point presentations by topics and other communication-based activities that transform the classroom into an interactive place. Further to the development of foreign language fluency, the researcher/lecturer believes that writing summaries and translating short professional texts should be part of the language seminars for logopedics.The bilingual glossaries provide clear and concise definitions, sample sentences that illustrate usage, and translation equivalents in Bulgarian, while the language practice resources reinforce the relevant terms in the field.

Editorial introductions

Editorial introductions

Recall of physiology knowledge among medical interns: an exploratory study in Riyadh, Saudi Arabia.

The aim of the study was to explore the factors associated with the recall of basic medical physiology knowledge among medical interns and to determine the level of retained basic science knowledge. Two hundred and four interns, 114 women and 90 men, working in two major tertiary medical care centers, King Fahad Medical City (KFMC; 29 students) and King Khalid University Hospital (KKUH; 117 students), in Riyadh city, participated in the study. An anonymous knowledge test with 10 validated multiple-choice questions was developed specifically for this purpose. One hundred and forty-six interns (117 working at KKUH and 29 at KFMC) had graduated from medical schools adopting a conventional instructional system, whereas 58 (3 from KKUH and 55 from KFMC had graduated from schools adopting an integrated system (hybrid problem-based learning). Fifty-two students (26%) gained a score ≥60%, whereas 152 students (74%) obtained <60% of the score. Higher scores were associated with younger age ( P < 0.01), traditional curriculum ( P < 0.001), interns from KKUH ( P < 0.001), and candidates for postgraduate studies ( P < 0.02). There was no significant association between recall of physiology knowledge and all other variables studied, including sex. Multivariate analyses show that age and traditional curriculum are the only significant predictors of knowledge retention. Almost three-fourths of the interns scored <60%, and higher scores were significantly associated with younger interns, traditional curriculum, working in KKUH, and interns preparing for graduate studies. However, the difference between the two curricula disappears when the influence of hospital training is considered.

Blended learning in medical physiology improves nursing students' study efficiency.

The rapid development of mobile phones and communication networks is profoundly changing the lives of people in China. With the gradual growth of Wi-Fi on college and university campuses, Chinese schools are setting off a wave of teaching reform combining online material with traditional classroom instruction. We adapted a Chinese University massive open online course physiology course into a private university online course, specifically designed for second-semester bachelor's level nursing students at Taishan Medical University. This online course blended with classroom teaching was offered to 108 freshmen from two parallel reform classes. A third class of 55 students was offered the traditional classroom lecture-based course as a control. Impressive teaching effects were achieved in reform classes, as indicated by significant improvement in student performance on the final examination and positive student feedback. The student surveys showed that 68% of students preferred the blended course over traditional classroom courses. The most highly rated advantages of the blended course were flexible learning time (84%) and improvement of independent study skills (75%). As higher education enters the internet era, exploiting the high-quality cyber resources may be the fastest and most economical way to improve teaching efficiency and enhance students' study experience.

One hundred and fifty years ago Charcot reported multiple sclerosis as a new neurological disease.

In May 1868, Jean Martin Charcot (1825–93) (Fig. 1A) delivered a series of major lectures, establishing multiple sclerosis as a novel disease of the nervous system. Delving into the early 19th century medico-scientific literature illustrates how confusions delayed the identification of multiple sclerosis as a single nosological entity. The confusion arose in part from the difficulty to relate polymorph symptoms to the same disease as clinical signs are highly variable during the course of the disease, reflecting either spinal, or cerebrospinal or purely cerebral neurological symptoms. Charcot’s merit was to realize, applying his rigorous methodology inherited from Laennec (1781–1826) and Claude Bernard (1813–78), to bring together clinical observation, anatomo-pathology and physiology. This approach, along with detailed observations from others, led to Charcot’s proposition that these apparently unrelated symptoms belonged to the same disease, which he named Sclerose en plaques, a term that (from 1954) became multiple sclerosis in the English literature. Here I wish to commemorate the 150th anniversary of Charcot’s brilliant demonstration and tentatively decipher the reasoning that led Charcot to successfully ‘extract the sclerose en plaques from the chaos of chronic myelitis’. Open in a separate window Figure 1 Charcot's tribute paid by his students. (A) Portrait of J.M. Charcot designed and engraved by Dr P. Richer ‘one of JM Charcot most distinguished students’ on the front page of the sixth edition of ‘Oeuvres completes de JM Charcot’. The importance of Charcot’s international reputation is shown by the fact that, between 1874 and 1882, his ‘Lecons cliniques’ were translated into German, Russian, English, Italian, Magyar, and Spanish. (B) Charcot’s statue, which was melted down in 1942; the stone pedestal was removed in 1967. (C) Main entrance of the Hospice de la Salpetriere (c. 1900) showing the statue of Charcot placed on the left. Sources: A: Charcot (1892); B and C: http://paris1900.lartnouveau.com/paris13/lieux/hopital_de_la_salpetriere.htm.

Experimental to Clinical Coronary Physiology.

Experimental to Clinical Coronary Physiology.

Recurrent Polyuria

Recurrent Polyuria

Meet the First Authors.

Meet the First Authors.

Hair dyes in pregnant women; is it safe?

Statins (3-hydroxy-3 methyl-glutaryl coenzyme-A reductase inhibitors) are the most commonly prescribed cholesterol-lowering medications due to their efficacy in reducing cardiovascular mortality and morbidities, tolerability, and safety profiles. Based on pathophysiologic similarities between cardiovascular disease and preeclampsia, a common and dangerous complication of pregnancy, there is an increasing interest in studying this class of medications during pregnancy to prevent and/or treat preeclampsia. Undergoing such a study, which entails the use of a pregnancy class X medication for an off-label indication in pregnancy, requires intensive multidisciplinary involvement of a group of experts in basic and clinical pharmacology, research methods, pregnancy physiology and maternal–fetal medicine, as well as U.S. Food and Drug Administration (FDA) regulatory guidelines and practice. Issues of potential fetal risk, altered maternal–fetal pharmacokinetics and pharmacodynamics, and regulatory challenges are real, and must be carefully considered in the process of research in this arena.

Engagement and higher order skill proficiency of students completing a medical physiology course in three diverse learning environments.

The primary aim of this study was to determine whether levels of student engagement, higher order skill proficiency, and knowledge acquisition demonstrated by medical students would differ when completing the same course in three diverse learning environments. Following Institutional Review Board approval, 56 first-year medical students, registered at the same medical school but attending class at three different campus centers, were enrolled in the study. All participants were completing a medical physiology course that utilized the same learning objectives but relied on different faculty incorporating diverse methodologies (percentage of class devoted to active learning strategies), course format (6-wk block vs. 17-wk semester), and student attendance. Students completed a validated survey of student engagement (SSE), a proctored online problem-based assessment of higher order skill proficiency [Collegiate Learning Assessment (CLA+); http://cae.org ], and the National Board of Medical Examiners (NBME) Physiology subject exam. In this limited sample, results indicate no significant differences between campus sites for any of the variables assessed. Levels of engagement were lower than expected compared with published values for graduate students. Higher order skill proficiency assessed by CLA+ was significantly higher than values reported for college seniors nationally. Surprisingly, SSE offered no prediction of performance on CLA+ or NBME, as there were no significant correlations between variables. These data indicate that, although first-year medical students may not perceive themselves as highly engaged, they are adept in using higher order skills and excel in meeting course learning objectives, regardless of learning environment.

OA105] Is CZT-spect dedicted system for myocardial imaging reliable in assessment of left ventricular voulmes as compared to echocardiography?

Background Estimation of left ventricular volumes, including ejection fraction (LVEF), is important in the diagnosis and the determination of severity of different cardiac diseases. Echocardiography and cardiac magnetic resonance imaging are clinically used for this purpose. However, myocardial perfusion imaging (MPI) is widely used in the diagnosis of ischemic heart disease, and the assessment of left ventricular volumes can improve the diagnostic accuracy in those patients. Development of single photon emission tomography SPECT with cadmium zinc telluride detector has improved image resolution as compared to standard sodium iodide SPECT camera. Does this improved image resolution affect quantitative assessment of left ventricular volume in MPI studies? In this study, assessment of left ventricle volumes end-diastolic and end-systolic (EDV, ESV) as well as LVEF is compared in images from three modalities. Methods A cohort of 65 patients including 29 men, and 36 women underwent echocardiography and MPI within one month at the clinical physiology department at Sahlgrenska university hospital, from January 2015 to October 2016. Among 65 patients 23 of them were excluded due to atrial fibrillation or low echocardiographic image quality, only 24 were scanned using heart dedicated scanner (DSPECT Spectrum Dynamics Medical®, and 21 were scanned using dual head SPECT (Philips ADAC Skylight® camera. Quantitative software QGS&QPS (Cedars-Sinai Medical Centre®) was used for the assessment of EDV, ESV and LVEF in MPI images. Correlation for assessment of EDV, ESV and LVEF between echocardiography versus standard SPECT camera and echocardiography versus cardiac dedicated scanner were measured with Pearson correlation coefficient. Results Comparison between echocardiography versus SPECT showed a strong positive correlation for assessment of ESV (r = 0,95, p Conclusion Preliminary results from this patient study shows, that quantitative assessment from dedicated cardiac scanner with solid state detector underestimate ESV as a result LVEF is overestimated in MPI studies as compared to echocardiography.

Long-term prognosis of unheralded myocardial infarction vs chronic angina; role of sex and coronary atherosclerosis burden

BackgroundAngina pectoris (AP) and unheralded myocardial infarction (MI) are considered random clinical equivalents of ischemic heart disease (IHD). Aim of the study was to evaluate the long-term progression of AP as opposed to unheralded MI as alternative first clinical presentations of IHD and the effect of sex on prognosis.MethodsThe study included 2272 consecutive patients, 1419 MI and 1353 AP, hospitalized from 1995 to 2007 at CNR Clinical Physiology Institute, Pisa, Italy and followed up to December 2013, who fulfilled the following criteria: unheralded MI or AP as first manifestation of IHD; age < = 70 years; known coronary anatomy; at least 10-year follow-up. Fatal and non fatal MI, all-cause, and cardiac deaths were the end-points.ResultsMales were predominant in MI (86%) as compared to AP (77%). Females were predominantly affected by AP (61%, MI 39%), and older than men (61 ± 7 vs 59 ± 8 years, p < 0.001). Coronary stenoses were prevalent in MI. During 115 ± 58 months follow-up, 628 deaths (23%) were observed, including 269 cardiac (43%), and 149 cancer deaths (24%). Long-term prognosis was significantly better in AP than MI group. The lowest prevalence of future MI was recorded in female AP (p < 0.001).ConclusionsMI as first clinical manifestation of IHD implies a more adverse prognosis than AP; future MI is a rare event in AP; sex influences the first presentation of IHD and its course with possible implications for preventive strategy.

Prediction of Physiological Response over Varying Forecast Lengths with a Wearable Health Monitoring Platform.

The goal of this study is to characterize the accuracy of prediction of physiological responses for varying forecast lengths using multi-modal data streams from wearable health monitoring platforms. We specifically focus on predicting breathing rate due to its significance in medical and exercise physiology research. We implement a nonlinear support vector machine regression model for accurate prediction of future values of these physiological signals with forecast windows of up to one minute long. We explore the effects of heart rate and various other sensing modalities in prediction of breathing rate. Results reveal that including other physiological responses and activity information captured by inertial measurements in the regression model improves the breathing rate prediction accuracy. We carried out experiments by collecting and analyzing physiological and activity data outside the lab using a wearable platform composed of various off-the-shelf sensors.

All play and no work: skits and models in teaching skeletal muscle physiology.

All play and no work: skits and models in teaching skeletal muscle physiology.

A large drawing of a nephron for teaching medical students renal physiology, histology, and pharmacology.

The purpose of this study is to see whether a large drawing of a nephron helped medical students in self-directed learning groups learn renal physiology, histology, and pharmacology before discussing clinical cases. The end points were the grades on the renal examination and a student survey. The classes in the fall of 2014 and 2015 used the drawing, but not those of 2012 and 2013. The Charles E. Schmidt College of Medicine at Florida Atlantic University is a newly formed Florida medical school, which enrolled its first class in the fall of 2011. The school relies on self-directed problem-based learning in year 1 and changes over to a case inquiry method in the latter part of year 1 and throughout year 2. At the start of the renal course, each student group received a poster of a nephron with the objective of learning the cell functions of the different nephron parts. During the first year of using the drawing, there was no improvement in grades. After a student suggested adjustment to the drawing, there was a statistically significant difference in the total test score in the second year ( P < 0.001). An unexpected finding was lower grades in all 4 yr in the area of acid-base balance and electrolytes compared with the other four areas tested. In the survey, the students found the drawing useful.

Use of case-based or hands-on laboratory exercises with physiology lectures improves knowledge retention, but veterinary medicine students prefer case-based activities.

Didactic lectures are prevalent in physiology courses within veterinary medicine programs, but more active learning methods have also been utilized. Our goal was to identify the most appropriate learning method to augment the lecture component of our physiology course. We hypothesized that case-based learning would be well received by students and would be more effective at helping them learn physiological concepts compared with more traditional laboratory exercises. In this study, approximately one-half of the laboratory sessions for the two-semester course were dedicated to traditional hands-on laboratory exercises, whereas the remaining one-half of the sessions were dedicated to case-based exercises. The lecture portion of the course was not altered. Student attitudes were evaluated after each session and at the end of each semester via quantitative and qualitative survey questions. Student performance was evaluated using section exams and end-of-semester posttests. The vast majority of survey responses received were positive for both cased-based activities and traditional hands-on laboratories. In addition, participation in both types of active learning activities, but not lecture, was associated with retention of conceptual knowledge based on student performance between the section exams and posttests ( P < 0.002). These results indicate that both case-based learning and laboratory exercises are beneficial learning activities to incorporate into a lecture-based physiology course. However, positive survey responses were significantly greater following case-based activities vs. traditional hands-on laboratories, and only participation in case-based activities resulted in greater student performance on the posttest ( P < 0.04). Therefore, case-based activities may be the preferred supplemental learning activity for veterinary medical physiology.

In Memoriam: Alberto Zanchetti (Parma July 27, 1926 - Milan March 24, 2018).

In Memoriam: Alberto Zanchetti (Parma July 27, 1926 - Milan March 24, 2018).

A Versatile Redox Responsive Nanoferrogels Based Sensor for Metabolics Analytics

Developed is an inexpensive label free redox responsive nanoferrogel molecular receptor integrated in a chemoresisistive sensor for rapid detection of Reactive Oxygen Species (ROS) such as H2O2 and H2O2 deriving metabolites, species are of interest in myriad applications including clinical, environmental, food, and plant physiology. Inexpensively fashioned by contact printing of redox responsive poly(N-isopropylacrylamide hydrogels herewith called ‘nanoferrogel’ on a conductive nanocellulose paper aerogel, the sensor is designed for specimen surface attachment as wearables, non-invasive transdermal sensors, and can be configured as microneedle sensor for in vivo analysis. Operating via ROS oxidation of the nanoferrogel trapped in the conductive aerogel film, the oxidized nanoferrogel volume change results in an overall change in conductivity, linearly proportional to ROS/ROS deriving metabolite concentration. In the presentation, the responsivity of the nanoferrogel to different ROS species such as H2O2, oxylipin, antioxidants will be demonstrated. The nanoferrogel based H2O2 sensor figures of merit, featuring, rapid (≤ 1min) H2O2 response, high selectivity, low limits of detection (≤ 0.01 µM),and broad linear dynamic range of (≤ 0.03 µM to ≥ 1.5M) will be highlighted. The nanoferrogel is perfectly recyclable, by electrochemical regeneration, affording ≥ 15 multiple usable cycles. Also showcased will be the adaptability of nanoferrogel for different sensor design configurations (e.g. micro/nanoelectrode systems), with some preliminary data attesting to the sensors utility for fundamental studies and detection of efflux of endogenous and exogenous H2O2 in single cells and other redox biomolecules, (e.g. glucose, choline). Preliminarily the sensor can be used for detection of bacterial (model used in our study Escherichia coli) autoinducers and metabolites, of importance in bacterial communication-quorum sensing. This would be a useful platform for understanding bacterial biofilm formation. Further, the nanoferrogel sensor fashioned for utility as a wearable device for detection of redox potential and inherent sweat metabolites will be demonstrated.