bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nicotinic receptor activation induces NMDA receptor independent long‐term potentiation of glutamatergic signalling in hippocampal oriens interneurons
Authors: Nicholson Elizabeth , Kullmann Dimitri M. 
Published: November 2020

Key points
Long‐term potentiation of glutamatergic transmission to hippocampal interneurons in stratum oriens does not require NMDA receptors and the induction mechanisms are incompletely understood.
Extracellular stimulation, conventionally used to monitor synaptic strength and induce long‐term potentiation (LTP), does not exclusively recruit glutamatergic axons.
We used optogenetic stimulation of either glutamatergic or cholinergic afferents to probe the relative roles of different signalling mechanisms in LTP induction.
Selective stimulation of cholinergic axons was sufficient to induce LTP, which was prevented by chelating postsynaptic Ca2+ or blocking nicotinic receptors.
The present study adds nicotinic receptors to the list of sources of Ca2+ that induce NMDA receptor independent LTP in hippocampal oriens interneurons.
AbstractMany interneurons located in stratum oriens of the rodent hippocampus exhibit a form of long‐term potentiation (LTP) of glutamatergic transmission that does not depend on NMDA receptors for its induction but, instead, requires Ca2+‐permeable AMPA receptors and group I metabotropic glutamate receptors. A role for cholinergic signalling has also been reported. However, electrical stimulation of presynaptic axons, conventionally used to evoke synaptic responses, does not allow the relative roles of glutamatergic and cholinergic synapses in the induction of LTP to be distinguished. Here, we show that repetitive optogenetic stimulation confined to cholinergic axons is sufficient to trigger a lasting potentiation of glutamatergic signalling. This phenomenon shows partial occlusion with LTP induced by electrical stimulation, and is sensitive to postsynaptic Ca2+ chelation and blockers of nicotinic receptors. ACh release from cholinergic axons is thus sufficient to trigger heterosynaptic potentiation of glutamatergic signalling to oriens interneurons in the hippocampus.
Guillain-Barré syndrome and COVID-19: association or coincidence
Authors: Gale Aislinn , Sabaretnam Suganya , Lewinsohn Asher 
Published: November 2020

COVID-19 is a novel disease best known to cause a cough, fever and respiratory failure. Recently, it has been recognised that COVID-19 may present in multi-systemic ways which can cause diagnostic uncertainty or error.We present a patient who attended hospital with features of Guillain-Barré syndrome (GBS) before developing clinical and radiological findings of COVID-19. While the authors recognise that neurological complications have been reported following COVID-19 infection, to their knowledge this report describes a unique presentation of GBS without preceding COVID-19 symptoms.Since these conditions may have considerable overlapping features including respiratory failure and (following prolonged critical care admission) profound weakness, it is possible that one diagnosis may be overlooked. Raising awareness of a possible association between these conditions is important so both are considered allowing appropriate investigations to be arranged to optimise the chance of neurological recovery and survival, while also protecting staff from potentially unrecognised COVID-19.
Neospora caninum: a new class of biopharmaceuticals in the therapeutic arsenal against cancer
Authors: Lantier Louis , Poupée-Beaugé Agathe , di Tommaso Anne , Ducournau Céline , Epardaud Mathieu , Lakhrif Zineb , Germon Stéphanie , Debierre-Grockiego Françoise , Mévélec Marie-Noëlle , Battistoni Arthur , Coënon Loïs , Deluce-Kakwata-Nkor Nora , Velge-Roussel Florence , Beauvillain Céline , Baranek Thomas , Lee Gordon Scott , Kervarrec Thibault , Touzé Antoine , Moiré Nathalie , Dimier-Poisson Isabelle 
Published: November 2020

BackgroundMicroorganisms that can be used for their lytic activity against tumor cells as well as inducing or reactivating antitumor immune responses are a relevant part of the available immunotherapy strategies. Viruses, bacteria and even protozoa have been largely explored with success as effective human antitumor agents. To date, only one oncolytic virus—T-VEC—has been approved by the US Food and Drug Administration for use in biological cancer therapy in clinical trials. The goal of our study is to evaluate the potential of a livestock pathogen, the protozoan Neospora caninum, non-pathogenic in humans, as an effective and safe antitumorous agent.Methods/ResultsWe demonstrated that the treatment of murine thymoma EG7 by subcutaneous injection of N. caninum tachyzoites either in or remotely from the tumor strongly inhibits tumor development, and often causes their complete eradication. Analysis of immune responses showed that N. caninum had the ability to 1) lyze infected cancer cells, 2) reactivate the immunosuppressed immune cells and 3) activate the systemic immune system by generating a protective antitumor response dependent on natural killer cells, CD8-T cells and associated with a strong interferon (IFN)-γ secretion in the tumor microenvironment. Most importantly, we observed a total clearance of the injected agent in the treated animals: N. caninum exhibited strong anticancer effects without persisting in the organism of treated mice. We also established in vitro and an in vivo non-obese diabetic/severe combined immunodeficiency mouse model that N. caninum infected and induced a strong regression of human Merkel cell carcinoma. Finally, we engineered a N. caninum strain to secrete human interleukin (IL)-15, associated with the alpha-subunit of the IL-15 receptor thus strengthening the immuno-stimulatory properties of N. caninum. Indeed, this NC1-IL15hRec strain induced both proliferation of and IFN-γ secretion by human peripheral blood mononuclear cells, as well as improved efficacy in vivo in the EG7 tumor model.ConclusionThese results highlight N. caninum as a potential, extremely effective and non-toxic anticancer agent, capable of being engineered to either express at its surface or to secrete biodrugs. Our work has identified the broad clinical possibilities of using N. caninum as an oncolytic protozoan in human medicine.
The management of drowning: a review of current evidence and guidelines
Authors: Castledine B , Phillips S 
Published: November 2020

AbstractThis article provides a review of the treatment of decompression illness (DCI) in the military setting. For those personnel who deliver military healthcare at all levels, there is an overview of the clinical picture, diagnosis and treatment aims when dealing with patients with DCI. The treatment aims are discussed using a situational approach from the perspectives of primary care, pre-hospital care through secondary care and onward to treatment by the diving medicine specialist. With ongoing medical support to worldwide diving operations, this narrative review provides an update in current DCI management for those involved in caring for military divers.
50 years: man and boy in the Royal Naval Medical Service
Authors: Proctor D 
Published: November 2020

AbstractThis article details some of my experiences as part of a 50-year career in or working for the Royal Naval Medical Service (RNMS), that started in 1966 when England last won the World Cup. In such a long career (29 years in uniform and 21 in the Civil Service), I have seen many changes to the RNMS itself and I hope that I can portray these, although with long service comes old age and all the frailties this encompasses. I currently work as a Specialist Instructional Officer in the Institute of Naval Medicine (INM) where I have been for the past 28 years.
Cold water survival – an evidence-based update
Authors: House C 
Published: November 2020

AbstractRoyal Navy (RN) cold water survival advice was historically based on data collated from immersion incident reports during World War II. This evidence-based review highlights the advances in the knowledge and understanding of the risks associated with cold water immersion and how this has been applied to provide up-to-date advice to maximise the chances of survival for passengers on board RN helicopters ditching into water.
The management of gastro-oesophageal reflux disease in the UK Armed Forces
Authors: Perigo O , Khan M 
Published: November 2020

AbstractGastro-oesophageal reflux disease (GORD) is a common presentation to primary care and has large direct and indirect effects on the UK economy. The purpose of this review is to highlight the management strategies for GORD among military personnel in primary and secondary care. Particular emphasis is placed on the outcomes from each form of treatment and the possible impact on deployability, in keeping with current UK military medical policy and guidance.
Medical and logistics aspects of the Peninsular War, 1808-1814
Authors: Wardley T , Goacher J , Neep S , Fleet S , White R , Banks A , Dale R , Belcher S , Cooper K , Webber Z , Adamson J 
Published: November 2020

AbstractFollowing the failure of the French maritime force at the Battle of Trafalgar, Napoleon sought to dominate Europe through his ‘Continental System’, using large, conscripted, land forces to control nation states and close European ports to British trade. To counter this denial of economic opportunity Britain deployed a large force to the Iberian Peninsula in 1808. Thus ensued the Peninsular War of 1808–14. This article discusses some of the medical advances identified from the war, including force health protection measures, surgical techniques and medical evacuation.
Consideration of the medical care and biomedical support of women and children on Role 2 Afloat maritime contingency operations
Authors: Hillman CM , Horrobin R , Mills S , Mercer S 
Published: November 2020

AbstractThe Royal Navy’s Role 2 Afloat (R2A) capability has now been firmly established in support of United Kingdom (UK) troops on contingency operations such as humanitarian aid and disaster relief operations. This article reviews the current capability of R2A to deliver medical care to children and pregnant women, including the challenges facing the deployed Biomedical Scientist (BMS).
CrossFitter’s knee: patellofemoral chondral injury following high-intensity functional training
Authors: Jackson J , Hart S , Fries CA , Robinson J , Murray J , Wood A M 
Published: November 2020

AbstractWe present a case series of patients with patellofemoral joint (PFJ) chondral injuries presenting as anterior knee pain secondary to participation in high-intensity functional training programmes. We aim to highlight PFJ chondral injuries as a potential complication of military servicemen engaging in high-intensity functional training programmes. This may allow medical staff to identify the injuries early, and highlight this possible injury mechanism to Physical Training staff to help educate participants and mitigate the risk of injury.
Creating a Healthy Ship
Authors: Morrow L , Abrams C , Shaw A 
Published: November 2020

AbstractIn 2015 HMS DUNCAN was chosen as the intervention ship for an Institute of Naval Medicine (INM)-led project entitledSecond Sea Lord (2SL)’s Feeding the Fleet Initiative. During her nine-month maiden deployment on Operation KIPION, a healthy lifestyle intervention was initiated, encompassing executive health, catering services, medical services and physical training. The key enabler of the success of the intervention was the formation of an effective Unit Health Committee. This article presents the lessons identified and provides useful examples from the intervention, which aimed to create a healthy lifestyle culture on board a deployed ship.
1982 Falklands War: An analysis of UK combat injuries and survival
Authors: Penn-Barwell J G , McGuire RA , Rickard RF 
Published: November 2020

AbstractIt is thought likely that the next conflict in which the Naval Service is closely engaged will show greater similarity to the Falklands War (Operation CORPORATE) of 35 years ago than to the recent, prolonged, counter-insurgency operation in Afghanistan (Operation HERRICK). This study uses registry data to examine casualties sustained on Op CORPORATE and compares the injury severity of survivors with that observed on Op HERRICK. Because of their mechanistic consistency, dismounted gunshot wound (GSW) casualties are used as the cohorts for comparison.This report details the first systematic quantitative analysis of Op CORPORATE casualties. The analysis suggests that, at least amongst those dismounted casualties injured by GSW, more severely injured casualties survived during Op HERRICK than during Op CORPORATE. Allowing for the different operational scenarios and the significant differences in the provision of medical care, it can be concluded that these differences were not as marked as might have been expected and that, overall, survival outcomes approached those seen more recently in Afghanistan.
Managing suspicious skin lesions on deployed operations
Authors: Holland T J , McIntosh S , Smith J J 
Published: November 2020

AbstractThe incidence of skin cancer is rising year on year. The general risk in the military population is low, but a missed lesion may have severe consequences. This paper outlines the key factors to consider when assessing a lesion, risk stratification methods and the challenges of managing suspected malignancy when operating remote from the UK.
Intravascular ultrasound, performed during resuscitative endovascular balloon occlusion of the aorta (REBOA), confirms correct balloon deployment and haemostasis - a potential solution for remote, austere and military settings
Authors: Rees P S C , Buckley A M , Watts S A , Kirkman E 
Published: November 2020

AbstractIntroductionResuscitative endovascular balloon occlusion of the aorta (REBOA) is rapidly evolving as an emergency haemorrhage control technique. It has wide potential applicability in remote and austere settings, and following military trauma where prolonged field care might be required. However, rapid confirmation of balloon delivery is a challenge which relies on estimates derived from anatomical measurements or trans-abdominal ultrasound. In addition, confirmation of adequate balloon expansion is difficult. Intravascular ultrasound (IVUS) offers a solution to these two issues, making REBOA a deliverable therapy in the pre-hospital and early hospital settings.MethodsIn an animal model of severe ballistic trauma, following characterisation of the technique, an IVUS-REBOA device was configured, combining a peripheral angioplasty balloon and a digital coronary IVUS catheter. This was introduced via a sheath into the femoral vessel over a conventional angioplasty guide wire.ResultsReal time IVUS imaging allowed confirmation of delivery of the balloon to the aorta, and also demonstrated full apposition once deployed. Furthermore, using ChromaFlo imaging, the device confirmed loss of pulsatile flow in the aorta after deployment, correlating with loss of transduced femoral pressure traces. Post-mortem examination confirmed correct anatomical balloon placement.SummaryFor the first time, in a porcine pilot study, we have demonstrated that IVUS-REBOA is feasible and confirms both correct balloon placement and haemostasis. It has potential to offer advantages to REBOA operators especially during the pre-hospital and retrieval phases, and in the early phase of hospital delivered damage control resuscitation at remote locations.
Helping St George: the Royal Naval Medical Service at Zeebrugge, 22-23 April 1918
Authors: Wickenden JVS , Walsh D 
Published: November 2020

AbstractOn the night of 22-23 April 1918, the Zeebrugge Raid, part of Operation Z.O., took place. This historical article gives some context to the raid and its purpose, studies the medical provision for and experience during the raid, and tells the stories of the medical staff involved.
Operation RUMAN: Role 2 Afloat delivering Humanitarian Aid and Disaster Relief operations in the Caribbean
Authors: Matthews J J 
Published: November 2020

AbstractIn the autumn of 2017, two Category 5 hurricanes caused extensive damage in the Caribbean. This resulted in the activation of two Role 2 Afloat (R2A) teams in support of Operation RUMAN, the military response to provide Humanitarian Aid and Disaster Relief (HADR) to the affected area. This paper documents the deployment of the R2A capability during Op RUMAN and outlines the main lessons identified in the delivery of HADR in the maritime environment.
Presentation and management of traumatic pneumothorax in the deployed setting
Authors: Cornell J 
Published: November 2020

AbstractPneumothorax is a potentially life-threatening complication of traumatic chest injury. Rapid assessment, recognition and management in the deployed pre-hospital and hospital environment is essential, as complications such as hypoxia and cardiovascular collapse require urgent intervention. This article aims to describe the evidence for presentation, management and occupational aspects of traumatic pneumothorax, which can prevent selection into specialist roles such as diving, submarine service and aviation.
Free Open Access Medical Education (FOAM) and its relevance to military clinicians
Authors: Winstanley M , Henning D , Gurney I 
Published: November 2020

AbstractClinicians are expected to regularly update their professional knowledge, and in doing so, they navigate more complex and wide-ranging educational resources, putting greater pressure on their time. Free open-access medical education (FOAM) is an environment led predominantly through social media which enables discussion, education and rapid dissemination of journal articles and other educational material.The Defence Medical Services have many different employment groups spread across a variety of medical specialties. FOAM can provide benefits to military clinicians in promoting and disseminating the work being done, and in terms of recruitment and education of clinical personnel, both in the firm base and in deployed settings. There are several potential pitfalls among FOAM resources which can be addressed by carefully appraising the resources being used and being aware of the possible biases. This article aims to highlight the possible uses of FOAM within the military as well as some methods to help engage users and ensure they are able to negotiate the hazards of the FOAM world.
Peripheral arterial disease
Authors: Swain C S , Khan M 
Published: November 2020

AbstractPeripheral arterial disease is traditionally considered a condition that affects an elderly population. Although rare in personnel in the Royal Navy, it has the potential to have a significant impact on individual operational capability. This review article addresses the clinical picture of peripheral arterial disease including examination, the differential diagnoses, and management in the pre-hospital military environment, and makes recommendations regarding referral to specialist care and future deployability.
Continuation resuscitation training on deployed contingency operations
Authors: Mitchell G , Smith J E 
Published: November 2020

AbstractBackgroundResuscitation training is conducted prior to operational deployment. During prolonged deployments, continuation training may be necessary to ensure skills are maintained. The aim of this study was to identify the continuation training needs of deployed medical personnel.MethodsA survey was distributed to all personnel of the Level 2 Hospital in Bentiu, South Sudan, during Op TRENTON 4.Results63 questionnaires were distributed with a response rate of 87%. The majority (84%) of deployed hospital personnel felt that continuation training would be beneficial.ConclusionContinuation training is desirable and possible in the deployed operational environment, but the fidelity of the training will depend on the equipment and training personnel available.
Role 2 Afloat support to the QUEEN ELIZABETH (QE) Class – an update from WESTLANT 18
Authors: Matthews J J 
Published: November 2020

AbstractWESTLANT 18 saw a Role 2 Afloat (R2A) team deploy on HMS QUEEN ELIZABETH (QNLZ) to support the First of Class Flying Trials for the F-35 Lightning 2 aircraft. This team established the R2A capability onboard QNLZ and began the process of developing R2A support to Carrier Strike Group (CSG) operations. The deployment was a great success and many lessons were identified. The experience from this deployment is summarised and the current R2A support to CSG is described.
Medicine and critical care in contingency operations in the resource-limited environment: a case study
Authors: O’Brien D , Jeyanathan J , Berry R , Houlberg K 
Published: November 2020

AbstractThis paper highlights the key lessons learned in the care of a critically unwell patient during a contingency operation in a resource-limited environment. These include dealing with vulnerabilities in the re-supply of medications and equipment, treating pathology that is not often seen in young, fit UK military personnel and force protection issues to ensure the maintenance of operational capability. It also highlights the rapid United Nations (UN) response to aeromedical evacuation and some of the challenges of performing a critical care transfer in this environment.
Marmaduke Philip Smyth Ward (1825-1885): Nelson’s grandson and naval surgeon
Authors: Fraser I D 
Published: November 2020

AbstractAs a naval hero Vice-Admiral Lord Horatio Nelson holds a special place in the affections of the British people. Any expectation that his country would provide for Lady Emma Hamilton and his daughter, Horatia, was almost forgotten when he died. However, following Emma’s death, Nelson’s family shaped Horatia’s destiny, which resulted in a happy marriage and a large family. Her second son, Marmaduke, was influenced by an uncle, a surgeon, who trained and guided him towards a surgical qualification and a life at sea as a surgeon in the Royal Navy. Despite a paucity of documentary evidence, it has been possible to trace his progress by analysing his Admiralty service record and abstracting information from an extensive biography of his mother. As another piece in the Nelson narrative, this account adds a medical perspective.
Lessons identified in delivering an orthopaedic training course in Freetown, Sierra Leone as part of the NIHR Global Health Research Group FIXT trial
Authors: Bolton W S , Howard A J H , Santos A C W , Chippendale T J , Bundu I , Jayne D G , Wood A M 
Published: November 2020

AbstractAimsThere are many challenges in delivering an orthopaedic training programme in Sierra Leone, West Africa, including human resource and equipment constraints. We provide a reflective analysis of adaptive strategies to overcome these.MethodsAn orthopaedic surgical training course was delivered in preparation for a clinical trial in Connaught Hospital, Freetown, Sierra Leone. The trial examines the implementation of Ilizarov frame fixation for tibia fractures in adults.ResultsWhilst it is possible to deliver a high-quality course in Sierra Leone, a significant amount of prior planning and preparation, including adaptive and contingency strategies, is required to achieve the desired outcome.ConclusionsWith the Royal Navy increasing its global reach, including deployment of new aircraft carriers, there are increasing opportunities to deliver medical training in low and middle-income countries in both the military and civilian sector. We believe this article may be useful for service and civilian practitioners intending to deliver education and training around the world.