bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermal Stimulation Changes Diffusivity of the Spinothalamic Tract
Authors: Lin Joanne C. , Mueller Christina , Younger Jarred W.
Published: October 2017

Study Design.

An experimental study.

Objective.

This study aimed to investigate task-dependent changes in fractional anisotropy (FA) within the spinal cord during painful stimulation.

Summary of Background Data.

Earlier experiments by Mandl et al (2008, 2013) used non-invasive functional diffusion tensor imaging (fDTI) to detect white matter fibers that were active during functional tasks. In two studies, it was observed that FA of involved white matter tracts exhibited repeatable task-related increases. In this study, we attempted to extend the fDTI work in the spinal cord.

Methods.

Twenty-three healthy, right-handed men (mean age 22 yrs, standard deviation [SD] = 4) were invited to participate in this study. Diffusion-weighted images were collected over spinal levels C2 to T4 during a painful thermal stimulus applied to the left thenar eminence. In order to investigate task-related activity, FA values within the contralateral (right) spinothalamic tract were analyzed using a generalized estimating equations (GEE) procedure. As a control, we also examined activity in the ipsilateral and contralateral corticospinal tracts, which are not considered to be involved in nociception.

Results.

Significant task-related decreases in FA were observed in the right spinothalamic tract at vertebral levels C2–C5 (Wald X
2(1) = 17.754, P < 0.001). There was no change in control regions at levels C7–T2 of the same tract, which are located below the level of input from dermatome C6, Wald X
2(1) = 0.185, P = 0.667. Results in all other regions assessed, that is, the left spinothalamic tract and bilateral corticospinal tract, were also not significant (P > 0.05).

Conclusion.

The current findings suggest that task-related changes in FA associated with the transmission of pain signals along the spinal cord can be detected using fDTI. We observed decreased FA values in the contralateral (right) spinothalamic tract following painful stimulation, while no such activity was apparent in control regions.

Level of Evidence: 5
Anatomical Analysis of Cutaneous Perforator Distribution in the Forearm
Authors: Kimura Tomomi , Ebisudani Shogo , Osugi Ikuko , Inagawa Kiichi
Published: October 2017

Background:

Few reports describe the distribution of cutaneous perforators from the radial and ulnar arteries in the forearm. This study aimed to map the location of the cutaneous perforators that arise directly from the radial and ulnar arteries in cadavers.

Methods:

Twenty-nine human cadaveric forearms were dissected. All radial and ulnar arteries cutaneous perforators were analyzed for total number and distribution. To define the distribution of each cutaneous perforator, the forearm was divided into 10 sections, with the sections labeled as 10%, 20%, 30%, and so on, beginning at the wrist.

Results:

From the radial artery, there were a total of 262 skin perforators with an average of 9.03 ± 2.28 (mean ± SD) per limb, whereas the total was 159 from the ulnar artery, with an average of 5.48 ± 1.49 per limb. Additionally, 128 (49%) radial artery cutaneous perforators and 75 (47%) from the ulnar artery were concentrated in the 0–30% section of the forearm. Both the radial and ulnar arteries had many cutaneous perforators in the forearm section labeled 70%, with 32 of 262 (12%) cutaneous perforators of the radial artery and 27 of 159 (17%) cutaneous perforators of the ulnar artery located here.

Conclusions:

There were more cutaneous perforators from the radial artery than from the ulnar artery, and both were concentrated in the distal one-third of the forearm and in the forearm section labeled 70%. This information could be helpful when harvesting forearm flaps.
Neuroimaging in the Diagnosis of Chronic Traumatic Encephalopathy: A Systematic Review
Authors: Sparks Philip , Lawrence Tim , Hinze Stephan
Published: October 2017

Objective:

Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repeated subconcussive and concussive head injury. Clinical features include cognitive, behavioral, mood, and motor impairments. Definitive diagnosis is only possible at postmortem. Here, the utility of neuroimaging in the diagnosis of CTE is evaluated by systematically reviewing recent evidence for changes in neuroimaging biomarkers in suspected cases of CTE compared with controls.

Data Sources:

Providing an update on a previous systematic review of articles published until December 2014, we searched for articles published between December 2014 and July 2016. We searched PubMed for studies assessing neuroimaging changes in symptomatic suspected cases of CTE with a history of repeated subconcussive or concussive head injury or participation in contact sports involving direct impact to the head. Exclusion criteria were case studies, review articles, and articles focusing on repetitive head trauma from military service, head banging, epilepsy, physical abuse, or animal models.

Main Results:

Seven articles met the review criteria, almost all of which studied professional athletes. The range of modalities were categorized into structural magnetic resonance imaging (MRI), diffusion MRI, and radionuclide studies. Biomarkers which differed significantly between suspected CTE and controls were Evans index (P = 0.05), cavum septum pellucidum (CSP) rate (P < 0.0006), length (P < 0.03) and ratio of CSP length to septum length (P < 0.03), regional differences in axial diffusivity (P < 0.05) and free/intracellular water fractions (P < 0.005), single-photon emission computed tomography perfusion abnormalities (P < 0.01), positron emission tomography (PET) signals from tau-binding, glucose-binding, and GABA receptor–binding radionuclides (P < 0.0001, P < 0.005, and P < 0.005, respectively). Important limitations include low specificity in identification of suspected cases of CTE across studies, the need for postmortem validation, and a lack of generalizability to nonprofessional athletes.

Conclusions:

The most promising biomarker is tau-binding radionuclide PET signal because it is most specific to the underlying neuropathology and differentiated CTE from both controls and patients with Alzheimer disease (P < 0.0001). Multimodal imaging will improve specificity further. Future research should minimize variability in identification of suspected cases of CTE using published clinical criteria.
The Starling Relationship and Veno-Arterial ECMO: Ventricular Distension Explained
Authors: Dickstein Marc L.
Published: October 2017

The use of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) to support patients with acute heart failure has been associated with ventricular distension and pulmonary edema, the mechanism of which is not fully understood. This study examined the impact of VA ECMO on left ventricular (LV) Starling curves to elaborate a framework for anticipating and treating LV distension. A previously developed and validated model of the cardiovascular system was used to generate pressure–volume (PV) loops and Starling curves while holding mean arterial pressure (mABP) constant at a range of values either by adjusting systemic resistance or by adding VA ECMO support. It was found that under all conditions of similar mAPB, the Starling curve was unchanged; therefore, the degree of LV distension is obligated by the mAPB (irrespective of whether controlled pharmacologically with or without ECMO support and independent of heart rate), LV contractility, and target stroke volume. The Starling relationship provides a conceptual framework for understanding the risk and treatment of LV distension during VA ECMO support.
Evaluation of Systemic Heparin Versus Bivalirudin in Adult Patients Supported by Extracorporeal Membrane Oxygenation
Authors: Berei Theodore J. , Lillyblad Matthew P. , Wilson Kelly J. , Garberich Ross F. , Hryniewicz Katarzyna M.
Published: October 2017

Systemic anticoagulation is a standard of care in adult patients supported by extracorporeal membrane oxygenation (ECMO) to prevent circuit thrombosis and subsequent thromboembolic events. Unfractionated heparin has long been considered the anticoagulant of choice, but emerging evidence reports successful ECMO runs with direct thrombin inhibitors. This retrospective study sought to determine whether bivalirudin offers distinct clinical benefits as the anticoagulant of choice in ECMO. Primary end points included thrombotic events during the initial 96 hours of anticoagulation, over the course of their entire ECMO run, and at any time during the admission, as well as in-hospital and 30-day mortality. Secondary end points included percent time within therapeutic range for each anticoagulant, neurologic events, vascular complications, and bleeding. Compared with patients receiving heparin, patients receiving bivalirudin show similar rates of thrombotic events across the three time points (17.9% vs. 9.1%; p = 0.47, 21.4% vs. 11.4%; p = 0.41, and 25% vs. 22.7%; p = 1.00, respectively). In-hospital (32.1% vs. 36.4%; p = 0.91) and 30-day mortality (32.1% vs. 36.4%; p = 0.91) were no different. Similarly, no differences were observed in percent time within therapeutic range (83.0% vs. 87.7%, p = 0.34), neurological events (7.1% vs. 11.4%, p = 0.99), vascular complications (57.1% vs. 38.6%, p = 0.20), or major (25.0% vs. 45.5%, p = 0.13) and minor (25.0% vs. 22.7%, p = 1.00) bleeding. These results suggest that bivalirudin is a viable alternative to heparin for anticoagulation in ECMO but may not offer a clinically significant advantage as the anticoagulant of choice.
Computational Parametric Study of the Axial and Radial Clearances in a Centrifugal Rotary Blood Pump
Authors: Rezaienia Mohammad Amin , Paul Gordon , Avital Eldad , Rothman Martin , Korakianitis Theodosios
Published: October 2017

In centrifugal rotary blood pumps (RBP), clearances are a critical parameter in determining blood trauma. This study investigates the effect of axial clearance (Cax) and radial clearance (Crad) on the hydrodynamic and hemolytic performance of a centrifugal RBP. A centrifugal pump was parameterized so that it could be defined by geometric variables Cax and Crad. Optimal Latin hypercube sampling was used to determine design points based on Cax, Crad, and rotor speed (ω). For each design point, a computational simulation was conducted to determine efficiency (η) and normalized index of hemolysis (NIH). Next, a response surface (RS) was created to estimate these performance parameters based on the design variables. The results show that for a given Cax, when Crad is decreased, η increases until Crad = 0.15 mm, beyond which η deceases. For a given Crad, Cax has a unimodal relationship with η. The NIH has a unimodal relationship with both Cax and Crad. The mechanisms behind these relationships were investigated by various analytical methods. It was found that vortices in the secondary flow paths were a critical factor in determining efficiency and hemolysis. The optimal clearance values discerned in this study are only valid for the specific impeller geometry and operating conditions analyzed.
Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment
Authors: Workman Alan D. , Granquist Eric J. , Adappa Nithin D.
Published: October 2017

Purpose of review

Odontogenic causes of sinusitis are frequently missed; clinicians often overlook odontogenic disease whenever examining individuals with symptomatic rhinosinusitis. Conventional treatments for chronic rhinosinusitis (CRS) will often fail in odontogenic sinusitis. There have been several recent developments in the understanding of mechanisms, diagnosis, and treatment of odontogenic sinusitis, and clinicians should be aware of these advances to best treat this patient population.

Recent findings

The majority of odontogenic disease is caused by periodontitis and iatrogenesis. Notably, dental pain or dental hypersensitivity is very commonly absent in odontogenic sinusitis, and symptoms are very similar to those seen in CRS overall. Unilaterality of nasal obstruction and foul nasal drainage are most suggestive of odontogenic sinusitis, but computed tomography is the gold standard for diagnosis. Conventional panoramic radiographs are very poorly suited to rule out odontogenic sinusitis, and cannot be relied on to identify disease. There does not appear to be an optimal sequence of treatment for odontogenic sinusitis; the dental source should be addressed and ESS is frequently also necessary to alleviate symptoms.

Odontogenic sinusitis has distinct pathophysiology, diagnostic considerations, microbiology, and treatment strategies whenever compared with chronic rhinosinusitis. Clinicians who can accurately identify odontogenic sources can increase efficacy of medical and surgical treatments and improve patient outcomes.
Lack of Correlation of Liver Tests With Fibrosis Stage at Diagnosis in Pediatric Primary Sclerosing Cholangitis
Authors: Cotter Jillian M. , Browne Lorna P. , Capocelli Kelley E. , McCoy Annette , Mack Cara L.
Published: October 2017

Objectives:

The aims of this study were to characterize pediatric primary sclerosing cholangitis (PSC) at a regional referral‐based institution, including scoring of biliary stricturing and liver fibrosis and correlation analyses of scores with serum liver tests, to identify biomarkers of disease severity.

Methods:

A retrospective review of 39 PSC subjects was performed, with collection of demographic and outcomes data. Magnetic resonance cholangiopancreaticogram (MRCP) and liver biopsies were re‐reviewed and scores of stricturing and fibrosis were correlated with serum liver tests.

Results:

Average age at PSC diagnosis was 11.2 years, 74% had inflammatory bowel disease and 51% had autoimmune hepatitis. Despite 83% with symptoms at presentation, only ~1/3 were symptomatic at a mean follow‐up of 4.1 years. Using a validated MRCP biliary scoring system, the mean intrahepatic score was 1.1 (out of 4) and extrahepatic score was 1.0 (out of 3). The mean Ishak liver fibrosis stage was 3.5 (out of 6) and 33% had cirrhosis. 92% were alive with their native liver and 5% had a liver transplant. Serum biomarker analyses revealed no correlation between Ishak liver fibrosis stage or MRCP score and laboratory values.

Conclusions:

Pediatric PSC patients cared for at a regional referral center had relatively mild disease compared with previously published reports, with low MRCP stricture scores despite significant liver fibrosis. Liver tests at presentation did not correlate with MRCP stricture score or liver fibrosis stage, suggesting the need for future studies to identify potential biomarkers of disease severity.
Family Health‐related Quality of Life in Pediatric Cyclic Vomiting Syndrome
Authors: Wang‐Hall Jennifer , Li B.U.K. , Tarbell Sally E.
Published: October 2017

Objective:

The aim of the study was to evaluate the relationship of disease characteristics and child anxiety symptoms to family health‐related quality of life (FHRQoL) in youth with cyclic vomiting syndrome (CVS).

Methods:

Forty‐two parents of youth ages 8 to 18 years diagnosed with CVS completed the Family Impact Module of the PedsQL, a measure of the impact of the child's illness on the family. We evaluated the relationship of disease characteristics and child and parent proxy reports of anxiety symptoms on the Screen for Childhood Anxiety and Related Emotional Disorders to FHRQoL.

Results:

Parent report of child anxiety symptoms and missed school days (mean = 11.93, standard deviation = 14.62) were the strongest predictors of FHRQoL (r2 = 0.33, df = 1.39, F = 8.51, P = 0.006). Other disease characteristics, including frequency, duration, chronicity of CVS episodes, and delay in initial CVS diagnosis were not significantly associated with the FHRQoL total score. Child anxiety symptoms by either parent and/or child report were associated with subscales of the FHRQoL, including family physical functioning, family communication, and family daily activities.

Conclusions:

HRQoL for the families assessed in this study was associated with anxiety symptoms to a greater extent than disease characteristics, indexing the importance of a biopsychosocial approach to CVS management. Screening for anxiety symptoms and support for school absences due to illness are indicated to help lessen the impact of CVS on the family as a whole.
Methods for Sexually Transmitted Disease Prevention Programs to Estimate the Health and Medical Cost Impact of Changes in Their Budget
Authors: Chesson Harrell W. , Ludovic Jennifer A. , Berruti Andrés A. , Gift Thomas L.
Published: October 2017

Background

The purpose of this article was to describe methods that sexually transmitted disease (STD) programs can use to estimate the potential effects of changes in their budgets in terms of disease burden and direct medical costs.

Methods

We proposed 2 distinct approaches to estimate the potential effect of changes in funding on subsequent STD burden, one based on an analysis of state-level STD prevention funding and gonorrhea case rates and one based on analyses of the effect of Disease Intervention Specialist (DIS) activities on gonorrhea case rates. We also illustrated how programs can estimate the impact of budget changes on intermediate outcomes, such as partner services. Finally, we provided an example of the application of these methods for a hypothetical state STD prevention program.

Results

The methods we proposed can provide general approximations of how a change in STD prevention funding might affect the level of STD prevention services provided, STD incidence rates, and the direct medical cost burden of STDs. In applying these methods to a hypothetical state, a reduction in annual funding of US $200,000 was estimated to lead to subsequent increases in STDs of 1.6% to 3.6%. Over 10 years, the reduction in funding totaled US $2.0 million, whereas the cumulative, additional direct medical costs of the increase in STDs totaled US $3.7 to US $8.4 million.

Conclusions

The methods we proposed, though subject to important limitations, can allow STD prevention personnel to calculate evidence-based estimates of the effects of changes in their budget.
Renal Cell Carcinoma With Leiomyomatous Stroma: A Group of Tumors With Indistinguishable Histopathologic Features, But 2 Distinct Genetic Profiles: Next-Generation Sequencing Analysis of 6 Cases Negative for Aberrations Related to the VHL gene
Authors: Petersson Fredrik , Martinek Petr , Vanecek Tomas , Pivovarcikova Kristyna , Peckova Kvetoslava , Ondic Ondrej , Perez-Montiel Delia , Skenderi Faruk , Ulamec Monika , Nenutil Rudolf , Hora Milan , Svoboda Tomas , Rotterova Pavla , Dusek Martin , Michal Michal , Hes Ondrej
Published: October 2017

We have studied a cohort of renal cell carcinomas (RCCs) with smooth-muscle stroma (N=6), which lacked any of following genetic aberrations: mutations in the VHL-gene-coding sequence, loss of heterozygosity of chromosome 3p, or hypermethylation of VHL. Using targeted next-generation sequencing, no intronic VHL mutations or mutations in selected genes involved in angiogenesis and genes frequently mutated in clear cell RCC were identified. Tumors were also tested for the presence of hotspot mutations in the TCEB1 gene with negative results in all cases. We conclude that there exists a group of RCCs with abundant leiomyomatous stroma, where the epithelial component is indistinguishable from conventional clear cell RCC and distinct from clear cell (tubulo-) papillary RCC and that these tumors lack aberrations related to the function of the VHL gene, mutations in genes involved in angiogenesis, and hotspot mutations in the TCEB1 gene.
Achieving Public Health Standards and Increasing Accreditation Readiness: Findings From the National Public Health Improvement Initiative
Authors: Rider Nikki , Frazier Cassandra M. , McKasson Sarah , Corso Liza , McKeever Jennifer
Published: October 2017

Objectives:

During 2010-2014, the Centers for Disease Control and Prevention implemented the National Public Health Improvement Initiative (NPHII) to assist 73 public health agencies in conducting activities to increase accreditation readiness, improve efficiency and effectiveness through quality improvement, and increase performance management capacity. A summative evaluation of NPHII was conducted to examine whether awardees met the initiative's objectives, including increasing readiness for accreditation.

Design:

A nonexperimental, utilization-focused evaluation with a multistrand, sequential mixed-methods approach was conducted to monitor awardee accomplishments and activities. Data analysis included descriptive statistics, as well as subanalyses of data by awardee characteristics. Thematic analysis using deductive a priori codes was used for qualitative analysis.

Results:

Ninety percent of awardees reported completing at least 1 accreditation prerequisite during NPHII, and more than half reported completing all 3 prerequisites by the end of the program. Three-fourths of awardees that completed a self-assessment reported closing gaps for at least 1 Public Health Accreditation Board (PHAB) standard. Within 3 years of the launch of PHAB accreditation, 7 NPHII awardees were accredited; another 38 had formally applied for accreditation.

Conclusions:

Through NPHII, awardees increased collaborative efforts around accreditation readiness, accelerated timelines for preparing for accreditation, and prioritized the completion of required accreditation activities.
A Survey of Prescribers' Attitudes, Knowledge, Comfort, and Fear of Consequences Related to an Opioid Overdose Education and Naloxone Distribution Program
Authors: Peckham Alyssa M. , Niculete Maria E. , Steinberg Howard , Boggs Douglas L.
Published: October 2017

Context:

The alarming increase in opioid-related fatalities has placed the United States in the midst of an opioid epidemic. In an effort to reduce opioid-related fatalities, each Veterans Affairs (VA) hospital is responsible for development of an OEND (Overdose Education and Naloxone Distribution) program to enhance naloxone distribution.

Objective:

To assess attitudes, knowledge, comfort level, and fear of consequences at the prescriber level related to the OEND program at VA Connecticut Healthcare System (VACHS).

Design:

Anonymous surveys were administered to VACHS prescribers to assess attitude, knowledge, comfort level, and fear of consequences using a 5-point Likert scale.

Setting:

VACHS.

Participants:

VACHS prescribers (primary care physicians/internists, psychiatrists, physician assistants/advanced practice registered nurses, pharmacists) in primary care/medicine, mental health, and substance use disorder (SUD).

Methods:

Differences across 4 domains were analyzed using analysis of variance testing, and pairwise post hoc analysis was conducted using Tukey's HSD for all significant findings. Regression modeling was conducted to evaluate correlations between each group and survey responses.

Main Outcome:

Identify differences and potential barriers to program implementation across professions and practice specialty.

Results:

While primary care/medicine, mental health, and SUD prescribers had positive attitudes toward dispensing naloxone, SUD clinicians reported being more comfortable, more knowledgeable, and less fearful of consequences. In general, psychiatrists reported to be more knowledgeable and comfortable prescribing naloxone. In addition, prescribers who received naloxone training reported themselves to be more comfortable, more knowledgeable, and less fearful of the consequences of dispensing naloxone.

Conclusions:

Results indicate that barriers to OEND implementation continue to exist, and not all clinicians or practice specialties at VACHS are comfortable with dispensing naloxone. A targeted approach to training health care clinicians may lead to increased acceptance of naloxone dispensing. Additional research is needed to elicit the best method of improved acceptance of naloxone to expand naloxone access.
Promoting Health Department Opioid-Prescribing Guidelines for New York City Emergency Departments: A Qualitative Evaluation
Authors: Nagel Frederick W. , Kattan Jessica A. , Mantha Shivani , Nelson Lewis S. , Kunins Hillary V. , Paone Denise
Published: October 2017

To address the epidemic of opioid misuse and overdose, the New York City Department of Health and Mental Hygiene partnered with an expert panel of emergency medicine physicians to develop voluntary guidelines for judicious prescribing of opioids upon discharge from an emergency department. A qualitative evaluation of the guidelines was conducted using semistructured interviews with emergency department directors and providers. The guidelines were widely supported by respondents and cited as helpful in easing difficult negotiations with patients requesting opioids. Involvement of the expert panel in development of guidelines was particularly valuable in ensuring their credibility. Health departments should consider partnering with emergency physicians to promote the public health goal of judicious opioid prescribing.
Revisiting the Skin Lines on the Forehead and Glabellar Area
Authors: Hwang Kun
Published: October 2017

This paper attempted to revisit the skin lines in forehead and glabellar area.

Using PubMed, Scopus, and Google, papers describing skin tension lines of face were searched. Papers with illustrations or pictures of the facial lines were selected and reviewed. The studies of the skin lines in the forehead and glabellar area were analyzed.

Langer used the term “cleavage of the cutis, anatomical lines.” Over the forehead, he found a border zone of horizontal folds that were interrupted many times by the ascending folds coming from the flabella area. Cox used the terms “cleavage lines of the skin” and “lines of increased tension.” In the glabellar area, cleavage lines were vertical and extended to the forehead. Rubin used the term “skin line.” In the midline area over the nose, the skin wrinkled vertically. Kraissl used the term “normal wrinkle line.” Above the nose, “curving vertical lines” were observed. Straith et al used the terms “normal tension line,” and “Langer line.” In the glabellar area, the horizontal lines from the upper eyelids became “curved vertically” until meeting the supra-brow horizontal line. Borges used the term “relaxed skin tension line.” At the medial end of the eyebrow, his relaxed skin tension line ran obliquely upward and medially, to meet the contralateral line. Namikawa et al used the term “cleavage lines of the skin.” It ran mediosuperiorly to inferolaterally, bordering the linea mediana anterior in glabellar area.

Following the consensus of most authors, a curved vertical line following the glabellar frown is recommended for incisions for flaps or grafts.
Selected Factors Against Functional Performance in Patients in the Early Period After Stroke
Authors: Przysada Grzegorz , Leszczak Justyna , Czenczek-Lewandowska Ewelina , Podgórska-Bednarz Justyna , Wyszyn´ska Justyna , Baran Joanna , Weres Aneta , Druz·bicki Mariusz
Published: October 2017

The main objective of the study was to evaluate the impact of selected clinical factors on functional performance in 693 patients in the early period after stroke. The level of functional performance of each patient was evaluated twice (before and after 4 weeks of rehabilitation) using the short version of the Barthel Index. A comprehensive 4-week rehabilitation program significantly improved the functional performance of stroke survivors (P = .0001). There was no significant relationship between functional improvement and age (P = .3800), sex (P = .4085), type of stroke (P = .7498), and side of paresis (P = .1573).
Community Lighting for Older Adults
Authors: Nastasi Julie Ann , Baumann Brynn , Glanton Shannon , Gordan Stephanie , Gower Natalie , Kennedy Caitlin , Mertz Layne , Russo Deanna , Williams Courtney
Published: October 2017

Objective:

To develop an understanding of community lighting and its impact on older adults.

Subjects and Methods:

This mixed-methods study addressed lighting in 94 facilities in a 3×3 block area. Lux, the amount of light on a surface area, was measured in key areas within facilities.

Results and Conclusions:

The amount of light and glare varied within and across facilities. Because of variability of lighting and glare, it is recommended to train older adults in techniques to increase lighting and decrease glare in the community.
Accessible Fall Prevention Interventions for Older Adults With Low Vision
Authors: Blaylock Sarah E. , Vogtle Laura K. , Warren Mary
Published: October 2017

Objectives:

To assess fall prevention services and provide information on tailoring interventions for older adults with low vision.

Methods:

A phenomenological qualitative design was conducted using semistructured interviews of visually impaired older adults. Interviews were audio recorded and transcribed verbatim for analysis.

Results:

Despite frequent falls, participants received limited fall interventions. Participants described key elements of an accessible intervention including visually accessible handouts tailored for visually impaired persons, multiple delivery methods, and an accessible location.

Conclusions:

Participants affirmed a lack of fall prevention services and provided insight into how to design educational interventions for older adults with vision impairment.
Communication Supports and Best Practices
Authors: King Julia M. , Simmons-Mackie Nina
Published: October 2017

When people with aphasia have difficulty communicating, there is a risk for miscommunication and negative outcomes related to medical care and safety (Blackstone, Beukelman, & Yorkston, 2015). This risk can be reduced by ensuring that each person with aphasia can communicate effectively when using different types of discourse and at different points in the rehabilitation process. People with aphasia may need communication supports, which could entail use of any intervention program, technique, strategy, training, or modification that supplements their receptive and expressive language skills to increase communicative effectiveness. Effective communication is addressed in best practice recommendations and guidelines for aphasia as well as The Joint Commission Standards for Patient-Centered Communication (Aphasia United, 2014
;
NHMRC AARP, 2014
;
N. Simmons-Mackie et al., 2017
;
The Joint Commission, 2010). This article summarizes how incorporating communication supports into varied forms of discourse and all aspects of aphasia rehabilitation and care aligns with best clinical practices and national accreditation requirements.
Person-Centered Memory and Communication Strategies for Adults With Dementia
Authors: Lanzi Alyssa , Burshnic Vanessa , Bourgeois Michelle S.
Published: October 2017

The increasing incidence of aging adults with cognitive-communication impairments and demand for services that enhance the quality of life of this population necessitates examination of the evidence-based strategies that hold the most promise in producing desired quality-of-life outcomes. The adoption of person-centered care approaches in health care (Kitwood, 1997) allows for a better understanding of how to include the person with cognitive-communication impairment in the process of identifying communication needs, developing intervention approaches, and modifying strategies as needs change. The continuum of dementia severity and the cognitive-communication characteristics at each stage are outlined as a guide for selecting compensatory communication supports to fit changing needs. Environmental features and the training of caregivers are important components of a person-centered care model that aims to ensure that individuals with dementia are respected and can live fulfilling lives.
Communication Supports for People With Motor Speech Disorders
Authors: Hanson Elizabeth K. , Fager Susan K.
Published: October 2017

Communication supports for people with motor speech disorders can include strategies and technologies to supplement natural speech efforts, resolve communication breakdowns, and replace natural speech when necessary to enhance participation in all communicative contexts. This article emphasizes communication supports that can enhance participation, as described in the World Health Organization's International Classification of Functioning, Disability and Health. The article begins with a discussion of partner and patient-reported assessments to evaluate participation levels and barriers to participation. Then, it provides an overview of communication supports for speakers with motor speech disorders, organized by the status of the disorder as stable, improving, or degenerative. The article includes nine case examples to illustrate principles and provide examples of how to address stable and changing needs.
Recent advances in the management of symptomatic vertebral artery stenosis
Authors: Drazyk Anna M. , Markus Hugh S.
Published: October 2017

Purpose of review

Vertebrobasilar stenosis accounts for 20% of posterior circulation strokes and is associated with high risk of early stroke recurrence. We review data from randomized controlled trials examining whether stenting may reduce this risk, including the recently published Vertebral Artery Ischaemia Stenting Trial (VIST).

Recent findings

VIST and VAST (Vertebral Artery Stenting Trial), having recruited both intracranial and extracranial vertebral stenosis and showed a low rate of perioperative stroke for extracranial (0 and 2%, respectively), but a higher rate for intracranial stenosis (15 and 22%, respectively). In VIST, the primary endpoint of stroke occurred in five patients in the stent group vs. 12 in the medical group (hazard ratio 0.40; 95% confidence interval 0.14–1.13, P = 0.08), although when days from last symptoms were adjusted for, the hazard ratio was 0.34 (95% confidence interval 0.12–0.98; P = 0.046). SAMMPRIS (Stenting and Aggressive Medical Management for the Prevention of Recurrent Stroke in Intracranial Stenosis) recruited only intracranial vertebral stenosis and showed a better outcome with intensive medical therapy than stenting.

Stenting of extracranial stenosis can be performed with a low operative risk. VIST suggests it may reduce longer term stroke risk, but this needs confirming in larger trials. For intracranial stenosis, due to a higher operative risk, current evidence favours medical treatment. SAMMPRIS have emphasized the need for intensive medical therapy whether or not stenting is performed.
The Drosophila small conductance potassium channel (SK) negatively regulates nociception
Authors: Walcott Kia , Mauthner Stephanie , Tsubouchi Asako , Robertson Jessica , Tracey W. Daniel
Published: October 2017

Inhibition of nociceptor activity is important for the prevention of spontaneous pain and hyperalgesia. To identify the critical K+channels that regulate nociceptor excitability we performed a forward genetic screen using aDrosophilalarval nociception paradigm. Knockdown of three K+channel loci, thesmall conductance calcium-activated potassium channel(SK),seizureandtiwaz, resulted in marked hypersensitive nociception behaviors. In more detailed studies ofSK, we found that hypersensitive phenotypes could be recapitulated with a genetically null allele. Importantly, the null mutant phenotype could be rescued with tissue specific expression of anSKcDNA in nociceptors. Optical recordings from nociceptive neurons showed a significant increase in mechanically activated Ca2+signals inSKmutant nociceptors. SK showed expression in peripheral neurons. Interestingly SK proteins localized to axons of these neurons but were not detected in dendrites. Our findings suggest a major role for SK channels in the regulation of nociceptor excitation and they are inconsistent with the hypothesis that the important site of action is within dendrites.

Highlights

–Specific potassium channels regulate nociceptor excitability.

–SK channels have a critical function in nociception.

–SK channels specifically localize to sensory axons

–SK channels are not detectable in sensory dendrites.
Osteo-Oto-Hepato-Enteric Syndrome (O2HE) is caused by loss of function mutations inUNC45A
Authors: Esteve Clothilde , Francescatto Ludmila , Tan Perciliz L. , Bourchany Aurélie , De Leusse Cécile , Marinier Evelyne , Blanchard Arnaud , Bourgeois Patrice , Brochier-Armanet Céline , Bruel Ange-Line , Delarue Arnauld , Duffourd Yannis , Ecochard-Dugelay Emmanuelle , Hery Géraldine , Huet Frédéric , Gauchez Philippe , Gonzales Emmanuel , Guettier-Bouttier Catherine , Komuta Mina , Lacoste Caroline , Maudinas Raphaelle , Mazodier Karin , Rimet Yves , Rivière Jean-Baptiste , Roquelaure Bertrand , Sigaudy Sabine , Stephenne Xavier , Thauvin-Robinet Christel , Thevenon Julien , Sarles Jacques , Levy Nicolas , Badens Catherine , Goulet Olivier , Hugot Jean-Pierre , Katsanis Nicholas , Faivre Laurence , Fabre Alexandre
Published: October 2017

Despite the rapid discovery of genes for rare genetic disorders, we continue to encounter individuals presenting with hitherto unknown syndromic manifestations. Here, we have studied four affected people in three families presenting with cholestasis, congenital diarrhea, impaired hearing and bone fragility, a clinical entity we have termed O2HE (Osteo-Oto-Hepato-enteric) syndrome. Whole exome sequencing of all affected individuals and their parents identified biallelic mutations in Unc-45 Myosin Chaperone A (UNC45A), as a likely driver for this disorder. Subsequent in vitro and in vivo functional studies of the candidate gene indicated a loss of function paradigm, wherein mutations attenuated or abolished protein activity with concomitant defects in gut development and function.
High-affinity low-capacity and low-affinity high-capacity N-acetyl-2-aminofluorene (AAF) macromolecular binding sites are revealed during the growth cycle of adult rat hepatocytes in primary culture
Authors: Koch K.S. , Moran T. , Shier W.T. , Leffert H.L.
Published: October 2017

Long-term cultures of primary adult rat hepatocytes were used to study the effects of N-acetyl-2-aminofluorene (AAF) on hepatocyte proliferation during the growth cycle; on the initiation of hepatocyte DNA synthesis in quiescent cultures; and, on hepatocyte DNA replication following the initiation of DNA synthesis. Scatchard analyses were used to identify the pharmacologic properties of radiolabeled AAF metabolite binding to hepatocyte macromolecules. Two classes of growth cycle-dependent AAF metabolite binding sites – a high-affinity low-capacity site (designated Site I) and a low-affinity high-capacity site (designated Site II) – associated with two spatially distinct classes of macromolecular targets, were revealed. Based upon radiolabeled AAF metabolite binding to purified hepatocyte genomic DNA or to DNA, RNA, proteins and lipids from isolated nuclei, Site IDAY 4targets (KD[APPARENT]≈ 2-4 x 10−6M and BMAX[APPARENT]≈ 6 pmols/106cells/24 h) were consistent with genomic DNA; and with AAF metabolized by a nuclear cytochrome P450. Based upon radiolabeled AAF binding to total cellular lysates, Site IIDAY 4targets (KD[APPARENT]≈ 1.5 x 10−3M and BMAX[APPARENT]≈ 350 pmols/106cells/24 h) were consistent with cytoplasmic proteins; and with AAF metabolized by cytoplasmic cytochrome P450s. DNA synthesis was not inhibited by concentrations of AAF that saturated DNA binding in the neighborhood of the Site I KD. Instead, hepatocyte DNA synthesis inhibition required higher concentrations of AAF approaching the Site II KD. These observations raise the possibility that carcinogenic DNA adducts derived from AAF metabolites form below concentrations of AAF that inhibit replicative and repair DNA synthesis.
Gene expression in patient-derived neural progenitors implicates WNT5A signaling in the etiology of schizophrenia
Authors: Evgrafov Oleg V , Armoskus Chris , Wrobel Bozena B , Spitsyna Valeria N , Souaiaia Tade , Herstein Jennifer S. , Walker Christopher P , Nguyen Joseph D , Camarena Adrian , Weitz Jonathan R , Kim Jae Mun ‘Hugo’ , Duarte Edder Lopez , Wang Kai , Simpson George M , Sobell Janet L , Medeiros Helena , Pato Michele T , Pato Carlos N , Knowles James A
Published: October 2017

BACKGROUND

GWAS of schizophrenia demonstrated that variations in the non-coding regions are responsible for most of common variation heritability of the disease. It is hypothesized that these risk variants alter gene expression. Thus, studying alterations in gene expression in schizophrenia may provide a direct approach to understanding the etiology of the disease. In this study we useCulturedNeural progenitor cells derived fromOlfactoryNeuroepithelium (CNON) as a genetically unaltered cellular model to elucidate the neurodevelopmental aspects of schizophrenia.

METHODS

We performed a gene expression study using RNA-Seq of CNON from 111 controls and 144 individuals with schizophrenia. Differentially expressed (DEX) genes were identified with DESeq2, using covariates to correct for sex, age, library batches and one surrogate variable component.

RESULTS

80 genes were DEX (FDR<10%), showing enrichment in cell migration, cell adhesion, developmental process, synapse assembly, cell proliferation and related gene ontology categories. Cadherin and Wnt signaling pathways were positive in overrepresentation test, and, in addition, many genes are specifically involved in Wnt5A signaling. The DEX genes were significantly, enriched in the genes overlapping SNPs with genome-wide significant association from the PGC GWAS of schizophrenia (PGC SCZ2). We also found substantial overlap with genes associated with other psychiatric disorders or brain development, enrichment in the same GO categories as genes with mutationsde novoin schizophrenia, and studies of iPSC-derived neural progenitor cells.

CONCLUSIONS

CNON cells are a good model of the neurodevelopmental aspects of schizophrenia and can be used to elucidate the etiology of the disorder.
Draft genomes of the fungal pathogen Phellinus noxius in Hong Kong
Authors: Tsang Karen Sze Wing , Lam Regent Yau Ching , Kwan Hoi Shan
Published: October 2017

The fungal pathogen Phellinus noxius is the underlying cause of brown root rot, a disease with causing tree mortality globally, causing extensive damage in urban areas and crop plants. This disease currently has no cure, and despite the global epidemic, little is known about the pathogenesis and virulence of this pathogen.

Using Ion Torrent PGM, Illumina MiSeq and PacBio RSII sequencing platforms with various genome assembly methods, we produced the draft genome sequences of four P. noxius strains isolated from infected trees in Hong Kong to further understand the pathogen and identify the mechanisms behind the aggressive nature and virulence of this fungus. The resulting genomes ranged from 30.8Mb to 31.8Mb in size, and of the four sequences, the YTM97 strain was chosen to produce a high-quality Hong Kong strain genome sequence, resulting in a 31Mb final assembly with 457 scaffolds, an N50 length of 275,889 bp and 96.2% genome completeness. RNA-seq of YTM97 using Illumina HiSeq400 was performed for improved gene prediction. AUGUSTUS and Genemark-ES prediction programs predicted 9,887 protein-coding genes which were annotated using GO and Pfam databases. The encoded carbohydrate active enzymes revealed large numbers of lignolytic enzymes present, comparable to those of other white-rot plant pathogens. In addition, P. noxius also possessed larger numbers of cellulose, xylan and hemicellulose degrading enzymes than other plant pathogens. Searches for virulence genes was also performed using PHI-Base and DFVF databases revealing a host of virulence-related genes and effectors. The combination of non-specific host range, unique carbohydrate active enzyme profile and large amount of putative virulence genes could explain the reasons behind the aggressive nature and increased virulence of this plant pathogen.

The draft genome sequences presented here will provide references for strains found in Hong Kong. Together with emerging research, this information could be used for genetic diversity and epidemiology research on a global scale as well as expediting our efforts towards discovering the mechanisms of pathogenicity of this devastating pathogen.
Identification of Cell States Using Super-Enhancer RNA
Authors: Tu Yueh-Hua , Juan Hsueh-Fen , Huang Hsuan-Cheng
Published: October 2017

A new class of regulatory elements called super-enhancers, comprised of multiple neighboring enhancers, have recently been reported to be the key transcriptional drivers of cellular, developmental, and disease states. Here, we propose to define super-enhancer RNA as highly expressed enhancer RNAs that are transcribed from a cluster of localized genomic regions. Using the cap analysis of gene expression sequencing data from FANTOM5, we systematically explored the enhancer and messenger RNA landscapes in hundreds of different cell types in response to various environments. Applying non-negative matrix factorization (NMF) to super-enhancer RNA profiles, we found that different cell types were well classified. In addition, through the NMF of individual time-course profiles from a single cell-type, super-enhancer RNAs were clustered into several states with progressive patterns. We further investigated the enriched biological functions of the proximal genes involved in each pattern, and found that they were associated with the corresponding developmental process. The proposed super-enhancer RNAs can act as a good alternative, without the complicated measurement of histone modifications, for identifying important regulatory elements of cell type specification and identifying dynamic cell states.
Transcriptional regulation by NR5A2 couples cell differentiation and inflammation in the pancreas
Authors: Cobo Isidoro , Martinelli Paola , Flández Marta , Bakiri Latifa , Zhang Mingfeng , Carrillo-de-Santa-Pau Enrique , Jia Jinping , Thommesen Liv , Bruland Torunn , del Pozo Natalia , Olson Sara , Smith Jill , Bamlet William R. , Petersen Gloria M , Malats Núria , Amundadottir Laufey T , Wagner Erwin F. , Real Francisco X
Published: October 2017

Tissue-specific differentiation and inflammatory programmes are thought to independently contribute to disease. The orphan nuclear receptor NR5A2 is a key regulator of pancreas differentiation and SNPs in or near the human gene are associated with risk of pancreatic cancer. In mice, Nr5a2 heterozygosity sensitizes the pancreas to damage, impairs regeneration, and cooperates with mutant KRas in tumor progression. Through global transcriptomic analysis, we uncover a basal pre-inflammatory state in the pancreas of Nr5a2 heterozygous mice that is reminiscent of pancreatitis-induced inflammation and is conserved in histologically normal human pancreata with reduced NR5A2 mRNA expression. In Nr5a2+/− mice, Nr5a2 undergoes a dramatic transcriptional switch relocating from tissue-specific to inflammatory loci thereby promoting AP-1-dependent gene transcription. Importantly, deletion of c-Jun in the pancreas of these mice rescues the pre-inflammatory phenotype and the defective regenerative response to damage. These findings provide compelling evidence that the same transcriptional networks supporting homeostasis in normal tissue can be subverted to foster inflammation upon genetic or environmental constraints.