Ultrasonography of a Helical Left Common Carotid Artery

Case Presentation: An 83-year-old woman was admitted to the intensive care unit for septic shock at which point an internal jugular central venous line was placed. The patient’s common carotid artery was visualized in an atypical location, lateral to the internal jugular vein. Further inspection revealed the common carotid artery travelling in a rotational trajectory around the internal jugular vein.Discussion: For at least two decades, point-of-care ultrasound has become the standard of care for placing central venous lines. This surprising anatomical orientation is rare and cautions physicians to fully explore a patient’s anatomy prior to placing central lines

The Financial Dialogue in the Development of Medical Treatment Plans

As patients face increasingly high out-of-pocket costs and difficulties navigating the healthcare system, failing to discuss available treatment options in financial terms can lead to grave consequences for patients. Medical bills are responsible for the majority of bankruptcies in the United States. Given the severe financial implications of medical bills, it is imperative that patients become more involved in discussions of their treatment plans and become aware of the costs of their decisions up front. Counseling about costs ensures that physicians avoid placing a debilitating financial burden on patients and maintain adherence to the ethical principle of non-maleficence. Various studies have shown that physicians lack proper education in health economics, which makes navigation of this aspect of healthcare daunting. Finding a place for teaching economics and health policy has been difficult given the necessity to deliver a voluminous amount of scientific content during medical education. Nevertheless, physicians function as part of a healthcare industry that is not immune from the economic principles that govern commerce in any other service business. We suggest incorporation of customer service techniques from other business settings into the traditional practice of humanistic medicine in order to facilitate cost discussion and improve patient understanding. A physician’s job is to educate the patient about potential plans of action to solve his/her problem, and costs represent key pieces of information for optimizing treatment plans. In the end, it is the patient who is entitled to decide what is best, or, in other words, the customer is always right

The Maghreb – one more important biodiversity hot spot for tiger beetle fauna (Coleoptera, Carabidae, Cicindelinae) in the Mediterranean region

The tiger beetle fauna of the Maghreb region is one of the richest in the Palaearctic, including 22 species and 5 subspecies and 19% of all Palaearctic species of Cicindelinae. Assembled by their chorotypes, the Maghreb tiger beetles fall into eight different groups that include Maghreb endemics (26% of fauna), Mediterranean (7%), West Mediterranean (40%), North African (4%), Mediterranean-Westturanian (4%), West Palaearctic (4%), Afrotropico-Indo-Mediterranean (4%), and Saharian (11%) species. The Mediterranean Sclerophyl and Atlas Steppe are the Maghreb biogeographical provinces with the highest species richness, while the Sahara Desert has the lowest Cicindelinae diversity. Twenty-five cicindelid species and subspecies (93% of Maghreb fauna) are restricted to only one or two habitat types in lowland areas. Only Calomera littoralis littoralis and Lophyra flexuosa flexuosa are recognized as eurytopic species and occur in three types of habitat. The highest tiger beetle diversity characterizes salt marshes and river banks (in both cases 11 species and subspecies or 41% of Maghreb fauna). Approximately 85% of all Maghreb tiger beetle species and subspecies are found in habitats potentially endangered by human activity

A sleep-active neuron can promote survival while sleep behavior is disturbed

Sleep is controlled by neurons that induce behavioral quiescence and physiological restoration. It is not known, however, how sleep neurons link sleep behavior and survival. In Caenorhabditis elegans, the sleep-active RIS neuron induces sleep behavior and is required for survival of starvation and wounding. Sleep-active neurons such as RIS might hypothetically promote survival primarily by causing sleep behavior and associated conservation of energy. Alternatively, RIS might provide a survival benefit that does not depend on behavioral sleep. To probe these hypotheses, we tested how activity of the sleep-active RIS neuron in Caenorhabditis elegans controls sleep behavior and survival during larval starvation. To manipulate the activity of RIS, we expressed constitutively active potassium channel (twk-18gf and egl-23gf) or sodium channel (unc-58gf) mutant alleles in this neuron. Low levels of unc-58gf expression in RIS increased RIS calcium transients and sleep. High levels of unc-58gf expression in RIS elevated baseline calcium activity and inhibited calcium activation transients, thus locking RIS activity at a high but constant level. This manipulation caused a nearly complete loss of sleep behavior but increased survival. Long-term optogenetic activation also caused constantly elevated RIS activity and a small trend towards increased survival. Disturbing sleep by lethal blue-light stimulation also overactivated RIS, which again increased survival. FLP-11 neuropeptides were important for both, induction of sleep behavior and starvation survival, suggesting that FLP-11 might have divergent roles downstream of RIS. These results indicate that promotion of sleep behavior and survival are separable functions of RIS. These two functions may normally be coupled but can be uncoupled during conditions of strong RIS activation or when sleep behavior is impaired. Through this uncoupling, RIS can provide survival benefits under conditions when behavioral sleep is disturbed. Promoting survival in the face of impaired sleep might be a general function of sleep neurons