Spontaneous interneuron activity plays a critical role in developing neuronal networks. Discharges conducted antidromically along the dorsal root (DR) precede those from the ventral root’s (VR) motoneurons. This work studied whether spinal interneurons project axons into the neonate’s dorsal roots. Experiments were carried out in postnatal Swiss-Webster mice. We utilized a staining technique and found that interneurons in the spinal cord’s dorsal horn send axons through the dorsal roots. In vitro electrophysiological recordings showed antidromic action potentials (dorsal root reflex; DRR) produced by depolarizing the primary afferent terminals. These reflexes appeared by stimulating the adjacent dorsal roots. We found that bicuculline reduced the DRR evoked by L5 dorsal root stimulation when recording from the L4 dorsal root. Simultaneously, the monosynaptic reflex (MR) in the L5 ventral root was not affected; nevertheless, a long-lasting after-discharge appeared. The addition of 2-amino-5 phosphonovaleric acid (AP5), an NMDA receptor antagonist, abolished the MR without changing the after-discharge. The absence of DRR and MR facilitated single action potentials in the dorsal and ventral roots that persisted even in low Ca2+ concentrations. The results suggest that firing interneurons could send their axons through the dorsal roots. These interneurons could activate motoneurons producing individual spikes recorded in the ventral roots. Identifying these interneurons and the persistence of their neuronal connectivity in adulthood remains to be established.

OBJECTIVES: The objective of this case report is to introduce the development process, structure, characteristics, and effectiveness of the web database (DB) system developed for the hypertension management program in the primary health care setting in the low-income urban areas of Peru. METHODS: A Korean research team cooperated with a Peruvian IT startup company to develop a web DB system to improve the data management of the hypertension management program. The entire web application infrastructure was hosted using the Amazon Web Service. Two different web platforms were established for the user groups of health workers and researchers (program managers). RESULTS: A total of 2,827 program participants were registered in the web DB system until December 2017. Health professionals can input the participant data while providing consultation to the program participants, and the data is accumulated in the web DB in real time. Input errors or data loss is prevented by setting restrictions in the data entry system. During the 4-year project period, 7,696 hours of working time and USD 39,536.48 for data management were saved as the result of web DB system utilization. CONCLUSIONS: The developed web DB system contributed to improve the health condition of the health program participants by providing necessary information to the health professionals at the right time. This case report could be a reference for other researcher to develop web databases for their own context, especially in developing countries.
Developing Countries ; Electronic Health Records ; Health Information Systems ; Health Occupations ; Hypertension* ; Peru* ; Primary Health Care*

In this study, a formulation of Bordetella pertussis proteoliposome (PLBp), diphtheria, and tetanus toxoids and alum (DT-PLBp) was evaluated as a trivalent vaccine candidate in BALB/c mice. Vaccine-induced protection was estimated using the intranasal challenge for pertussis and enzyme-linked immunosorbent assay fvto assess serological responses for diphtheria or tetanus. Both, diphtheria-tetanus-whole cell pertussis (DTP) and diphtheria-tetanus vaccines (DT) were used as controls. Animals immunized with DT-PLBp, PLBp alone, and DTP showed total reduction of CFU in lungs 7 days after intranasal challenge. Likewise, formulations DT-PLBp, DTP, and DT elicited antibody levels ≥2 IU/mL against tetanus and diphtheria, considered protective when neutralization tests are used. Overall, results showed that combination of PLBp with tetanus and diphtheria toxoids did not affect the immunogenicity of each antigen alone.
Animals ; Bordetella pertussis* ; Bordetella* ; Diphtheria Toxoid ; Diphtheria* ; Enzyme-Linked Immunosorbent Assay ; Lung ; Mice* ; Neutralization Tests ; Tetanus Toxoid* ; Tetanus* ; Vaccines ; Whooping Cough

Objectives: This study aims to assess the effect of ultralow dose 0.005% estriol vaginal gel in women with genitourinary syndrome of menopause (GSM). Methods: In this prospective and multicenter single-arm study, efficacy was assessed by the evaluation of the epithelial maturation value (MV), vaginal pH, symptoms and signs of vulvovaginal atrophy. Tolerability, acceptability, and the effect on intimate relationships were also evaluated. Results: We included 35 postmenopausal women with moderate-to-severe vaginal dryness. The most bothering symptom reported was vaginal dryness. The mean increase in the MV after 7 and 14 days of treatment were 22.1 (P < 0.001) and 39.9 (P < 0.001) points, with an increase in the superficial cells of 17.7 percentage points (pp) (95% confidence interval [CI], 7.9–27.4; P < 0.001) and 41.4 pp (95% CI, 28.2–54.6; P < 0.001) observed at the timepoints. Additionally, the pH decreased by 0.6 ± 0.7 (mean ± SD) at 7 days (P < 0.0001) and by 1.1 ± 0.8 at 14 days (P < 0.0001) from a baseline mean value of 6.3 ± 0.8. The severity of vaginal dryness (range, 0 [none] to 3 [severe]) was significantly reduced by a mean of 1.4 points (P < 0.0001) at 7 days and 2 points (P < 0.0001) at 14 days. Conclusions Ultralow dose 0.005% estriol vaginal gel produced a rapid improvement of most relevant symptoms and signs of GSM. This clinically meaningful response was observed from the initial days of treatment, confirming a fast onset and a progressive action.

Bilateral posterior communicating (pComm) artery aneurysms represent only 2% of mirror intracranial aneurysms. Usually, these are surgically approached through bilateral craniotomies for clipping. We present the case of a 50-year-old female presenting with headache and horizontal diplopia. Neurological examination revealed a left oculomotor palsy, with no other neurological deficits. Imaging studies revealed bilateral aneurysmatic lesions in both internal carotid arteries (ICA). A conventional left pterional approach was planned in order to treat the symptomatic aneurysm, and, if deemed feasible, a contralateral clipping through the same approach. The procedure was performed in a hybrid operating room (HOR), performing an intraoperative digital subtraction angiography (DSA) and roadmapping assistance during dissection and clipping. Transoperatively, a post-fixed optic chiasm was identified, with a wide interoptic space, which allowed us to perform the contralateral clipping through a unilateral approach. This technique for clipping bilateral pComm aneurysms can be performed when the proper anatomical features are met.

Chronic limb-threatening ischemia is rarely associated with previous traumatic injury. We present a case of a 28-year-old male with progressive digit ulcers, a weak pulse, cyanosis, and a cold limb. Eight months prior, he had a motorcycle accident resulting in a right clavicle fracture and brachial plexus injury. Computed tomography angiography revealed occlusion of the right subclavian artery near a surgically implanted reduction plate. The patient underwent an open subclavianbrachial bypass with a reversed saphenous vein graft. His postoperative recovery was uneventful. After 3 months, he had a euthermic right hand with a palpable pulse and his ulcers had completely healed. This case reinforces the need for patients with a neurological deficit in the upper extremity caused by blunt trauma to undergo thorough vascular examination to identify potential arterial injury and compromised perfusion.

Thrombectomy procedures following intra-aneurysmatic lesions are extremely rare, and few cases have been reported. This article describes a microsurgical intra-aneurysmatic thrombectomy (MIaT) for a distal anterior cerebral artery (DACA) aneurysm. We present the case of a 48-year-old female that was admitted to the emergency room, showing neurologic deterioration with focal deficits. A computed tomography angiography (CTA) scan revealed an aneurysm located in the distal segment of the left anterior cerebral artery. During the surgical procedure, after clipping, a wellformed clot was visualized through the aneurysm’s wall obstructing the left DACA flow. We proceeded to open the aneurysm’s dome to remove the thrombus and clip the aneurysm neck, re-establishing the flow of the left DACA.Intra-aneurysmatic thrombosis can occur as a complication during clipping, obstructing the distal flow of vital arteries and causing fatal results in the patient’s postoperative status. MIaT is a good technique for restoring the flow of the affected vessel and allows a secure aneurysm clipping after thrombus removal.

Introduction: A 7.2 magnitude earthquake arising from the West Valley Fault will result in thousands of lives lost and severe damage to property and infrastructure. This study aimed to determine the disaster preparedness of barangays in Metro Manila along the West Valley Fault. Methods: This was a cross-sectional study of high risk barangays in six cities along the West Valley Fault using the Disaster Preparedness Audit. A total of 40 barangays were assessed on their levels of disaster preparedness in terms of percentage fulfilment of different criteria in the four thematic areas: 1) prevention and mitigation 2) preparedness 3) response and rehabilitation, and; 4) recovery. Results: None of the surveyed barangays could fulfil all the 27 criteria for disaster preparedness. Most were only able to satisfy 50-74% of the criteria. As per thematic area, no barangay met ≥75% of the criteria for prevention and mitigation whereas 87.5%, 67.5% and 80% satisfied ≥75% of the criteria for preparedness, response and recovery, respectively. In terms of overall disaster preparedness, less than half of the surveyed barangays satisfied ≥75% of the total criteria. Conclusion Most of the barangays surveyed are inadequately prepared to cope with disaster arising from a major earthquake generated by the West Valley Fault.