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Neuronal and molecular substrates for optimal foraging in Caenorhabditis elegans
Variation in food quality and abundance requires animals to decide whether to stay on a poor food patch or leave in search of better food. An important question in behavioral ecology asks when is it optimal for an animal to leave a food patch it is depleting. Although optimal foraging is central to evolutionary success, the neural and molecular mechanisms underlying it are poorly understood. Here we investigate the neuronal basis for adaptive food-leaving behavior in response to resource depletion in Caenorhabditis elegans, and identify several of the signaling pathways involved. The ASE neurons, previously implicated in salt chemoattraction, promote food-leaving behavior via a cGMP pathway as food becomes limited. High ambient O2 promotes food-leaving via the O2-sensing neurons AQR, PQR, and URX. Ectopic activation of these neurons using channelrhodopsin is sufficient to induce high food-leaving behavior. In contrast, the neuropeptide receptor NPR-1, which regulates social behavior on food, acts in the ASE neurons, the nociceptive ASH neurons, and in the RMG interneuron to repress food-leaving. Finally, we show that neuroendocrine signaling by TGF-β/DAF-7 and neuronal insulin signaling are necessary for adaptive food-leaving behavior. We suggest that animals integrate information about their nutritional state with ambient oxygen and gustatory stimuli to formulate optimal foraging strategies.
Journal Article
Return to Sport After Hip and Knee Arthroplasty: Counseling the Patient on Resuming an Active Lifestyle
Purposeof Review
The purpose of this review is to summarize the available literature on the epidemiology, biomechanics, clinical outcomes, and complications of return to sport after TJA, as well as provide guidelines for patients’ safe return to athletic activity.
Recent Findings
As volume and indications for total joint arthroplasty (TJA) expand, arthroplasty candidates today are demographically younger, more physically active, and have higher expectations for postoperative function. Many TJA patients wish to resume sports activity that may theoretically place their reconstruction under more biomechanical stress and risk for early wear or failure. Recommendations for postoperative patient activity following TJA have historically largely been surgeon-dependent and in the context of evolving prosthetic design and surgical techniques.
Summary
We endorse a three-tiered framework for return to sporting activities: (1) low-impact sports are generally recommended, (2) intermediate-impact sports are generally recommended with experience, and (3) high-impact sports are generally not recommended though activity-specific joint decisions between patient and surgeon can be made.
Journal Article
Recovery of the Hypothalamo-Pituitary-Adrenal Axis After Transsphenoidal Adenomectomy for Non–ACTH-Secreting Macroadenomas
Abstract
Context
Secondary adrenal insufficiency is a potential complication of transsphenoidal adenomectomy (TSA). Most centers test recovery of the hypothalamo-pituitary-adrenal (HPA) axis after TSA, but, to our knowledge, there are no data predicting likelihood of recovery or the frequency of later recovery of HPA function.
Objective
To assess timing and predictors of HPA axis recovery after TSA.
Design
Single-center, retrospective analysis of consecutive pituitary surgeries performed between February 2015 and September 2018.
Patients
Patients (N = 109) with short Synacthen test (SST) data before and at sequential time points after TSA.
Main outcome measures
Recovery of HPA axis function at 6 weeks, and 3, 6, and 9 to12 months after TSA.
Results
Preoperative SST indicated adrenal insufficiency in 21.1% Among these patients, 34.8% recovered by 6 weeks after TSA. Among the 65.2% (n = 15) remaining, 13.3% and 20% recovered at 3 months and 9 to 12 months, respectively. Of the 29% of patients with adrenal insufficiency at the 6-week SST, 16%, 12%, and 6% subsequently recovered at 3, 6, and 9 to 12 months, respectively. Preoperative SST 30-minute cortisol, postoperative day 8 cortisol, and 6-week postoperative SST baseline cortisol levels above or below 430 nmol/L [15.5 μg/dL; AUC ROC, 0.86]; 160 nmol/L (5.8 μg/dL; AUC ROC, 0.75); and 180 nmol/L (6.5 μg/dL; AUC ROC, 0.88), were identified as cutoffs for predicting 6-week HPA recovery. No patients with all three cutoffs below the threshold recovered within 12 months after TSA, whereas 92% with all cutoffs above the threshold recovered HPA function within 6 weeks (OR, 12.200; 95% CI, 5.268 to 28.255).
Conclusion
HPA axis recovery can occur as late as 9 to 12 months after TSA, demonstrating the need for periodic reassessment of patients who initially have SST-determined adrenal insufficiency after TSA. Pre- and postoperative SST values can guide which patients are likely to recover function and potentially avoid unnecessary lifelong glucocorticoid replacement.
After TSA, pre- and postoperative SST cortisol levels can predict 6-week HPA axis recovery. Recovery occurs even 12 months after TSA, demonstrating the need for periodic retesting.
Journal Article
Robin Hood
Recounts the legend of Robin Hood, who plundered the king's purse and poached his deer and whose generosity endeared him to the poor.
Book
The direct anterior approach to the hip: a useful tool in experienced hands or just another approach?
The direct anterior approach (DAA) to the hip was initially described in the nineteenth century and has been used sporadically for total hip arthroplasty (THA). However, recent increased interest in tissue-sparing and small incision arthroplasty has given rise to a sharp increase in the utilization of the DAA. Although some previous studies claimed that this approach results in less muscle damage and pain as well as rapid recovery, a paucity in the literature exists to conclusively support these claims. While the DAA may be comparable to other THA approaches, no evidence to date shows improved long-term outcomes for patients compared to other surgical approaches for THA. However, the advent of new surgical instruments and tables designed specifically for use with the DAA has made the approach more feasible for surgeons. In addition, the capacity to utilize fluoroscopy intraoperatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons during their learning curve. An understanding of its limitations and challenges is vital for the safe employment of this technique. This review summarizes the pearls and pitfalls of the DAA for THA in order to improve the understanding of this surgical technique for hip replacement surgeons.
Journal Article
Fodor's essential Great Britain
Presents a travel guide to England, Scotland, and Wales, providing recommendations on hotels, restaurants, shopping, local transportation, sights of interest, and nightlife.
Book
Association between primary language and perioperative outcomes for geriatric hip fractures
The purpose of this study was to assess whether language affects patient time to surgery following hip fractures.
Patients >55 years who underwent operative hip fracture repair between 2014 and 2021 were reviewed for demographics, language, hospital quality measures, and outcomes. Patients were split into English (E) or non-English (NE) cohorts based on their primary language.
A total of 1880 patients (1477 E, 403 NE) were included. The E cohort was younger, had lower body mass index, and lower American Society of Anesthesiology Score (P < .01). The E cohort had more White patients (P < .01), whereas the NE cohort had more Hispanic, Asian, and patients with unknown backgrounds (P < .01 for all). At baseline, the E cohort patients were more likely to be community ambulators (P < .01). There were no differences in time to surgery or length of stay (P > .05).
Despite poorer baseline medical conditions, NE speaking patients received similar care to English speakers highlighting the importance of an effective standardized protocol with readily available translation services.
Level III, Retrospective cohort study.
Journal Article