Citations

Introduction: Cerebral microbleed (CMB) location may predict underlying pathology. Deep CMBs are more associated with hypertensive vascular disease, while lobar CMBs are more associated with cerebral amyloid angiopathy (CAA). The objective of this study was to determine the neuroimaging pathology associated with CMBs. Methods: We analyzed 1,831 nondemented ARIC participants (mean age=76.3 ±5.3 years, 40% male, 27% black) with 3T MRI scans at the fifth exam (2011-13). We fit multinomial logistic regression models to assess the effect of brain volumes (AD signature region atrophy, total gray matter, frontal, and log 2 -transformed white matter hyperintensities (WMH) volume), infarct frequencies (lacunar, non-lacunar, and total), and APOE (number of ε4 alleles) on CMB location (no, any deep, or lobar only CMBs). Models were weighted for the sample selection scheme and adjusted for age, male, education, hypertension, ever smoking status, diabetes, race-site membership, and estimated intracranial volume (brain volume models only). Results: The frequency of CMBs was 24.1%. A larger WMH volume, greater total infarct frequency, and smaller total grey volume increased the relative risks (RR) of both deep and lobar CMBs compared to no CMBs; increasing the WMH volume also increased the RR of deep to lobar CMBs. Additional lacunar infarcts increased the RR of deep compared to no CMBs, whereas AD signature region atrophy and APOE ε4 homozygosity increased the RR of lobar CMBs. Conclusion: CMBs are a common vascular pathology in the elderly. Deep CMB presence is associated with MRI features of hypertensive small vessel disease, while lobar CMB presence is associated with MRI features of CAA and Alzheimer’s disease.

Objective The objective of this study was to introduce musculoskeletal physical examination skills in the gross anatomy course as a teaching tool and to evaluate medical students’ perceptions of this experience. Methods A list of 27 clinical examinations of the upper and lower limbs was generated from published core recommendations for undergraduate medical education. During gross anatomy laboratory sessions, teaching assistants (third year medical students) presented one or two of the clinical skills related to that day’s dissection to groups of 3–4 students at a time. The anatomic relationships tested by the clinical examinations were highlighted. One question on the laboratory examination at the end of the unit was an Objective Structured Clinical Examination (OSCE) station where students were given a clinical scenario and asked to demonstrate a physical examination that they would use in evaluating the patient. Following the upper and lower limb units, the students were given a Likert‐scale survey to evaluate their perceptions of the experience. Results Survey responses indicated that most students felt the physical examination demonstrations improved their understanding of the clinical significance of the related anatomy, increased their interest in and motivation to learn the material, and made the laboratory experience more enjoyable. Conclusions Introducing musculoskeletal physical examination skills in the gross anatomy course can be an effective way to emphasize the clinical significance of the anatomy, thereby enhancing students’ motivation to learn the material.

Acute exercise appears to have positive influence on arterial function during the recovery period, yet the effect of obesity is poorly understood in recovery. We examined the effects of an acute bout of exercise on arterial function in obese versus healthy weight individuals. Young (23 yr), lean (n=38, BMI=22.3 kg/m 2 ) and obese (n=20, BMI=34.0 kg/m 2 ) individuals had arterial measurements obtained at rest, and 15 and 30 min following a maximal bout of aerobic exercise. Arterial tonometry and ultrasound were used to obtain central BP, arterial compliance and stiffness (beta stiffness, elastic modulus (Ep), and central pulse wave velocity (PWV)). Despite similar central mean BP, the obese group had higher cPWV following exercise. Beta stiffness and Ep responded similarly to exercise between groups. Arterial compliance was higher in obese but the response in recovery was similar between groups. Lean Obese Pre 15‐min post 30‐min post Pre 15‐min post 30‐min post Mean aortic BP 82 83 82 87 86 87 Central PWV 5.67 5.46 5.35 5.84 6.11 6.16 Beta Stiffness 5.89 6.34 5.78 4.88 6.04 5.31 Elastic Modulus 69 75 67 67 78 66 In this young cohort, obesity was associated with increased central arterial stiffness, independent of BP, but higher arterial compliance. This suggests that measures of arterial stiffness provide differential information potentially associated with where in the arterial tree measures were made.

Acute systemic induced inflammation negatively affects arterial function in young healthy adults. An acute bout of aerobic exercise reduces arterial stiffness and improves endothelial function. Therefore, we evaluated endothelial function and wave reflection in older adults in response to acute systemic inflammation and the effect of moderate intensity endurance exercise immediately prior to induced inflammation. 59 healthy volunteers (range 55 – 75 years) were randomly allocated to an exercise or control group. Arterial function and inflammatory markers were measured at baseline, 24 h and 48 h after influenza vaccine and sham injections. CRP increased approximately 1.5 times, 24 and 48 h after vaccination while IL‐6 increased 24 hours after vaccination compared to the sham injection. Unexpectedly, arterial function was unaltered (Table). Inflammation and endothelial function were dissociated following vaccine‐induced acute systemic inflammation in older adults. Acute exercise prior to vaccination had no effect of inflammation or vascular function. Support: AHA #10PRE3500083 (SMR).

Introduction Heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS), measures of autonomic nervous system function, are associated with cardiovascular (CV) outcome. African Americans (AA) have an increased prevalence of CV disorders in comparison to Caucasians (C). Purpose To determine race specific responses in BPV, BRS and HRV before and after maximal exercise. Methods 37 AA and 37 C (24 years) underwent maximal exercise on a cycle ergometer. BPV, BRS and HRV measurements were assessed using finger plethysmography before and after exercise. Data were log transformed and pre‐and post‐max test values were compared by race. Results Acute exercise significantly decreased BRS, LF‐HRV and HF‐HRV and significantly increased LF/HF‐HRV in both AA and C. With exercise, C significantly decreased measures of BRS and HRV more compared to AA; BRS‐SAPRRI transfer mean (C: 2.65±.54 to 1.09±.81 versus AA: 2.70±.40 to 1.70±.92), BRS‐down down (C: 3.21±.55 to 1.74±.49 versus AA: 3.28±1.0 to 2.2±.71), HRV‐LF (C: 6.39±.86 to 3.68±1.42 versus AA: 6.37±1.24 to 5.18±2.14) and HRV‐HF (C: 7.38±1.23 to 3.53±1.73 versus AA: 7.51±1.09 to 5.38±2.16). Conclusion C exhibited increased vagal withdrawal and greater reductions in BRS compared to AA in response to acute exercise. The impact of these racial differences in autonomic control on CV risk needs further investigation.

Background There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. Methods We conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement. Results Sixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified. Conclusions Harmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.

Abstract Immunoassays designed to detect SARS-CoV-2 protein antigens are now commercially available. The most widely used tests are rapid lateral flow assays that generate results in ~15 minutes for diagnosis at the point-of-care. Higher throughput, laboratory-based SARS-CoV-2 antigen (Ag) assays have also been developed. The overall accuracy of SARS-CoV-2 Ag tests, however, is not well defined. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the literature and develop best-practice guidance related to SARS-CoV-2 Ag testing. This guideline is the third in a series of rapid, frequently updated COVID-19 diagnostic guidelines developed by IDSA. IDSA’s goal was to develop evidence-based recommendations or suggestions that assist clinicians, clinical laboratories, patients, public health authorities, administrators, and policymakers in decisions related to the optimal use of SARS-CoV-2 Ag tests in both medical and nonmedical settings. A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review identified and prioritized clinical questions related to the use of SARS-CoV-2 Ag tests. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 5 diagnostic recommendations. These recommendations address Ag testing in symptomatic and asymptomatic individuals as well as assess single versus repeat testing strategies. Data on the clinical performance of US Food and Drug Administration SARS-CoV-2 Ag tests with Emergency Use Authorization are mostly limited to single, one-time testing versus standard nucleic acid amplification testing (NAAT) as the reference standard. Rapid Ag tests have high specificity and low to modest sensitivity compared with reference NAAT methods. Antigen test sensitivity is heavily dependent on viral load, with differences observed between symptomatic compared with asymptomatic individuals and the time of testing post-onset of symptoms. Based on these observations, rapid reverse transcriptase–polymerase chain reaction (RT-PCR) or laboratory-based NAAT remain the diagnostic methods of choice for diagnosing SARS-CoV-2 infection. However, when molecular testing is not readily available or is logistically infeasible, Ag testing can help identify some individuals with SARS-CoV-2 infection. The overall quality of available evidence supporting use of Ag testing was graded as very low to moderate.