Concerns have been raised in the academic community about the impact of the USMLE changing the Step 1 exam to pass/fail. This study used a deep neural network (DNN) to model this year’s rank order list at our program and determine the effect of disregarding the Step 1 scores. Correlation with and without the Step 1 scores was very high suggesting that once an applicant has reached the interview and ranking stage, Step 1 did not have a high impact on the rank order

Objective: This study investigated the effect of bilateral greater splanchnic nerve (GSN) transection on hepatic injury during acute necrotizing pancreatitis (ANP) in dogs.

Methods: Twenty-four healthy adult beagle dogs were randomly divided into a sham operation group (SO group, n=8), ANP model group (ANP group, n=8), and ANP with bilateral GSN transection group (GSNT group, n=8). ANP was induced by sodium taurocholate and trypsin infusion into the pancreatic duct; dogs in the GSNT group underwent bilateral GSN transection immediately following ANP induction. Serum tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), pancreatic amylase (AMY), alanine aminotransferase (ALT), and aspartate transaminase (AST) were monitored dynamically. The dogs were sacrificed on day 7 after the operation, pancreatic and hepatic tissues were harvested for pathology, and the expression of p-NF-κB p65 in liver tissues was measured by western blotting.

Results: Serum AMY, TNF-α, IL-1β, IL-6, AST, and ALT levels did not differ significantly between the three groups at 2h before the operation (P>0.05). Serum TNF-α, IL-1β, IL-6, AMY, ALT, and AST levels, pancreatic and hepatic pathological scores, and p-NF-κB p65 expression in liver tissues were significantly higher in the ANP group than in the SO group after the operation (all P<0.05). Serum TNF-α, IL-1β, IL-6, ALT and AST, pancreatic and liver pathological scores, and p-NF-κB p65 protein expression in liver tissues were lower in the GSNT group than in the ANP group after the operation (all P<0.05), whereas serum AMY levels did not differ significantly between these two groups (P>0.05).

Conclusion: Bilateral greater splanchnic nerve transection alleviates liver injury during ANP in dogs.

Nowadays two important processes are taking place simultaneously: global warming and population ageing. Ageing leads to changes in temperature control mechanisms that make elderly people more vulnerable to temperatures out of their comfort range. In addition to diminished thermoregulatory mechanisms, normal ageing is associated with declined postural control, which is an independent risk factor for falls in older adults. So, we have hypothesized that postural balance of older adults can be affected by high environmental temperatures. We carried out a controlled trial with 68 healthy older adults (mean age 73.3 years, 69 % female), each of whom had been assessed twice on the same day using Modified Clinical Tests of Sensory Interaction for Balance (mCTSIB) and the 100% Limits of Stability Test (LOS) to assess balance. They were conducted on the force platform Basic Balance Master System. All volunteers were residents of the Metropolitan Region of São Paulo (SPMA), a subtropical megacity. Repeated sessions were conducted with air temperatures set at 24 °C and 32 °C, in a balanced order. These temperatures were chosen in order to simulate extreme heat indoor SPMA climatology and a comfort temperature. We did not find significant differences for any individual measures or composite scores when comparing static balance assessed by mCTSIB performance under the two experimental temperatures. In the LOS test, except for the reaction time, all measurements were slightly better in the control session than in the heat session, but the difference was only statistically significant in the endpoint excursion (EPE) variable. In the composite score of LOS, a trend for difference was observed, with a p value of 0.10. Our results indicate that brief heat exposure may have detrimental effects on some aspects of balance in older adults.