Highlights of the BMC series: September 2019

Novel biodegradable surgical metal clips • Income inequality and mass shootings • Impact of rural address on depression treatment outcomes • Interactive ultrasound session to reduce maternal stress in high-risk pregnancies • An innovative technique to map heart signaling pathways

BMC SurgeryNovel biodegradable magnesium alloy clips compared with titanium clips for hepatectomy in a rat model


Metal clips are widely used for surgical procedures such as wound closure, vessel ligation or bowel reconstruction. Unfortunately, most of the currently used metal clips are made of titanium or titanium alloys which, when exposed to a magnetic field, can interfere with imaging techniques and induce local tissue damages. The need to find an alternative to titanium is, therefore, a surgical necessity. As of late, magnesium alloys have shown promising properties for surgical use due to their excellent biocompatibility and biodegradability. Such alloys are already used for bone screws, orthopedic implants and various dental surgery procedures. The Graduate School of Medicine of Kobe University has recently developed a novel surgical biodegradable metal clip constructed from magnesium alloy. The developers have reported the tolerance, biocompatibility and mechanical strength of their clips compared with those made of titanium in a rat model of hepatectomy. The results of the study demonstrate that magnesium alloy clips are safe, cheap to produce, less prone to interfere with imaging techniques, and could be used shortly after further examination on larger animals and other complex surgical interventions.


BMC Public HealthIncome inequality and mass shootings in the United States

It may be prudent for academics and policymakers to identify policies that increase general social welfare in order to solve the mass shootings epidemic in the United States.

Multiple sources report that there has been roughly one mass shooting a day in the United States since 2013, more than any other country. Several factors contribute to creating an environment fertile for such violence, but there is a paucity of research on whether the recent increase in income inequality is associated with the rise of mass shootings. The impact of the recent mass shooting events is particularly concerning as they extend beyond the events’ targeted areas and have major social repercussions. In 1968, the American sociologist Robert Merton observed that communities with large differences in household income maintain an environment of anger, frustration, resentment, and hostility. In BMC Public Health, Kwon et al. published results of a combination of socioeconomic data from the Federal Bureau of Investigations and media sources from 3,144 counties between 1990 and 2015. The results of this study strongly suggest that the recent growth of income inequality is significantly correlated to mass shootings in the United States. Poverty rates were however not shown to be associated with these tragic events. This study, combined with others from the mass shooting literature, reinforces the idea that socioeconomic factors are the main driving factors of mass shooting events and that improving general social welfare has more impact than policy strategies to reduce gun violence.


BMC Family PracticeImpact of rural address and distance from clinic on depression outcomes within a primary care medical home practice


Depression is one of the leading causes of disability worldwide, affecting more than 300 million people. It is a chronic condition associated with a high rate of recurrence, relapse, and comorbidity. The collaborative care management (CCM) model has been shown to greatly improve the treatment outcomes of patients suffering from depression. However, its effect varies depending on the studied population. Physicians from a medical center based in Rochester, Minnesota performed a retrospective cohort study including 3,870 patients diagnosed with depression residing in different geographical patterns (rural vs. urban area). Surprisingly, patients with depression living in a rural setting had better treatment outcomes when compared with patients living in urban areas. This may be associated with the greater support and sense of community observed in rural areas, along with phone calls and online visits performed by the collaborative care management. The collaborative care management improved depression outcomes regardless of the residential area, but the improved outcomes seen in rural settings declined as the patient’s distance away from their primary care clinic increased.


BMC Pregnancy and Childbirth Experiences of interactive ultrasound examination among women at risk of preterm birth: a qualitative study


I think it was really nice; we spent quite a long time chatting about what he was doing with the umbilical cord, and he looked like he was smiling a bit and just being happy. 

Pregnant women presenting a risk of preterm delivery have a higher risk to develop depression and anxiety symptoms. As maternal stress further increases the risk of preterm birth as well as adverse obstetric and neonatal outcomes, it is essential to provide psychological support to women at risk. A university hospital in Finland conducted a pilot study including 13 women presenting risks of preterm delivery. The study focused on three main axes to increase the future mother’s general wellbeing. During ultrasound sessions, under the guidance of a psychologist and obstetrician, emphasis was placed on including the mother as an active participant, considering the fetus as a real person rather than an object, and strengthening mental images of the baby. Taken together, these simple changes awakened emotions and reinforced the mother-baby bond. Although the sample size was a limitation, this study provides promising information about reducing the stress in high-risk pregnancy and encourages practitioners to adopt a more personalized approach.


BMC Biomedical EngineeringLights, camera, path splitter: a new approach for truly simultaneous dual optical mapping of the heart with a single camera

Jaimes et al. BMC Biomedical Engineering, 2019

Intracellular fluctuations of calcium are the main driving force of heart contractility. They are induced and coordinated by electrical current. Calcium flux also regulates DNA expression and cardiac muscle cell growth during development and cardiac pathology.  The prevalence of altered calcium homeostasis in a high number of cardiac diseases illustrates the importance of understanding the regulation of calcium signals in cardiac research. As of late, many imaging techniques have allowed scientists to map and record both electric currents and calcium flux at different cellular levels. These techniques however, are extremely costly, technically challenging, and often require genetically modified models. Recently, researchers from the Sheikh Zayed Institute for Pediatric and Surgical Innovation in Washington have developed an innovative tool to increase the accessibility of optical mapping techniques allowing scientists to step up their research. Jaimes et al. have described for the first time, a mapping system recording simultaneously both electric and calcium currents in both single cell and multicellular preparations, using commercially available equipment. This novel platform allows a fast and successful implementation of high-tech recordings providing good spatio-temporal resolution, which is necessary for the investigation of electric and calcium currents both in physiological and pathological situations.

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