Potential Discharge Research Articles

The General Anesthetic Isoflurane Bilaterally Modulates Neuronal Excitability

SummaryVolatile anesthetics induce hyperactivity during induction while producing anesthesia at higher concentrations. They also bidirectionally modulate many neuronal functions. However, the neuronal mechanism is unclear. The effects of isoflurane on sodium channel currents were analyzed in acute mouse brain slices, including sodium leak (NALCN) currents and voltage-gated sodium channels (Nav) currents. Isoflurane at sub-anesthetic concentrations increased the spontaneous firing rate of CA3 pyramidal neurons, whereas anesthetic concentrations of isoflurane decreased the firing rate. Isoflurane at sub-anesthetic concentrations enhanced NALCN conductance but minimally inhibited Nav currents. Isoflurane at anesthetic concentrations depressed Nav currents and action potential amplitudes. Isoflurane at sub-anesthetic concentrations depolarized resting membrane potential (RMP) of neurons, whereas hyperpolarized the RMP at anesthetic concentrations. Isoflurane at low concentrations induced hyperactivity in vivo, which was diminished in NALCN knockdown mice. In conclusion, enhancement of NALCN by isoflurane contributes to its bidirectional modulation of neuronal excitability and the hyperactivity during induction.

Sex Differences in the Sympathetic Neural Recruitment and Hemodynamic Response to Head-Up Tilt in Older Hypertensives.

This study tested the hypothesis that older hypertensive women display augmented pressor responses and aberrant sympathetic neural discharge patterning in response to orthostatic stress versus older hypertensive men. We evaluated, in older hypertensive and normotensive men and women (n=12 each group), blood pressure, heart rate, cardiac index (acetylene rebreathing), total peripheral resistance, and muscle sympathetic nerve activity (microneurography) at baseline (supine; 3 minutes) and during graded head-up tilt (30° for 5 minutes and 60° for 20 minutes). Sympathetic action potential discharge patterns were studied using wavelet-based methodology. In the upright posture, systolic and diastolic blood pressure responses were greater in hypertensive women versus hypertensive men and normotensive women (P<0.05). No differences existed in the heart rate, stroke index, or cardiac index response between groups; however, the total peripheral resistance response throughout graded head-up tilt was markedly greater in hypertensive women (P<0.01). Yet, the increase in integrated muscle sympathetic nerve activity burst frequency and burst incidence were similar between hypertensive women and men in the supine and upright postures. However, the increase in the mean action potential content per integrated burst and recruitment of previously dormant, larger-sized action potentials during 60° head-up tilt was greater in hypertensive women versus hypertensive men and normotensive women (P<0.001). Therefore, total sympathetic action potential firing frequency was markedly greater in hypertensive women throughout 60° head-up tilt (P<0.001). In conclusion, older hypertensive women displayed exaggerated pressor and peripheral vasoconstrictor responses to orthostasis versus hypertensive men, under conditions of augmented and aberrant sympathetic neural recruitment, rather than increased burst frequency, in the upright posture.

NiCl2 Cathode with the High Load Capacity for High Specific Power Thermal Battery

The advanced thermal batteries with CoS2 cathode are applied to provide high energy, delivering lower specific power, because it is not suitable for high current discharge. NiCl2, possessing a high potential and large current discharge capacity, is considered as one of the cathode candidates for high power thermal battery. LiB/NiCl2 couple outputs effectively specific power of ∼17.3kWkg−1 in this work at 500°C and 0.5Acm−2 (8Ag−1). However, NiCl2 has highly dissolution in LiF-LiCl-LiBr electrolyte (widely used in thermal batteries), resulting in the capacity loss and severe safety problem. Here, cross-sections between NiCl2 cathode and LiF-LiCl-LiBr electrolyte have been characterised by SEM after discharge at 500°C, and 0.5Acm−2-discharged interface exhibits blurrier boundary than that of 0.2Acm−2-discharged.

ANALISIS KETAHANAN AIR DI KOTA TERNATE PROVINSI MALUKU UTARA

The biggest problem in Ternate City is availability of water and potential for natural disasters, because it’s in the fire ring and climate in there is influenced by the tropical and seasonal climate. The purpose of this study is determine the water resistance in Ternate City for 20 th years until 2039. Water requirements are calculated by exponential method projections, the data based on population, industry, livestock and the area of agricultural land. Water availability debit data is based on water resources infrastructure data that has been available in there. Based on the results of the analysis, known that the total requirement of Ternate City in 2039 is 1.427 m 3 / sec, total potential of mainstay discharge in 2039 is 43.139 m 3 /sec and total potention of dependable flow is 3 0.700 m /sec, so it can be concluded that the water demand in there is still not fulfilled to its full potential but has a great potential for reliable debits. So that, infrastructure development planning is needed in the form of as many as 98 pieces of reservoirs with a total reservoir of 5.67 million m 3 /sec spread across the largest watershed locations in several areas in Ternate City

Optimized photo-stimulation of halorhodopsin for long-term neuronal inhibition

BackgroundOptogenetic silencing techniques have expanded the causal understanding of the functions of diverse neuronal cell types in both the healthy and diseased brain. A widely used inhibitory optogenetic actuator is eNpHR3.0, an improved version of the light-driven chloride pump halorhodopsin derived from Natronomonas pharaonis. A major drawback of eNpHR3.0 is related to its pronounced inactivation on a time-scale of seconds, which renders it unsuited for applications that require long-lasting silencing.ResultsUsing transgenic mice and Xenopus laevis oocytes expressing an eNpHR3.0-EYFP fusion protein, we here report optimized photo-stimulation techniques that profoundly increase the stability of eNpHR3.0-mediated currents during long-term photo-stimulation. We demonstrate that optimized photo-stimulation enables prolonged hyperpolarization and suppression of action potential discharge on a time-scale of minutes.ConclusionsCollectively, our findings extend the utility of eNpHR3.0 to the long-lasting inhibition of excitable cells, thus facilitating the optogenetic dissection of neural circuits.

Non-synaptic Plasticity in Leech Touch Cells.

The role of Na+/K+-pumps in activity-dependent synaptic plasticity has been described in both vertebrates and invertebrates. Here, we provide evidence that the Na+/K+-pump is also involved in activity-dependent non-synaptic cellular plasticity in leech sensory neurons. We show that the resting membrane potential (RMP) of T cells hyperpolarizes in response to repeated somatic current injection, while at the same time their spike count (SC) and the input resistance (IR) increase. Our Hodgkin–Huxley-type neuron model, adjusted to physiological T cell properties, suggests that repetitive action potential discharges lead to increased Na+/K+-pump activity, which then hyperpolarizes the RMP. In consequence, a slow, non-inactivating current decreases, which is presumably mediated by voltage-dependent, low-threshold potassium channels. Closing of these putative M-type channels due to hyperpolarization of the resting potential increases the IR of the cell, leading to a larger number of spikes. By this mechanism, the response behavior switches from rapidly to slowly adapting spiking. These changes in spiking behavior also effect other T cells on the same side of the ganglion, which are connected via a combination of electrical and chemical synapses. An increased SC in the presynaptic T cell results in larger postsynaptic responses (PRs) in the other T cells. However, when the number of elicited presynaptic spikes is kept constant, the PR does not change. These results suggest that T cells change their responses in an activity-dependent manner through non-synaptic rather than synaptic plasticity. These changes might act as a gain-control mechanism. Depending on the previous activity, this gain could scale the relative impacts of synaptic inputs from other mechanoreceptors, versus the spike responses to tactile skin stimulation. This multi-tasking ability, and its flexible adaptation to previous activity, might make the T cell a key player in a preparatory network, enabling the leech to perform fast behavioral reactions to skin stimulation.

Propofol decreases spike firing frequency with an increase in spike synchronization in the cerebral cortex

Little is known about how propofol modulates the spike firing correlation between excitatory and inhibitory cortical neurons in vivo. We performed extracellular unit recordings from rat insular cortical neurons, and classified neurons with high spontaneous firing frequency, bursting, and short spike width as high frequency with bursting neurons (HFB; pseudo fast-spiking GABAergic neurons) and other neurons with low spontaneous firing frequency and no bursting were classified as non-HFB. Intravenous administration of propofol (12 mg/kg) from the caudal vein reduced the firing frequency of HFB, whereas propofol initially increased (within 30 s) and then decreased the firing frequency of non-HFB. Both HFB and non-HFB spontaneous action potential discharge was depressed by propofol with a greater depression seen for HFB. Cross-correlograms and auto-correlograms demonstrated propofol-induced increases in the ratio of the peak, which were mostly observed around 0–10 ms divided to baseline amplitude. The analysis of interspike intervals showed a decrease in spike firing at 20–100 Hz and a relative increase at 8–15 Hz. These results suggest that propofol induces a larger suppression of firing frequency in HFB and an enhancement of synchronized neural activities in the α frequency band in the cerebral cortex (192 words).

A comparative study on the impact of Gd2O3 burnable neutron absorber in UO2 and (U, Th)O2 fuels

The performance of gadolinium burnable absorber (GdBA) for reactivity control in UO2 and (U, Th)O2 fuels and its impact on spent fuel characteristics was performed. Five fuel assemblies: one without GdBA fuel rod and four each containing 16, 24, 34 and 44 GdBA fuel rods in both fuels were investigated. Reactivity swing in all the FAs with GdBA rods in UO2 fuel was higher than their counterparts with similar GdBA fuel rods in (U, Th)O2 fuel. The excess reactivity in all FAs with (U, Th)O2 fuel was higher than UO2 fuel. At the end of single discharge burn-up (~ 49.64 GWd/tHM), the excess reactivity of (U, Th)O2 fuel remained positive (16,000 pcm) while UO2 fuel shows a negative value (−6,000 pcm), which suggest a longer discharge burn-up in (U, Th)O2 fuel. The concentration of plutonium isotopes and minor actinides were significantly higher in UO2 fuel than in (U, Th)O2 fuel except for 236Np. However, the concentration of non-actinides (gadolinium and iodine isotopes) except for 135Xe were respectively smaller in (U, Th)O2 fuel than in UO2 fuel but may be two times higher in (U, Th)O2 fuel due to its potential longer discharge burn-up.

Role of TRP channels in Gq-coupled protease-activated receptor 1-mediated activation of mouse nodose pulmonary C-fibers.

We evaluated the mechanisms underlying protease-activated receptor 1 (PAR1)-mediated activation of nodose C-fibers in mouse lungs. The PAR1-induced action potential discharge at the terminals was strongly inhibited in phospholipase C-β3 (PLCβ3)-deficient animals. At the level of the cell soma, PAR1 activation led to an increase in cytosolic calcium that was largely inhibited by transient receptor potential (TRP) A1 antagonism. Patch-clamp recordings, however, revealed that neither TRPA1 nor TRPV1 or any other ruthenium red-sensitive ion channels are required for the PAR1-mediated inward current or membrane depolarization in isolated nodose neurons. Consistent with these findings, PAR1-mediated action potential discharge in mouse lung nodose C-fiber terminals was unaltered in Trpa1/Trpv1 double-knockout animals and Trpc3/Trpc6 double-knockout animals. The activation of the C-fibers was also not inhibited by ruthenium red at concentrations that blocked TRPV1- and TRPA1-dependent responses. The biophysical data show that PAR1/Gq-mediated activation of nodose C-fibers may involve multiple ion channels downstream from PLCβ3 activation. TRPA1 is an ion channel that participates in PAR1/Gq-mediated elevation in intracellular calcium. There is little evidence, however, that TRPA1, TRPV1, TRPC3, TRPC6, or other ruthenium red-sensitive TRP channels are required for PAR1/Gq-PLCβ3-mediated membrane depolarization and action potential discharge in bronchopulmonary nodose C-fibers in the mouse.

2059. Antimicrobial Stewardship of Community Parenteral Antimicrobial Therapy: A Health System Approach

BackgroundCommunity parenteral antimicrobial therapy (CoPAT) allows patients to receive intravenous (IV) antimicrobials outside the hospital; however, inappropriate use occurs and can lead to adverse outcomes. In addition, these patients are at high risk of readmission. Our objective was to assess the quality of CoPAT in a large healthcare system in order to guide implementation of an intervention requiring mandatory review by antimicrobial stewardship.MethodsWe identified patients with orders for IV antimicrobials at discharge between January 1 and December 10, 2018. Patients were excluded if transferred to an acute care facility, left against medical advice, or died. 250 patients were selected using a random number generator and reviewed consecutively until 100 confirmed CoPAT encounters were identified. Each encounter was evaluated for evidence of ID consultation, opportunities for stewardship interventions in seven categories (See Table 1), and adverse events such as emergency room (ER) visits and readmissions.ResultsThe query identified 4,642 potential CoPAT discharges from 22 hospitals (see Table 2). 117 encounters were reviewed to reach 100 true CoPAT discharges (85% query accuracy). Of these, 55 (55%) received a formal ID consult, 6 (6%) had an ID pharmacist or ID physician curbside, and 5 (5%) had an ID clinic follow-up appointment scheduled without formal ID consult. Opportunity for stewardship intervention was found in 50 (50%) patients (see Table 1). There were 31 (31%) patients who were seen in the ER (n = 21) and/or re-admitted (n = 19) to the hospital during or shortly after completion of CoPAT, of which 25 (81%) were potentially related to CoPAT, including abnormal laboratory findings, PICC-line complications, and signs or symptoms of infection.ConclusionCoPAT patients are complex with high healthcare utilization. Mandatory ID review of patients receiving CoPAT has the potential to impact 2,000 lives annually in a large health system. Disclosures All authors: No reported disclosures.

Water balance for irrigation area

Water balance for the irrigation area will be achieved if every time for irrigation water needs is never greater than the availability of water and in certain same conditions. Salamdarma irrigation area is located on the border area of the Indramayu and Subang regions, West Java Province which is managed by PT Jasa Tirta II Patrol Section. The purpose of this research is to control the water balance of Salamdarma irrigation area. The analysis by taking into account the needs and availability of water for irrigation. The method used is water balance from rainfall data using hydrology analysis with R80 % for potential discharge and cropping pattern analysis for water requirement. The results of the analysis show that the amount of average water requirement is 30 m3/s and the average potential discharge is 64 m3/s. This means that the needs and availability of water in Salamdarma irrigation area are still balanced.

Circuit-Specific Early Impairment of Proprioceptive Sensory Neurons in the SOD1G93A Mouse Model for ALS.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease in which motor neurons degenerate, resulting in muscle atrophy, paralysis, and fatality. Studies using mouse models of ALS indicate a protracted period of disease development with progressive motor neuron pathology, evident as early as embryonic and postnatal stages. Key missing information includes concomitant alterations in the sensorimotor circuit essential for normal development and function of the neuromuscular system. Leveraging unique brainstem circuitry, we show in vitro evidence for reflex circuit-specific postnatal abnormalities in the jaw proprioceptive sensory neurons in the well-studied SOD1G93A mouse. These include impaired and arrhythmic action potential burst discharge associated with a deficit in Nav1.6 Na+ channels. However, the mechanoreceptive and nociceptive trigeminal ganglion neurons and the visual sensory retinal ganglion neurons were resistant to excitability changes in age-matched SOD1G93A mice. Computational modeling of the observed disruption in sensory patterns predicted asynchronous self-sustained motor neuron discharge suggestive of imminent reflexive defects, such as muscle fasciculations in ALS. These results demonstrate a novel reflex circuit-specific proprioceptive sensory abnormality in ALS.SIGNIFICANCE STATEMENT Neurodegenerative diseases have prolonged periods of disease development and progression. Identifying early markers of vulnerability can therefore help devise better diagnostic and treatment strategies. In this study, we examined postnatal abnormalities in the electrical excitability of muscle spindle afferent proprioceptive neurons in the well-studied SOD1G93A mouse model for neurodegenerative motor neuron disease, amyotrophic lateral sclerosis. Our findings suggest that these proprioceptive sensory neurons are exclusively afflicted early in the disease process relative to sensory neurons of other modalities. Moreover, they presented Nav1.6 Na+ channel deficiency, which contributed to arrhythmic burst discharge. Such sensory arrhythmia could initiate reflexive defects, such as muscle fasciculations in amyotrophic lateral sclerosis, as suggested by our computational model.

The PVN enhances cardiorespiratory responses to acute hypoxia via input to the nTS.

Chemoreflex neurocircuitry includes the paraventricular nucleus (PVN), but the role of PVN efferent projections to specific cardiorespiratory nuclei is unclear. We hypothesized that the PVN contributes to cardiorespiratory responses to hypoxia via projections to the nucleus tractus solitarii (nTS). Rats received bilateral PVN microinjections of adeno-associated virus expressing inhibitory designer receptor exclusively activated by designer drug (GiDREADD) or green fluorescent protein (GFP) control. Efficacy of GiDREADD inhibition by the designer receptor exclusively activated by designer drug (DREADD) agonist Compound 21 (C21) was verified in PVN slices; C21 reduced evoked action potential discharge by reducing excitability to injected current in GiDREADD-expressing PVN neurons. We evaluated hypoxic ventilatory responses (plethysmography) and PVN and nTS neuronal activation (cFos immunoreactivity) to 2 h hypoxia (10% O2) in conscious GFP and GiDREADD rats after intraperitoneal C21 injection. Generalized PVN inhibition via systemic C21 blunted hypoxic ventilatory responses and reduced PVN and also nTS neuronal activation during hypoxia. To determine if the PVN-nTS pathway contributes to these effects, we evaluated cardiorespiratory responses to hypoxia during selective PVN terminal inhibition in the nTS. Anesthetized GFP and GiDREADD rats exposed to brief hypoxia (10% O2, 45 s) exhibited depressor and tachycardic responses and increased sympathetic and phrenic nerve activity. C21 was then microinjected into the nTS, followed after 60 min by another hypoxic episode. In GiDREADD but not GFP rats, PVN terminal inhibition by nTS C21 strongly attenuated the phrenic amplitude response to hypoxia. Interestingly, C21 augmented tachycardic and sympathetic responses without altering the coupling of splanchnic sympathetic nerve activity to phrenic nerve activity during hypoxia. Data demonstrate that the PVN, including projections to the nTS, is critical in shaping sympathetic and respiratory responses to hypoxia.

Biocompatibility and surface properties of hydrogenated amorphous silicon-germanium thin films prepared by LF-PECVD

We studied the surface morphology and biocompatibility of hydrogenated amorphous silicon-germanium (a-Si1-xGex:H) thin films prepared by Low Frequency Plasma Enhanced Chemical Vapor Deposition (LF-PECVD). These films were deposited on a Corning 2947 glass substrate having a thickness of 3 μm, the electrical performance showed a decreased electrical resistance for low regime voltage. The root mean square (RMS) surface roughness of the films was measured by atomic force microscopy (AFM) in a non-contact mode. A biocompatibility tests was carried out using primary cultures of dorsal root ganglion (DRG) of Wistar rats. The DRG neurons were incubated for 18 hours on a-Si1-xGex:H thin films, and subsequent electrophysiological recording was performed. These neurons displayed typical ionic currents, including a fast-inward current at the beginning of voltage clamp pulse (Na+ current) and ensuing outward currents (K+ current). In current clamp experiments, depolarizing current pulse injection caused typical action potential discharge of the neurons. These results confirmed the feasibility of using a-Si1-xGex:H thin films as a biocompatible material.

Protocols for early discharging of premature infants: an empirical assessment on safety and savings.

Background Preterm newborns may be discharged when clinical conditions are stable. Several criteria for early discharge have been proposed in the literature. This study carried out the first quantitative comparison of their impact in terms of hospitalization savings, safety and costs. Methods This study was based on the clinical histories of 213 premature infants born in the Neonatal Intensive Care Unit of Padova University Hospital between 2013 and 2014. Seventeen early discharge criteria were drawn from the literature and retrospectively applied to these data, and computation of hospitalization savings, safety and costs implied by each criterion was carried out. Results Among the criteria considered, average gains ranged from 1.1 to 10.3 hospital days and between 0.3 and 1.1 fewer infections per discharged infant. Criteria that led to saving more hospital days had higher cost-effectiveness in terms of crisis and infection, and they spared infants from more infections. However, episodes of apnea and bradycardia were detected after the potential early discharge date for all criteria, with a mean number of episodes numbering between 0.3 and 1.4. Conclusion The results highlight a clear trade-off between days saved and health risks for infants, with potential consequences for health care costs.

Asynchronous action potential discharge in human muscle sympathetic nerve activity

What strategies are employed by the sympathetic system to communicate with the circulation? Muscle sympathetic nerve activity (MSNA) occurs in bursts of synchronous action potential (AP) discharge, yet whether between-burst asynchronous AP firing exists remains unknown. Using multiunit microneurography and a continuous wavelet transform to isolate APs, we studied AP synchronicity within human MSNA. Asynchronous APs were defined as those which occurred between bursts. Experiment 1 quantified AP synchronicity in eight individuals at baseline (BSL), -10 mmHg lower body negative pressure (LBNP), -40 mmHg LBNP, and end-expiratory apnea (APN). At BSL, 33 ± 12% of total AP activity was asynchronous. Asynchronous discharge was unchanged from BSL (67 ± 37 AP/min) to -10 mmHg LBNP (69 ± 33 AP/min), -40 mmHg LBNP (83 ± 68 AP/min), or APN (62 ± 39 AP/min). Across all conditions, asynchronous AP probability and frequency decreased with increasing AP size. Experiment 2 examined the impact of the ganglia on AP synchronicity by using nicotinic blockade (trimethaphan). The largest asynchronous APs were derecruited from BSL (11 ± 4 asynchronous AP clusters) to the last minute of the trimethaphan infusion with visible bursts (7 ± 2 asynchronous AP clusters). However, the 6 ± 2 smallest asynchronous AP clusters could not be blocked by trimethaphan and persisted to fire 100 ± 0% asynchronously without forming bursts. Nonnicotinic ganglionic mechanisms affect some, but not all, asynchronous activity. The fundamental behavior of human MSNA contains between-burst asynchronous AP discharge, which accounts for a considerable amount of BSL activity.NEW & NOTEWORTHY Historically, sympathetic nerve activity destined for the blood vessels supplying skeletal muscle (MSNA) has been characterized by spontaneous bursts formed by synchronous action potential (AP) discharge. However, this study found a considerable amount (~30% during baseline) of sympathetic AP discharge to fire asynchronously between bursts of human MSNA. Trimethaphan infusion revealed that nonnicotinic ganglionic mechanisms contribute to some, but not all, asynchronous discharge. Asynchronous sympathetic AP discharge represents a fundamental behavior of MSNA.

Safe Transportation in-Spica Following Surgical Treatment of Infantile DDH: Solutions and Threats.

Government regulations mandate appropriate vehicular restraints for children under 4 years of age. Patients treated for infantile developmental dysplasia of the hip (DDH) with spica casts often require special accommodations. Previous work suggests that car seat loaner programs may help achieve these goals while avoiding the need for costly ambulance transportation. The purpose of this study was to evaluate our center's experience with postdischarge transportation in a large population of DDH infants and identify future threats to our program. We performed a retrospective review of patients 4 years or younger of age who underwent closed or open reduction for DDH at our center between 2011 and 2018. Only the initial surgery of staged procedures was included. Patient demographic factors were recorded, as were procedure type, final restraint used for postdischarge transportation, and any potential discharge delays secondary to transportation issues. Costs were compared amongst transportation options. Our cohort consisted of 130 patients (mean age, 1.4±0.9 y; 98 females) treated for DDH. In total 41 children (31.5%) underwent closed reduction procedures, whereas 89 patients (68.5%) underwent open reductions. After reduction, 62 (47.7%) received 2-legged spica casts and 68 (52.3%) received 1.5-legged casts. The most common restraint was a hospital-loaned Hippo car seat (73, 55.8%) followed by family-owned car seats (27, 20.8%). Eight patients (6.2%) experienced delays in discharge while waiting for adequate restraints, 6 patients (4.6%) were transported by ambulance, and 4 patients (3.1%) left against medical advice with inadequate restraints. Following surgical treatment of DDH, over 50% of patients with a spica cast were discharged using our center's car seat loaner program. However, availability and cost can present barriers for patients, with 4.6% of patients still being transported home by ambulance and 3.1% with inadequate restraints against medical advice. Costs of car seats are significant both for patients' families intending to purchase them, as well as for hospitals maintaining loaner programs and replacing used/lost seats. Moving forward, the recent cessation of production of the most common "spica car seat" threatens the longevity of existing loaner programs and calls renewed attention to the issue of safe transportation in-spica from providers and car-seat manufacturers alike. Level III.

Safety and Feasibility of a Rapid Outpatient Management Strategy for Transient Ischemic Attack and Minor Stroke: The Rapid Access Vascular Evaluation–Neurology (RAVEN) Approach

Although most transient ischemic attack and minor stroke patients in US emergency departments (EDs) are admitted, experience in other countries suggests that timely outpatient evaluation of transient ischemic attack and minor stroke can be safe. We assess the feasibility and safety of a rapid outpatient stroke clinic for transient ischemic attack and minor stroke: Rapid Access Vascular Evaluation-Neurology (RAVEN). Transient ischemic attack and minor stroke patients presenting to the ED with a National Institutes of Health Stroke Scale score of 5 or less and nondisabling deficit were assessed for potential discharge to RAVEN with a protocol incorporating social and medical criteria. Outpatient evaluation by a vascular neurologist, including vessel imaging, was performed within 24 hours at the RAVEN clinic. Participants were evaluated for compliance with clinic attendance and 90-day recurrent transient ischemic attack and minor stroke and hospitalization rates. Between December 2016 and June 2018, 162 transient ischemic attack and minor stroke patients were discharged to RAVEN. One hundred fifty-four patients (95.1%) appeared as scheduled and 101 (66%) had a final diagnosis of transient ischemic attack and minor stroke. Two patients (1.3%) required hospitalization (one for worsening symptoms and another for intracranial arterial stenosis caused by zoster) at RAVEN evaluation. Among the 101 patients with confirmed transient ischemic attack and minor stroke, 18 (19.1%) had returned to an ED or been admitted at 90 days. Five were noted to have had recurrent neurologic symptoms diagnosed as transient ischemic attack (4.9%), whereas one had a recurrent stroke (0.9%). No individuals with transient ischemic attack and minor stroke died, and none received thrombolytics or thrombectomy, during the interval period. These 90-day outcomes were similar to historical published data on transient ischemic attack and minor stroke. Rapid outpatient management appears a feasible and safe strategy for transient ischemic attack and minor stroke patients evaluated in the ED, with recurrent stroke and transient ischemic attack rates comparable to historical published data.

Mapping spatial patterns of groundwater discharge in a deep lake using high-resolution temperature sensors

ABSTRACTIdentifying groundwater discharge zones to lakes is important because the groundwater system can contribute a significant flux of water and solutes and potentially influence lake chemistry and ecology. We present a new instrument, Temperature Mapper (TM), to map groundwater discharge zones in lakes via temperature anomalies along the lake bottom, tested in Lake Constance at 2 former sand and gravel extraction sites. TM is essentially a 4 m wide sled with an array of 19 high-resolution sensors attached to an aluminum lattice towed along the lake bed behind a boat. It is able to map spatial temperature patterns representing groundwater discharge zones at a resolution of 20 cm laterally and 2.5 m in path direction. We conducted 2 field campaigns in February 2016 and February 2017, during which TM identified several temperature anomalies interpreted as groundwater discharging zones. Radon-222 was also analyzed at selected locations as an independent indicator of groundwater discharge. Overall, when comparing the different methods and different years, we observed similar spatial patterns of preferential groundwater discharge. TM offers a useful qualitative tool to identify and map potential groundwater discharge zones in lakes or coastal areas that can then be further studied by more quantitative, small-scale methods such as chemical tracers or seepage meters.

MrgprX1 Mediates Neuronal Excitability and Itch Through Tetrodotoxin-Resistant Sodium Channels.

In this study, we sought to elucidate the molecular mechanism underlying human Mas-related G protein-coupled receptor X1 (MrgprX1) mediated itch sensation. We found that activation of MrgprX1 by BAM8-22 triggered robust action potential discharges in dorsal root ganglion (DRG) neurons. This neuronal excitability is not mediated by Transient receptor potential (TRP) cation channels, M-type potassium channels, or chloride channels. Instead, activation of MrgprX1 lowers the activation threshold of TTX-resistant sodium channels and induces inward sodium currents. These MrgprX1-elicited action potential discharges can be blocked by Pertussis toxin (PTX) and a Gβγ inhibitor - Gallein. Behavioral results showed that Nav1.9 knockout but not Trpa1 knockout significantly reduced BAM8-22 evoked scratching behavior. Collectively, these data suggest that activation of MrgprX1 triggers itch sensation by increasing the activity of TTX-resistant voltage-gated sodium channels.