Issue Information

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Sectioned images and 3D models of a cadaver head with reference to dermal filler injection

Publication date: Available online 2 March 2018
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Dong Sun Shin, YoungJoo Shim, Bong Chul Kim
The purpose of this study was to describe anatomical consideration with reference to dermal filler injection on sectioned images and three dimensional (3D) models using Visible Korean for medical education and clinical training purposes in the field of facial surgery. Serially sectioned images of the head were acquired from a cadaver. Anatomic structures related to dermal filler injection were 3D-reconstructed based on sectioned images, and additional structures were built on the basis of the established ones using a semi-automatic method. The anatomical 3D models were assembled and converted to a PDF file (66MB), which can be downloaded and used for free. In the PDF file, noticeable anatomical structures related with dermal filler injection can be identified on the 3D models as well as on the sectioned anatomical images. The 3D models in PDF were optimized and displayed in real time. These state-of-the-art sectioned images, outlined images, and 3D models will aid students and trainees to acquire a better understanding of the anatomy related to dermal filler injection, and will also improve medical understanding of patients and the general public. The 3D models in PDF files also can be used on dermal filler injection simulations.



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Editorial Board

Publication date: March 2018
Source:Annals of Anatomy - Anatomischer Anzeiger, Volume 216





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Living Up to the Hype: Protein Synthesis Promotes Hypertranscription in Embryonic Stem Cells

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Miriama Kruta, Robert A.J. Signer
The rapid proliferation and unlimited self-renewal of embryonic stem cells depends upon a permissive chromatin landscape that enables hypertranscription. In this issue of Cell Stem Cell, Bulut-Karslioglu et al. report that euchromatin and transcriptional output are enhanced by protein synthesis in embryonic stem cells (Bulut-Karslioglu et al., 2018).

Teaser

The rapid proliferation and unlimited self-renewal of embryonic stem cells depends upon a permissive chromatin landscape that enables hypertranscription. In this issue of Cell Stem Cell, Bulut-Karslioglu et al. report that euchromatin and transcriptional output are enhanced by protein synthesis in embryonic stem cells (Bulut-Karslioglu et al., 2018).


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Sensors of Succinate: Neural Stem Cell Grafts Fight Neuroinflammation

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Zaal Kokaia, Olle Lindvall
In this issue of Cell Stem Cell, Peruzzotti-Jametti et al. (2018) demonstrate how neural stem cells, transplanted in a mouse model of multiple sclerosis, respond to extracellular succinate and modulate neuroinflammation by releasing anti-inflammatory prostaglandin E2 and scavenging succinate. This mechanism reduces CNS damage and ameliorates motor impairment.

Teaser

In this issue of Cell Stem Cell, Peruzzotti-Jametti et al. (2018) demonstrate how neural stem cells, transplanted in a mouse model of multiple sclerosis, respond to extracellular succinate and modulate neuroinflammation by releasing anti-inflammatory prostaglandin E2 and scavenging succinate. This mechanism reduces CNS damage and ameliorates motor impairment.


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Reversing Time: Ezh1 Deficiency Hastens Definitive Hematopoiesis

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): April C. Apostol, Anna E. Beaudin
The inability to derive multipotent hematopoietic stem cells in vitro stems in part from a limited understanding of how multipotency is acquired during development. Recently in Nature,Vo et al. (2018) reveal the epigenetic enzyme Ezh1 as a master regulator of multipotency during hematopoietic stem cell development.

Teaser

The inability to derive multipotent hematopoietic stem cells in vitro stems in part from a limited understanding of how multipotency is acquired during development. Recently in Nature, Vo et al. (2018) reveal the epigenetic enzyme Ezh1 as a master regulator of multipotency during hematopoietic stem cell development.


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Who Defends the Stem Cell’s Citadel?

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Hélène Strick-Marchand, David Durantel
Recently in Cell, Wu et al. (2018) demonstrated that intrinsic expression of a subset of interferon stimulated genes confers resistance to viral infections in stem cells both in vitro and in vivo, while differentiated cells lose this intrinsic gatekeeper expression pattern in favor of inducible interferon responses.

Teaser

Recently in Cell, Wu et al. (2018) demonstrated that intrinsic expression of a subset of interferon stimulated genes confers resistance to viral infections in stem cells both in vitro and in vivo, while differentiated cells lose this intrinsic gatekeeper expression pattern in favor of inducible interferon responses.


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Organoid Models of Cancer Explode with Possibilities

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Senthil K. Muthuswamy
Organoids have tremendous promise for modeling human cancers and revealing new biological insights. Sachs et al. (2018), Seino et al. (2018) (in this issue of Cell Stem Cell), and Broutier et al. (2017) derive cancer organoids from breast, pancreas, and liver, respectively, not only reporting new methodologies but also showing their utility for translational and clinical cancer research.

Teaser

Organoids have tremendous promise for modeling human cancers and revealing new biological insights. Sachs et al. (2018), Seino et al. (2018) (in this issue of Cell Stem Cell), and Broutier et al. (2017) derive cancer organoids from breast, pancreas, and liver, respectively, not only reporting new methodologies but also showing their utility for translational and clinical cancer research.


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Engineering a Strong Bond between Stem Cells and Biotechnology

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Anh Nguyen, Matt Pavlovich




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Mentoring the Next Generation: Robert Langer

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3

Mentor-mentee relationships are essential for professional development, but developing these interpersonal skills is not often highlighted as a priority in scientific endeavors. In a yearlong series, Cell Stem Cell interviews prominent scientists who have prioritized mentorship over the years. Here, we chat with Dr. Robert Langer about his views.

Teaser

Mentor-mentee relationships are essential for professional development, but developing these interpersonal skills is not often highlighted as a priority in scientific endeavors. In a yearlong series, Cell Stem Cell interviews prominent scientists who have prioritized mentorship over the years. Here, we chat with Dr. Robert Langer about his views.


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Human Pluripotent Stem Cell-Derived Engineered Tissues: Clinical Considerations

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Kelly R. Stevens, Charles E. Murry
The combined power of human pluripotent stem cells and tissue engineering promises to revolutionize medicine by building tissue patches and artificial replacement organs for patients battling diverse diseases. Here, we articulate some big questions that need to be addressed before such engineered tissues become mainstream in the clinic.

Teaser

The combined power of human pluripotent stem cells and tissue engineering promises to revolutionize medicine by building tissue patches and artificial replacement organs for patients battling diverse diseases. Here, we articulate some big questions that need to be addressed before such engineered tissues become mainstream in the clinic.


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Engineering Human Bone Marrow Proxies

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Paul E. Bourgine, Ivan Martin, Timm Schroeder
Recent advances in engineering complex organs in vitro inspire the development of human bone marrow equivalents to foster scientific discovery and innovative therapeutics. Here, we discuss challenges in generating relevant human bone marrow proxies, potential design principles, and future directions.

Teaser

Recent advances in engineering complex organs in vitro inspire the development of human bone marrow equivalents to foster scientific discovery and innovative therapeutics. Here, we discuss challenges in generating relevant human bone marrow proxies, potential design principles, and future directions.


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Understanding the Extracellular Matrix to Enhance Stem Cell-Based Tissue Regeneration

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Laura E. Niklason
The extracellular matrix is a biologically critical entity that has historically been poorly understood. Here we discuss how new tools for characterizing matrix composition and function enable us to design and deliver advanced matrices in vitro, to optimize regeneration, and in vivo, within a variety of tissues and organs.

Teaser

The extracellular matrix is a biologically critical entity that has historically been poorly understood. Here we discuss how new tools for characterizing matrix composition and function enable us to design and deliver advanced matrices in vitro, to optimize regeneration, and in vivo, within a variety of tissues and organs.


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Regenerative Rehabilitation: Applied Biophysics Meets Stem Cell Therapeutics

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Thomas A. Rando, Fabrisia Ambrosio
The emerging field of regenerative rehabilitation integrates biological and bioengineering advances in regenerative medicine with rehabilitative sciences. Here we highlight recent stem cell-based examples of the regenerative rehabilitation paradigm to promote tissue repair and regeneration, and we discuss remaining challenges and future directions for the field.

Teaser

The emerging field of regenerative rehabilitation integrates biological and bioengineering advances in regenerative medicine with rehabilitative sciences. Here we highlight recent stem cell-based examples of the regenerative rehabilitation paradigm to promote tissue repair and regeneration, and we discuss remaining challenges and future directions for the field.


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Organs-on-a-Chip: A Fast Track for Engineered Human Tissues in Drug Development

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Kacey Ronaldson-Bouchard, Gordana Vunjak-Novakovic
Organs-on-a-chip (OOCs) are miniature tissues and organs grown in vitro that enable modeling of human physiology and disease. The technology has emerged from converging advances in tissue engineering, semiconductor fabrication, and human cell sourcing. Encompassing innovations in human stem cell technology, OOCs offer a promising approach to emulate human patho/physiology in vitro, and address limitations of current cell and animal models. Here, we review the design considerations for single and multi-organ OOCs, discuss remaining challenges, and highlight the potential impact of OOCs as a fast-track opportunity for tissue engineering to advance drug development and precision medicine.

Teaser

Ronaldson-Bouchard and Vunjak-Novakovic discuss the design considerations for single and multi-organ organs-on-a-chip (OOCs) and highlight the potential impact of OOCs as a fast-track opportunity for tissue engineering to advance drug development and precision medicine.


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Engineering Stem and Stromal Cell Therapies for Musculoskeletal Tissue Repair

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Claudia Loebel, Jason A. Burdick
Stem cells and tissue-derived stromal cells stimulate the repair of degenerated and injured tissues, motivating a growing number of cell-based interventions in the musculoskeletal field. Recent investigations have indicated that these cells are critical for their trophic and immunomodulatory role in controlling endogenous cells. This Review presents recent clinical advances where stem cells and stromal cells have been used to stimulate musculoskeletal tissue repair, including delivery strategies to improve cell viability and retention. Emerging bioengineering strategies are highlighted, particularly toward the development of biomaterials for capturing aspects of the native tissue environment, altering the healing niche, and recruiting endogenous cells.

Teaser

Loebel and Burdick highlight emerging bioengineering strategies using stem and stromal cells for musculoskeletal tissue repair, particularly focusing on the development of biomaterials for capturing aspects of the native tissue environment, altering the healing niche, and recruiting endogenous cells.


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Vascular Tissue Engineering: Progress, Challenges, and Clinical Promise

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): H.-H. Greco Song, Rowza T. Rumma, C. Keith Ozaki, Elazer R. Edelman, Christopher S. Chen
Although the clinical demand for bioengineered blood vessels continues to rise, current options for vascular conduits remain limited. The synergistic combination of emerging advances in tissue fabrication and stem cell engineering promises new strategies for engineering autologous blood vessels that recapitulate not only the mechanical properties of native vessels but also their biological function. Here we explore recent bioengineering advances in creating functional blood macro and microvessels, particularly featuring stem cells as a seed source. We also highlight progress in integrating engineered vascular tissues with the host after implantation as well as the exciting pre-clinical and clinical applications of this technology.

Teaser

Song et al. explore recent bioengineering advances in creating functional blood macro- and microvessels, particularly featuring stem cells as a seed source. They highlight progress in integrating engineered vascular tissues with the host after implantation as well as the exciting pre-clinical and clinical applications of this technology.


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The Transcriptionally Permissive Chromatin State of Embryonic Stem Cells Is Acutely Tuned to Translational Output

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Aydan Bulut-Karslioglu, Trisha A. Macrae, Juan A. Oses-Prieto, Sergio Covarrubias, Michelle Percharde, Gregory Ku, Aaron Diaz, Michael T. McManus, Alma L. Burlingame, Miguel Ramalho-Santos
A permissive chromatin environment coupled to hypertranscription drives the rapid proliferation of embryonic stem cells (ESCs) and peri-implantation embryos. We carried out a genome-wide screen to systematically dissect the regulation of the euchromatic state of ESCs. The results revealed that cellular growth pathways, most prominently translation, perpetuate the euchromatic state and hypertranscription of ESCs. Acute inhibition of translation rapidly depletes euchromatic marks in mouse ESCs and blastocysts, concurrent with delocalization of RNA polymerase II and reduction in nascent transcription. Translation inhibition promotes rewiring of chromatin accessibility, which decreases at a subset of active developmental enhancers and increases at histone genes and transposable elements. Proteome-scale analyses revealed that several euchromatin regulators are unstable proteins and continuously depend on a high translational output. We propose that this mechanistic interdependence of euchromatin, transcription, and translation sets the pace of proliferation at peri-implantation and may be employed by other stem/progenitor cells.

Graphical abstract

Teaser

Bulut-Karslioglu et al. show that the transcriptionally permissive chromatin landscapes in mouse embryonic stem cells and blastocysts are acutely sensitive to variations in translational output. This positive feedback loop between permissive chromatin and translation, in turn, may set the rapid pace of growth during early embryonic development.


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CD157 Marks Tissue-Resident Endothelial Stem Cells with Homeostatic and Regenerative Properties

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Taku Wakabayashi, Hisamichi Naito, Jun-ichi Suehiro, Yang Lin, Hideya Kawaji, Tomohiro Iba, Tsukasa Kouno, Sachi Ishikawa-Kato, Masaaki Furuno, Kazuhiro Takara, Fumitaka Muramatsu, Jia Weizhen, Hiroyasu Kidoya, Katsuhiko Ishihara, Yoshihide Hayashizaki, Kohji Nishida, Mervin C. Yoder, Nobuyuki Takakura
The generation of new blood vessels via angiogenesis is critical for meeting tissue oxygen demands. A role for adult stem cells in this process remains unclear. Here, we identified CD157 (bst1, bone marrow stromal antigen 1) as a marker of tissue-resident vascular endothelial stem cells (VESCs) in large arteries and veins of numerous mouse organs. Single CD157⁺ VESCs form colonies in vitro and generate donor-derived portal vein, sinusoids, and central vein endothelial cells upon transplantation in the liver. In response to injury, VESCs expand and regenerate entire vasculature structures, supporting the existence of an endothelial hierarchy within blood vessels. Genetic lineage tracing revealed that VESCs maintain large vessels and sinusoids in the normal liver for more than a year, and transplantation of VESCs rescued bleeding phenotypes in a mouse model of hemophilia. Our findings show that tissue-resident VESCs display self-renewal capacity and that vascular regeneration potential exists in peripheral blood vessels.

Graphical abstract

Teaser

Whether tissue-resident vascular endothelial stem cells (VESCs) exist has remained unclear. The present study demonstrates that CD157 marks vessel-resident VESCs in mouse organs that are capable of clonal expansion, angiogenesis initiation, and blood vessel maintenance. These findings represent a paradigm shift in understanding endothelial cell hierarchy within the blood vessels.


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Vangl2/RhoA Signaling Pathway Regulates Stem Cell Self-Renewal Programs and Growth in Rhabdomyosarcoma

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Madeline N. Hayes, Karin McCarthy, Alexander Jin, Mariana L. Oliveira, Sowmya Iyer, Sara P. Garcia, Sivasish Sindiri, Berkley Gryder, Zainab Motala, G. Petur Nielsen, Jean-Paul Borg, Matt van de Rijn, David Malkin, Javed Khan, Myron S. Ignatius, David M. Langenau
Tumor growth and relapse are driven by tumor propagating cells (TPCs). However, mechanisms regulating TPC fate choices, maintenance, and self-renewal are not fully understood. Here, we show that Van Gogh-like 2 (Vangl2), a core regulator of the non-canonical Wnt/planar cell polarity (Wnt/PCP) pathway, affects TPC self-renewal in rhabdomyosarcoma (RMS)—a pediatric cancer of muscle. VANGL2 is expressed in a majority of human RMS and within early mononuclear progenitor cells. VANGL2 depletion inhibited cell proliferation, reduced TPC numbers, and induced differentiation of human RMS in vitro and in mouse xenografts. Using a zebrafish model of embryonal rhabdomyosarcoma (ERMS), we determined that Vangl2 expression enriches for TPCs and promotes their self-renewal. Expression of constitutively active and dominant-negative isoforms of RHOA revealed that it acts downstream of VANGL2 to regulate proliferation and maintenance of TPCs in human RMS. Our studies offer insights into pathways that control TPCs and identify new potential therapeutic targets.

Graphical abstract

Teaser

Hayes et al. find that Vangl2 specifically labels progenitors that sustain growth and self-renewal in both zebrafish and human rhabdomyosarcoma and is required for their maintenance. This work reveals direct regulation of stem cell programs and tumor growth by Vangl2/RhoA signaling, offering opportunities for direct assessment and therapeutic targeting.


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SETD7 Drives Cardiac Lineage Commitment through Stage-Specific Transcriptional Activation

Publication date: 1 March 2018
Source:Cell Stem Cell, Volume 22, Issue 3
Author(s): Jaecheol Lee, Ning-Yi Shao, David T. Paik, Haodi Wu, Hongchao Guo, Vittavat Termglinchan, Jared M. Churko, Youngkyun Kim, Tomoya Kitani, Ming-Tao Zhao, Yue Zhang, Kitchener D. Wilson, Ioannis Karakikes, Michael P. Snyder, Joseph C. Wu
Cardiac development requires coordinated and large-scale rearrangements of the epigenome. The roles and precise mechanisms through which specific epigenetic modifying enzymes control cardiac lineage specification, however, remain unclear. Here we show that the H3K4 methyltransferase SETD7 controls cardiac differentiation by reading H3K36 marks independently of its enzymatic activity. Through chromatin immunoprecipitation sequencing (ChIP-seq), we found that SETD7 targets distinct sets of genes to drive their stage-specific expression during cardiomyocyte differentiation. SETD7 associates with different co-factors at these stages, including SWI/SNF chromatin-remodeling factors during mesodermal formation and the transcription factor NKX2.5 in cardiac progenitors to drive their differentiation. Further analyses revealed that SETD7 binds methylated H3K36 in the bodies of its target genes to facilitate RNA polymerase II (Pol II)-dependent transcription. Moreover, abnormal SETD7 expression impairs functional attributes of terminally differentiated cardiomyocytes. Together, these results reveal how SETD7 acts at sequential steps in cardiac lineage commitment, and they provide insights into crosstalk between dynamic epigenetic marks and chromatin-modifying enzymes.

Graphical abstract

Teaser

Wu and colleagues define SETD7 as a key regulator of cardiac lineage commitment. SETD7 regulates the expression of lineage-specific target genes and interacts with various co-factors during cardiomyocyte differentiation. SETD7 associates with H3K36me3 histone modification, which is required for the transcriptional activation.


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Eliminating bias and accelerating the clinical translation of oral microbiome research in oral oncology

Publication date: Available online 1 March 2018
Source:Oral Oncology
Author(s): Rohit Kunnath Menon, Divya Gopinath




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Impact of perioperative hyperglycemia in patients undergoing microvascular reconstruction

Abstract

Background

The effects of perioperative hyperglycemia on complications and outcomes in microvascular reconstruction have not been reported in the literature.

Methods

A retrospective cohort of 203 patients undergoing microvascular reconstruction was generated. Perioperative glucose levels and clinical factors were tested for associations with complications using simple and multivariate analyses.

Results

Hyperglycemia (blood glucose ≥ 180 mg/dL) occurred in 91 patients (44.8%) perioperatively, and was associated with increased rates of surgical complications, medical complications, surgical site infections, fistulas, and wound dehiscence. On univariate analysis, a more strict definition of hyperglycemia (blood glucose ≥ 165 mg/dL) was significantly associated with greater rates of venous thrombosis, although this lost statistical significance on multivariate analysis.

Conclusion

Perioperative hyperglycemia occurs commonly in patients undergoing microvascular reconstruction and is associated with higher rates of complications, independent of a preexisting diagnosis of diabetes mellitus. Further research is needed to define the ideal glycemic target in this population.

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A new technique for evaluating heel xerosis grade and the effects of moisturizer on heel skin dryness

Abstract

Background

Dryness-related heel skin problems are common; however, there are very few studies about heel skin dryness. The objective of this study was to develop new assessment methods for evaluating heel skin dryness, to clarify the characteristics associated with heal skin dryness, and assess the effectiveness of moisturizer use according to dryness severity.

Materials and methods

We investigated the heel skin of 150 Korean women (aged 20-78 years). Heel skin images were taken using a DSLR camera and the distribution or severity of flakes, scaling, cracking, and fissures were visually assessed. Skin properties such as hydration, transepidermal water loss (TEWL), amount of dead skin cells, and efficacy of moisturizer were evaluated according to heel xerosis grade. Furthermore, as conventional evaluation methods for desquamation are not appropriate for heel skin, we developed new techniques using binarization of magnified images.

Results

Skin hydration tended to decrease and TEWL tended to increase as heel dryness grade increased. The amount of dead skin cells increased with increasing dryness grade using the new technique. Subjects in the severe dryness group achieved similar hydration levels as normal subjects at baseline after 3 hours of moisturizer application.

Conclusion

Our new methods of visually classifying heel dryness and quantifying dead skin cells using magnified images effectively evaluated heel skin properties. As heel skin is prone to dryness, daily repetitive application of moisturizer might be helpful for hydrating dry heel skin, and ultimately preventing complications.

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Poor inter-rater reliability of hidradenitis suppurativa phenotypes

Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): K.R. van Straalen, T. Verhagen, B. Horváth, C. Ardon, A.R.J.V. Vossen, R. Driessen, J. Boer, A. Rondags, E.P. Prens, H.H. van der Zee




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T-cell–mediated immune response to pneumococcal conjugate vaccine (PCV-13) and tetanus toxoid vaccine in patients with moderate-to-severe psoriasis during tofacitinib treatment

Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Kevin L. Winthrop, Neil Korman, William Abramovits, Scott T. Rottinghaus, Huaming Tan, Annie Gardner, Geoffrey Mukwaya, Mandeep Kaur, Hernan Valdez
BackgroundPsoriasis is often treated with immunomodulatory therapies that can affect the immune response to common antigens. Tofacitinib is an oral Janus kinase inhibitor.ObjectiveTo characterize the effect of long-term exposure to tofacitinib 10 mg twice daily on T-cell function in psoriasis patients.MethodsPatients completing at least 3 months' continuous treatment with tofacitinib 10 mg twice daily were vaccinated with T-cell–dependent vaccines (monovalent tetanus toxoid and 13-valent pneumococcal conjugate [PCV-13]). Patients were assessed at baseline (before vaccination) and then again 4 weeks after vaccination. For PCV-13, we evaluated serotype-specific, opsonophagocytic antibody responses, and for tetanus toxoid, we evaluated humoral responses.ResultsAmong 60 patients who completed the study, the geometric mean fold rise from baseline for the 13 PCV serotypes at 4 weeks postvaccination varied from 8.3 (serotype 3) to 101.9 (serotype 6A). Similar results were observed for patients with and without lymphopenia at baseline. For tetanus toxoid, 51 (88%) patients had ≥2-fold and 35 (60%) patients had ≥4-fold rise in antibody concentration.LimitationsThere was no placebo control.ConclusionMost psoriasis patients who receive tofacitinib can mount satisfactory T-cell–dependent responses to PCV-13 and tetanus vaccines.



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Interleukin-17, Inflammation, and Cardiovascular Risk in Patients With Psoriasis

Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Benjamin Lockshin, Yevgeniy Balagula, Joseph F. Merola
In addition to being recognized as a chronic inflammatory disease that manifests in the skin, psoriasis is increasingly understood to be a systemic disease that causes immune dysregulation throughout the body. The systemic nature of psoriasis is evidenced by the higher burden of comorbidities and shorter life expectancies of patients with psoriasis, particularly those with early onset and severe disease. Notably, psoriasis is associated with an increased risk for cardiovascular disease, which is the most common cause of morbidity and mortality in patients with psoriasis. In this review, we examine the association between psoriasis and cardiovascular disease and specifically focus on the role of interleukin-17–mediated inflammation as a potential mechanistic link between psoriasis and cardiovascular disease. Moreover, we describe potential treatment approaches to reduce the burden of cardiovascular disease in patients with psoriasis, and discuss the clinical importance of the association of these 2 diseases with respect to patient management and education.



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Preimplantation Genetic Diagnosis of Multiple Endocrine Neoplasia Type 2A Using Informative Markers Identified by Targeted Sequencing

Thyroid , Vol. 0, No. 0.


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Issue Information

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Preface to Journal of Dermatology special issue: Psoriasis

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Issue Information

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Correlating the Dermatology Life Quality Index and Skin Discoloration Impact Evaluation Questionnaire tools in disorders of hyperpigmentation

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The SS18-SSX Oncoprotein Hijacks KDM2B-PRC1.1 to Drive Synovial Sarcoma

Publication date: Available online 1 March 2018
Source:Cancer Cell
Author(s): Ana Banito, Xiang Li, Aimée N. Laporte, Jae-Seok Roe, Francisco Sanchez-Vega, Chun-Hao Huang, Amanda R. Dancsok, Katerina Hatzi, Chi-Chao Chen, Darjus F. Tschaharganeh, Rohit Chandwani, Nilgun Tasdemir, Kevin B. Jones, Mario R. Capecchi, Christopher R. Vakoc, Nikolaus Schultz, Marc Ladanyi, Torsten O. Nielsen, Scott W. Lowe
Synovial sarcoma is an aggressive cancer invariably associated with a chromosomal translocation involving genes encoding the SWI-SNF complex component SS18 and an SSX (SSX1 or SSX2) transcriptional repressor. Using functional genomics, we identify KDM2B, a histone demethylase and component of a non-canonical polycomb repressive complex 1 (PRC1.1), as selectively required for sustaining synovial sarcoma cell transformation. SS18-SSX1 physically interacts with PRC1.1 and co-associates with SWI/SNF and KDM2B complexes on unmethylated CpG islands. Via KDM2B, SS18-SSX1 binds and aberrantly activates expression of developmentally regulated genes otherwise targets of polycomb-mediated repression, which is restored upon KDM2B depletion, leading to irreversible mesenchymal differentiation. Thus, SS18-SSX1 deregulates developmental programs to drive transformation by hijacking a transcriptional repressive complex to aberrantly activate gene expression.

Graphical abstract

Teaser

Banito et al. show that SS18-SSX fusions characteristic of synovial sarcoma associate with KDM2B-PRC1.1, a non-canonical polycomb repressive complex 1, to aberrantly activate the expression of developmentally regulated transcription factors that are normally targets of polycomb-mediated gene repression.


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ORY-1001, a Potent and Selective Covalent KDM1A Inhibitor, for the Treatment of Acute Leukemia

Publication date: Available online 1 March 2018
Source:Cancer Cell
Author(s): Tamara Maes, Cristina Mascaró, Iñigo Tirapu, Angels Estiarte, Filippo Ciceri, Serena Lunardi, Nathalie Guibourt, Alvaro Perdones, Michele M.P. Lufino, Tim C.P. Somervaille, Dan H. Wiseman, Cihangir Duy, Ari Melnick, Christophe Willekens, Alberto Ortega, Marc Martinell, Nuria Valls, Guido Kurz, Matthew Fyfe, Julio Cesar Castro-Palomino, Carlos Buesa
The lysine-specific demethylase KDM1A is a key regulator of stem cell potential in acute myeloid leukemia (AML). ORY-1001 is a highly potent and selective KDM1A inhibitor that induces H3K4me2 accumulation on KDM1A target genes, blast differentiation, and reduction of leukemic stem cell capacity in AML. ORY-1001 exhibits potent synergy with standard-of-care drugs and selective epigenetic inhibitors, reduces growth of an AML xenograft model, and extends survival in a mouse PDX (patient-derived xenograft) model of T cell acute leukemia. Surrogate pharmacodynamic biomarkers developed based on expression changes in leukemia cell lines were translated to samples from patients treated with ORY-1001. ORY-1001 is a selective KDM1A inhibitor in clinical trials and is currently being evaluated in patients with leukemia and solid tumors.

Teaser

Maes et al. develop ORY-1001, a highly potent and selective inhibitor of KDM1A/LSD1. ORY-1001 induces differentiation of leukemic cells in cell lines, primary AML samples, and AML patients. ORY-1001 is able to decrease leukemic growth and prolong survival of mouse models of acute leukemia.


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Comparative Heterochromatin Profiling Reveals Conserved and Unique Epigenome Signatures Linked to Adaptation and Development of Malaria Parasites

Publication date: Available online 1 March 2018
Source:Cell Host & Microbe
Author(s): Sabine A. Fraschka, Michael Filarsky, Regina Hoo, Igor Niederwieser, Xue Yan Yam, Nicolas M.B. Brancucci, Franziska Mohring, Annals T. Mushunje, Ximei Huang, Peter R. Christensen, Francois Nosten, Zbynek Bozdech, Bruce Russell, Robert W. Moon, Matthias Marti, Peter R. Preiser, Richárd Bártfai, Till S. Voss
Heterochromatin-dependent gene silencing is central to the adaptation and survival of Plasmodium falciparum malaria parasites, allowing clonally variant gene expression during blood infection in humans. By assessing genome-wide heterochromatin protein 1 (HP1) occupancy, we present a comprehensive analysis of heterochromatin landscapes across different Plasmodium species, strains, and life cycle stages. Common targets of epigenetic silencing include fast-evolving multi-gene families encoding surface antigens and a small set of conserved HP1-associated genes with regulatory potential. Many P. falciparum heterochromatic genes are marked in a strain-specific manner, increasing the parasite's adaptive capacity. Whereas heterochromatin is strictly maintained during mitotic proliferation of asexual blood stage parasites, substantial heterochromatin reorganization occurs in differentiating gametocytes and appears crucial for the activation of key gametocyte-specific genes and adaptation of erythrocyte remodeling machinery. Collectively, these findings provide a catalog of heterochromatic genes and reveal conserved and specialized features of epigenetic control across the genus Plasmodium.

Graphical abstract

Teaser

Fraschka, Filarsky et al. performed a genome-wide characterization of heterochromatin organization across multiple species, strains, and life cycle stages of malaria parasites. This revealed that heterochromatic gene silencing is a conserved strategy to drive clonal variation of surface antigens and to control life cycle stage transitions and cell differentiation.


http://ift.tt/2FIOnYM

Dicer-2-Dependent Generation of Viral DNA from Defective Genomes of RNA Viruses Modulates Antiviral Immunity in Insects

Publication date: Available online 1 March 2018
Source:Cell Host & Microbe
Author(s): Enzo Z. Poirier, Bertsy Goic, Lorena Tomé-Poderti, Lionel Frangeul, Jérémy Boussier, Valérie Gausson, Hervé Blanc, Thomas Vallet, Hyelee Loyd, Laura I. Levi, Sophie Lanciano, Chloé Baron, Sarah H. Merkling, Louis Lambrechts, Marie Mirouze, Susan Carpenter, Marco Vignuzzi, Maria-Carla Saleh
The RNAi pathway confers antiviral immunity in insects. Virus-specific siRNA responses are amplified via the reverse transcription of viral RNA to viral DNA (vDNA). The nature, biogenesis, and regulation of vDNA are unclear. We find that vDNA produced during RNA virus infection of Drosophila and mosquitoes is present in both linear and circular forms. Circular vDNA (cvDNA) is sufficient to produce siRNAs that confer partially protective immunity when challenged with a cognate virus. cvDNAs bear homology to defective viral genomes (DVGs), and DVGs serve as templates for vDNA and cvDNA synthesis. Accordingly, DVGs promote the amplification of vDNA-mediated antiviral RNAi responses in infected Drosophila. Furthermore, vDNA synthesis is regulated by the DExD/H helicase domain of Dicer-2 in a mechanism distinct from its role in siRNA generation. We suggest that, analogous to mammalian RIG-I-like receptors, Dicer-2 functions like a pattern recognition receptor for DVGs to modulate antiviral immunity in insects.

Graphical abstract

Teaser

Poirier et al. show that during RNA virus infection of insects, circular viral DNA is produced, regulated by Dicer-2 helicase domain. The main template for viral DNA is defective viral genomes, which appear to be key viral products modulating the host immune response and the establishment of viral persistence.


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Inflammation-Modulated Metabolic Reprogramming Is Required for DUOX-Dependent Gut Immunity in Drosophila

Publication date: Available online 1 March 2018
Source:Cell Host & Microbe
Author(s): Kyung-Ah Lee, Kyu-Chan Cho, Boram Kim, In-Hwan Jang, Kibum Nam, Young Eun Kwon, Myungjin Kim, Do Young Hyeon, Daehee Hwang, Jae-Hong Seol, Won-Jae Lee
DUOX, a member of the NADPH oxidase family, acts as the first line of defense against enteric pathogens by producing microbicidal reactive oxygen species. DUOX is activated upon enteric infection, but the mechanisms regulating DUOX activity remain incompletely understood. Using Drosophila genetic tools, we show that enteric infection results in "pro-catabolic" signaling that initiates metabolic reprogramming of enterocytes toward lipid catabolism, which ultimately governs DUOX homeostasis. Infection induces signaling cascades involving TRAF3 and kinases AMPK and WTS, which regulate TOR kinase to control the balance of lipogenesis versus lipolysis. Enhancing lipogenesis blocks DUOX activity, whereas stimulating lipolysis via ATG1-dependent lipophagy is required for DUOX activation. Drosophila with altered activity in TRAF3-AMPK/WTS-ATG1 pathway components exhibit abolished infection-induced lipolysis, reduced DUOX activation, and enhanced susceptibility to enteric infection. Thus, this work uncovers signaling cascades governing inflammation-induced metabolic reprogramming and provides insight into the pathophysiology of immune-metabolic interactions in the microbe-laden gut epithelia.

Graphical abstract

Teaser

DUOX, a member of the NADPH oxidase family, acts as the first line of host defense in the Drosophila intestine. Lee et al. show that pathogen infection stimulates pro-catabolic signaling that initiates metabolic reprogramming toward lipid catabolism, which is required for DUOX activation and host resistance to enteric infection.


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Dual Antithrombotic Plus Adjunctive Antiinflammatory Therapy to Improve Cardiovascular Outcome in Atrial Fibrillation Patients with Concurrent Acute Coronary Syndrome: A Triple-Pathway Strategy

Publication date: Available online 1 March 2018
Source:Medical Hypotheses
Author(s): Gerald Chi, Adeel Jamil, Miroslav Radulovic, Umer Jamil, Muhammad A. Balouch, Jolanta Marszalek, Zahra Karimi, Seyedmahdi Pahlavani, Mehrian Jafarizade, Husnain Shaukat, Sunny Kumar, Arzu Kalayci
The concurrence of atrial fibrillation and acute coronary syndrome poses a conundrum in the antithrombotic management as intensification of anticoagulation or antiplatelet therapy inevitably comes at the price of an increased bleeding risk. Various antithrombotic combinations have been attempted to prevent the recurrent cardiovascular events, however, there has been limited success in effective risk reduction for this high risk population. Given the overarching effect of interleukin 1β-driven inflammation on the arrhythmogenesis, thrombogenesis, and hypercoagulability, we hypothesize that the triple-pathway strategy (i.e., incorporating antiinflammatory therapy into anticoagulant and antiplatelet therapy) would grant incremental cardiovascular benefits for atrial fibrillation patients with coexisting acute coronary syndrome and stent placement.



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Collagen type III and elastin genes polymorphism and the risk of nonsyndromic striae

Summary

Background

Striae have been reported to be one of the most common skin lesions and a commonly encountered esthetic problem.

Objectives

The aim of this research was to examine elastin gene polymorphism (rs7787362, ELN) and collagen type III alpha 1 polymorphism (rs1800255, COL3A1) among polish woman population with SD in comparison with women without the lesions and to verify these polymorphisms as risk factors for SD.

Methods

Seventy female students (35 with striae (the mean age 23.9 years, SD 1.2 years) and 35 without these lesions (22.9 years, SD 1.7 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors for SD and had a cheek swabbed for cells for DNA isolation.

Results

Analysis of polymorphisms of elastin gene (rs7787362) and COL3A1 gene (rs1800255) showed that women with SD and without these lesions did not differ in these aspects. Polymorphism rs7787362 was also analyzed in relation to SD in different locations, and showed no differences.

Conclusion

In conclusion, we found that there are some clinical factors that reduced the risk of SD: history of intended weight loss, negative family history of SD, and lower BMI. Gene polymorphisms analysis in patients with SD may help to establish the etiology of these lesions and to target the therapy. Analysis of polymorphisms of elastin gene (rs7787362) did not show differences in allele distribution between women with and without SD. Polymorphisms of COL3A1 gene (rs1800255) also did not differ between the examined groups.

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IL1A (-889) gene polymorphism is associated with the effect of diet as a risk factor in Acne Vulgaris

Summary

Background

Despite the several studies suggesting the genetic basis of acne vulgaris, the exact genetic architecture of this very common condition is not yet clear.

Aim of the work

This study aimed to investigate the association between IL-1A (−889) gene polymorphism and acne vulgaris in a sample of patients.

Subjects and Method

Blood samples from 100 patients with acne vulgaris and 100 healthy age, sex, and BMI matched controls were obtained. DNA samples were isolated from blood cells, and the PCR-RFLP method was used for genotyping.

Results

The genotype distributions of IL-1A (−889) polymorphism were as expected under Hardy-Weinberg equilibrium. T allele was predominant in the patients, while C allele predominated in the control subjects (P value < .001). The frequency of TT genotype in patients was significantly higher than in the control subjects (P value < .001). CT genotype was significantly more frequent in the control subjects compared to patients (P value < .001). Among the 47 patients who reported diet as a risk factor for triggering or exacerbating their lesions, 62.5% had TT genotype (P value = .038).

Conclusion

IL-1A (−889) gene polymorphism has a role in the pathogenesis of acne vulgaris. We suggest that the triggering or exacerbating effect of diet on acne may be related to IL-1A (−889) gene polymorphism.

http://ift.tt/2CSFuZP

A Novel Transcranial Magnetic Stimulator for Focal Stimulation of Rodent Brain

Publication date: Available online 1 March 2018
Source:Brain Stimulation
Author(s): Qinglei Meng, Li Jing, Jean Paul Badjo, Xiaoming Du, Elliot Hong, Yihong Yang, Hanbing Lu, Fow-Sen Choa




http://ift.tt/2F7k1hm

Low maternal melatonin level increases autism spectrum disorder risk in children

Publication date: Available online 1 March 2018
Source:Research in Developmental Disabilities
Author(s): Wiebe Braam, Friederike Ehrhart, Anneke P.H.M. Maas, Marcel G. Smits, Leopold Curfs
BackgroundIt is assumed that autism spectrum disorder (ASD) is caused by a combination of de novo inherited variation and common variation as well as environmental factors. It often co-occurs with intellectual disability (ID). Almost eight hundred potential causative genetic variations have been found in ASD patients. However, not one of them is responsible for more than 1% of ASD cases. Low melatonin levels are a frequent finding in ASD patients. Melatonin levels are negatively correlated with severity of autistic impairments, it is important for normal neurodevelopment and is highly effective in protecting DNA from oxidative damage. Melatonin deficiency could be a major factor, and well a common heritable variation, that increases the susceptibility to environmental risk factors for ASD. ASD is already present at birth. As the fetus does not produce melatonin, low maternal melatonin levels may be involved.MethodsWe measured 6-sulfatoxymelatonin in urine of 60 mothers of a child with ASD and controls.Results6-sulfatoxymelatonin levels were significantly lower in mothers with an ASD child than in controls (p = 0.012).ConclusionsLow parental melatonin levels could be one of the contributors to ASD and possibly ID etiology. Our findings need to be duplicated on a larger scale. If our hypothesis is correct, this could lead to policies to detect future parents who are at risk and to treatment strategies to ASD and intellectual disability risk.



http://ift.tt/2FdHT6y

Collagen type III and elastin genes polymorphism and the risk of nonsyndromic striae

Summary

Background

Striae have been reported to be one of the most common skin lesions and a commonly encountered esthetic problem.

Objectives

The aim of this research was to examine elastin gene polymorphism (rs7787362, ELN) and collagen type III alpha 1 polymorphism (rs1800255, COL3A1) among polish woman population with SD in comparison with women without the lesions and to verify these polymorphisms as risk factors for SD.

Methods

Seventy female students (35 with striae (the mean age 23.9 years, SD 1.2 years) and 35 without these lesions (22.9 years, SD 1.7 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors for SD and had a cheek swabbed for cells for DNA isolation.

Results

Analysis of polymorphisms of elastin gene (rs7787362) and COL3A1 gene (rs1800255) showed that women with SD and without these lesions did not differ in these aspects. Polymorphism rs7787362 was also analyzed in relation to SD in different locations, and showed no differences.

Conclusion

In conclusion, we found that there are some clinical factors that reduced the risk of SD: history of intended weight loss, negative family history of SD, and lower BMI. Gene polymorphisms analysis in patients with SD may help to establish the etiology of these lesions and to target the therapy. Analysis of polymorphisms of elastin gene (rs7787362) did not show differences in allele distribution between women with and without SD. Polymorphisms of COL3A1 gene (rs1800255) also did not differ between the examined groups.

http://ift.tt/2FdVQ4b

IL1A (-889) gene polymorphism is associated with the effect of diet as a risk factor in Acne Vulgaris

Summary

Background

Despite the several studies suggesting the genetic basis of acne vulgaris, the exact genetic architecture of this very common condition is not yet clear.

Aim of the work

This study aimed to investigate the association between IL-1A (−889) gene polymorphism and acne vulgaris in a sample of patients.

Subjects and Method

Blood samples from 100 patients with acne vulgaris and 100 healthy age, sex, and BMI matched controls were obtained. DNA samples were isolated from blood cells, and the PCR-RFLP method was used for genotyping.

Results

The genotype distributions of IL-1A (−889) polymorphism were as expected under Hardy-Weinberg equilibrium. T allele was predominant in the patients, while C allele predominated in the control subjects (P value < .001). The frequency of TT genotype in patients was significantly higher than in the control subjects (P value < .001). CT genotype was significantly more frequent in the control subjects compared to patients (P value < .001). Among the 47 patients who reported diet as a risk factor for triggering or exacerbating their lesions, 62.5% had TT genotype (P value = .038).

Conclusion

IL-1A (−889) gene polymorphism has a role in the pathogenesis of acne vulgaris. We suggest that the triggering or exacerbating effect of diet on acne may be related to IL-1A (−889) gene polymorphism.

http://ift.tt/2CSFuZP

CME Accreditation Page

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Forthcoming Issues

Global Health in Otolaryngology

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The Stapes Prosthesis

Since the original carved Teflon stapes over vein graft, stapedectomy prostheses have undergone evolution. Prostheses shapes, materials, and surgical techniques for placement have reflected advances in biomaterials and surgical tools. The variability in prostheses has reflected alternative techniques of stapedectomy and stapedotomy and differing strategies for attachment to the incus. Although many iterations of stapes prostheses have been proposed, excellent results can be achieved with various prostheses designed to rest on tissue grafts in stapedectomy techniques or pass through the footplate in stapedotomy techniques when used by surgeons experienced with technique details specific to the selected prosthesis.

http://ift.tt/2oJpOD3

Controversies in the Evaluation and Management of Otosclerosis

Controversies have been associated with the etiology, diagnosis, evaluation, and management of otosclerosis since Valsalva first described stapes fixation as a cause of hearing loss. Although the exact mechanism of the bone remodeling associated with otosclerosis remains uncertain, stapedotomy has been accepted as the surgical treatment of most patients with stapedial otosclerosis. There remains a disparity of opinion, however, regarding the role of preoperative imaging, surgical technique, implant selection, and medical therapy for cochlear otosclerosis. In addition, opinions vary regarding the optimal postoperative care of patients undergoing stapedotomy and a patient's ability to participate in activities that may result in barotrauma.

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Copyright-Page

Elsevier

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Otosclerosis

Over the past several years, with the evolution of genetic and molecular research, several etiologic factors have been implicated in the pathogenesis of otosclerosis. Overall, current evidence suggests that otosclerosis is a complex disease with a variety of potential pathways contributing to the development of abnormal bone remodeling in the otic capsule. These pathways involved in the pathogenesis of otosclerosis are influenced by both genetic and environmental factors.

http://ift.tt/2oLkxL1

Otosclerosis and Stapes Surgery

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Advanced Otosclerosis

Diagnosis and treatment of advanced otosclerosis can be controversial. In 1961, House and Sheehy defined advanced otosclerosis as hearing loss in air conduction threshold by 85 dB with nonmeasurable bone conduction. Recently, the definition of advanced otosclerosis is mostly based on the decrease of speech recognition. There are some treatment modalities: stapes surgery and hearing aids, cochlear implantation, or direct acoustic cochlear implant. The authors propose a new algorithm for treatment. If the patient is treated with cochlear implantation, the surgeon should be cautious for facial nerve stimulation after surgery because it is the most prevalent complication.

http://ift.tt/2HZ8i6C

Medical Management of Otosclerosis

Otosclerosis/otospongiosis is a primary osteodystrophy of the otic capsule that affects genetically predisposed individuals and leads to progressive hearing loss. Diagnosis is usually clinical, based on the findings of anamnesis, physical examination, and audiometric evaluation. However, high-resolution computed tomography scan and MRI have played an important role in the diagnosis and therapeutic approach of otosclerosis and in assisting in the differential diagnosis. The therapeutic approach is aimed at preventing, or at least minimizing, disease progression while attempting to restore hearing. The use of sodium fluoride and bisphosphonates can be an important adjunct, perhaps even primary treatment, in managing active lesions.

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Potential of Robot-Based Surgery for Otosclerosis Surgery

Otosclerosis surgery is performed through a transcanal approach and requires long, thin instruments with submillimetric precision and precise amplitude of motion. The functional outcomes and complications of otosclerosis surgery depend on the experience of the surgeon. Thus, any technological assistance that can enhance the surgeon's dexterity and rapidly reduce the learning curve could yield an even safer surgical procedure. One of the options is to use robotic assistance to achieve this goal. An overview of different robots designed for otosclerosis surgery is presented focusing on the RobOtol system that we have designed as a multitask platform for ear surgery.

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Use of Lasers in Otosclerosis Surgery

Lasers were introduced as an atraumatic modality for accomplishing several of the crucial steps in otosclerosis surgery. Advances in laser technology have spurred coevolution of refinements in the technique of the operation. Several varieties of laser systems are available to suit individual preference and to augment a surgeon's armamentarium; however, a clear advantage in terms of surgical outcome or patient safety remains to be demonstrated.

http://ift.tt/2oJRuaZ

Otosclerosis and Stapes Surgery

The roots of our knowledge about otosclerosis go back to the early eighteenth century. Since then, countless numbers of scientists have studied the pathogenesis and therapy of the disease. The articles in this issue of Otolaryngologic Clinics of North America flow from history to pathophysiology, clinical evaluation, surgical and medical management to future perspectives. As concepts are constantly progressing, timely topics such as genetics and molecular biology, endoscopic ear surgery and robotic surgery are also included in this issue.

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Revision Surgery for Otosclerosis

This article is an overview of the care of patients requiring revision surgery for otosclerosis. Preoperative evaluation of the patient including surgical history, audiologic results, and physical findings is discussed, and the causes of failure of primary surgery are reviewed. A discussion of evidence-based surgical technique and postoperative care then follows.

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Contents

Sujana S. Chandrasekhar

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Contributors

SUJANA S. CHANDRASEKHAR, MD

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Diagnosis and management of a fatal case of sepsis caused by Candida parapsilosis sensu stricto in a neonate with omphalocele

Publication date: June 2018
Source:Medical Mycology Case Reports, Volume 20
Author(s): Simone Santana, Tania Salci, Patricia Andriato, Patricia Bonfim-Mendonça, Silvana Caparroz-Assef, Melyssa Negri, Terezinha Svidzinski
We present a fatal case of persistent neonatal candidemia by Candida parapsilosis following omphalocele, without other anomalies. Despite an encouraging initial prognosis, after surgical correction and closure of the abdominal wall the case became difficult to treat, as in addition to the exposure of the patient to multiple risk factors for candidemia, antifungal therapy apparently was not adequate.



http://ift.tt/2F5v8Ye

Hemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis in the setting of Acquired Immunodeficiency Syndrome (AIDS)

Publication date: June 2018
Source:Medical Mycology Case Reports, Volume 20
Author(s): Samuel Asanad, Brendan Cerk, Veronica Ramirez
Hemophagocytic lymphohistiocytosis (HLH) is a rare and aggressive disease involving immune system over-activation leading to hemophagocytosis. HLH requires early diagnosis and prompt treatment initiation, especially in patients with Acquired Immunodeficiency Syndrome (AIDS). We present a case of a middle-aged male with AIDS and renal failure, who developed HLH secondary to disseminated histoplasmosis. Etoposide chemotherapy as recommended by the HLH 2004 Guidelines was deferred and treatment focused instead on anti-fungal therapy. Anti-retroviral therapy followed thereafter.



http://ift.tt/2FNzJ2F

Mould meningitis associated with intravenous drug use

Publication date: June 2018
Source:Medical Mycology Case Reports, Volume 20
Author(s): Hassan Shah, Stephen Honeybul, Stephanie Tang, Ian Arthur, Sally McLaren, Peter Boan
Fungal meningitis is most commonly causes by Cryptococcus species and dimorphic fungi. We present a rare case of mould meningitis, ventriculitis and subependymal nodules in an immunocompetent patient, having likely seeded the meninges and ventricular system through intravenous drug use. The causative mould remains undetermined. The case highlights the poor sensitivity of CSF culture and the need to consider surgical biopsy where there is diagnostic difficulty and fungal infection is being considered.



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Tracheal, laryngeal and pulmonary mucormycosis followed by organizing pneumonia in a patient with Adult Onset Still's Disease

Publication date: June 2018
Source:Medical Mycology Case Reports, Volume 20
Author(s): Fabian Leo, Michael Zeh, Annegret Prothmann, Oliver Kurzai, Sylke Kurz, Christian Grohé
We report a case of tracheal, laryngeal and pulmonary mucormycosis in a patient receiving immunosuppressive medication for an autoinflammatory fever syndrome. Mucormycosis was confirmed by histopathology from tracheal specimens and molecular evidence of Lichtheimia.A surgical approach was not possible because of the multifocal disease pattern and the extent of tracheal involvement. The patient was successfully treated with liposomal amphotericin B followed by posaconazole maintenance therapy. After 9 months, recurrent pulmonary mucormycosis was suspected but emerged as organizing pneumonia without evidence of active fungal infection.



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Blastomycosis in a Renal Transplant Recipient: Case of Immune Reconstitution Inflammatory Syndrome

Publication date: Available online 1 March 2018
Source:Medical Mycology Case Reports
Author(s): Alexis Guenette, Shahid Husain, Ana Konvalinka, William Geddie, Coleman Rotstein
There are limited data on blastomycosis in solid organ transplant recipients with the subsequent development of the immune reconstitution inflammatory syndrome (IRIS). Herein we describe a case of pulmonary blastomycosis in a renal transplant recipient with the development of concomitant IRIS.



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Assessment of Systemic Adenosine Effect Using Color Doppler Ultrasound of the Splenic Artery—Feasibility and Potential Clinical Utility for Coronary Interventions

Publication date: Available online 1 March 2018
Source:Ultrasound in Medicine & Biology
Author(s): Oliver Klein-Wiele, Walied Sherifa, Marietta Garmer, Kaffer Kara, Dietrich Grönemeyer, Birgit Hailer
Adenosine induces coronary vasodilation and simultaneously reduces splanchnic perfusion. This effect can be absent in adenosine non-responders. Imaging of splanchnic arteries under adenosine assessing this effect has not been performed in humans previously. In 26 patients, splenic artery color Doppler was performed during an infusion of adenosine. Peak velocity in the splenic artery was measured before the infusion and at 2 min. Results were compared qualitatively with perfusion imaging in magnetic resonance. A total of 24 patients showed a drop of splenic artery peak velocity from 62.3 ± 18.1 to 40.4 ± 15.7 cm/s (p < 0.001), which corresponded to perfusion restriction in magnetic resonance. Two patients with constant splenic artery velocity did not show perfusion restriction. We showed feasibility of assessing changes in splenic artery velocity under adenosine for the first time in humans. Further studies are needed to investigate whether this novel application is a robust tool to rule out inadequate adenosine effect during measurement of fractional flow reserve in coronary catheterization.



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Newer advances in lesional surgery for movement disorders

Milind Sankhe, Omkar Churi

Neurology India 2018 66(7):113-121

An analysis of the existing literature on lesioning for movement disorders was undertaken to review lesion therapy and its advances. Advances in imaging technology and electrophysiological techniques used for localization of brain structures and its functions, such as microelectrode recordings and macrostimulation, have greatly improved the ability to accurately identify the target nuclei such as the ventrointermediate nucleus (Vim), globus pallidus interna (GPi) and subthalamic nucleus (STN). Many important changes are happening in the understanding of lesion making. Its application as a cheaper modality of treatment; being less cumbersome; having a wider geographical appeal; and more options to create a lesion, appeals to the clinician. The procedure is undergoing a revival.

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Expanding the phenotypic spectrum of type III GM1 gangliosidosis: Progressive dystonia with auditory startle

Sreeja H Pillai, Soumya Sundaram, Syed M Zafer, Roopa Rajan

Neurology India 2018 66(7):149-150



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Interleaving pallidal deep brain stimulation improves the degree of benefit obtained in a patient with dystonia

Shizhen Zhang, Yi Wang, Peng Li, Wei Wang

Neurology India 2018 66(7):138-141



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Neurosurgery for movement disorders in India: Balloons to Electrodes

Srinivas Dwarakanath, Harsh Deora

Neurology India 2018 66(7):5-9



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Belly dancer's dyskinesia: A rare movement disorder

Chaturbhuj Rathore, Sanjay Prakash, Dharmesh Bhalodiya

Neurology India 2018 66(7):156-157



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The rise of movement disorders

Mark Hallett

Neurology India 2018 66(7):10-11



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Lateralized hyperkinetic motor behavior

Balaji Krishnaiah, Jayant Acharya, Aiesha Ahmed

Neurology India 2018 66(7):131-134

Seizures are followed by a post-ictal period, which is characterized by usual slowing of brain activity. This case report describes a 68-year old woman who presented with right-sided rhythmic, non-voluntary, semi-purposeful motor behavior that started 2 days after an episode of generalized seizure. Her initial electroencephalogram (EEG) showed beta activity with no evidence of epileptiform discharges. Computed tomography scan showed hypodensity in the left parieto-occipital region. Magnetic resonance imaging (MRI) showed restricted diffusion/fluid-attenuated inversion recovery hyperintensities in the left precentral and post-central gyrus. Unilateral compulsive motor behavior during the post-ictal state should be considered, and not confused with partial status epilepticus to avoid unnecessary treatment. Abnormal magnetic resonance imaging (MRI) findings, which are reversible, can help with the diagnostic and therapeutic approach.

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Classification of movement disorders: The problem of terminology

Sanjay Pandey

Neurology India 2018 66(7):12-14



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Parkinsonian syndromes: A review

Prachaya Srivanitchapoom, Yuvadee Pitakpatapee, Arpakorn Suengtaworn

Neurology India 2018 66(7):15-25

Since James Parkinson published his remarkable clinical observations in the "An Essay On The Shaking Palsy" in 1817, the number of diseases included in the spectrum of parkinsonian syndromes (a group of diseases that have some part of their clinical features resembling those seen in Parkinson's disease), are growing. Careful history taking, comprehensive neurological examination, and utilization of proper investigations will lead the physicians to make an accurate diagnosis of the specific disease entity present. In this recent review, we cover the issue of classification of parkinsonian syndromes, and comprehensively review the characteristic features of the commonly encountered diseases that present with this syndrome. The salient aspects of the epidemiology, key clinical features, proper investigations, and possible treatment options of these diseases have also been addressed.

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Does cerebral infarction ameliorate essential tremor? A mini-review

Rohan Mahale, Anish Mehta, Nikith Shetty, R Srinivasa

Neurology India 2018 66(7):152-154



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Comparative Study of Management of BPPV (Benign Paroxysmal Positional Vertigo) with only Drugs Versus Drugs Plus Epley Manoeuvre

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for 20% of all vertigo cases. Idiopathic BPPV is most common between the ages of 50 and 70, although the condition is found in all age groups. The importance of early diagnosis and treatment can lead to a much improved quality of life for patients afflicted by this ailment. It is presently common for physicians to treat these patients mainly with benzodiazepines, antihistamines, and anticholinergic medications, especially if the history and physical is consistent with BPPV. This method of treatment has had questionable success. Several reviews of the management of vertigo have shown that no medication in current use has well established curative or prophylactic value or is suitable for long-term treatment. Epleys manoeuvre is also used in the treatment of BPPV. This manoeuvre relocates free floating particles from the affected semi-circular canals back into utricle, thus relieving the symptoms of vertigo. The purpose of this study is to compare the efficacy of Epleys manoeuvre with conventional drug therapy versus conventional therapy alone in patients who present with vertigo. The purpose of this study to evaluate and examine two methods of treatment.

http://ift.tt/2HYBPwX

Chemical Shift Magnetic Resonance Imaging Could Predict Subclinical Cortisol Production from an Incidentally Discovered Adrenal Mass

Abstract

Context

To investigate whether any association between chemical shift magnetic resonance (MRI) findings, cortisol secretion and pathological findings exist that could predict subclinical hypercortisolism (SCH) in patients with adrenal incidentalomas (AI).

Design

Retrospective, cross sectional study in a tertiary centre.

Patients

Sixty-eight subjects with AIs and 13 patients with Cushing's syndrome (CS). Patients with AIs were categorized according to cortisol levels post 1mg dexamethasone (post-DST).

Measurements

Visual inspection of the lipid content of the adrenal tumour and calculation of adrenal-to-spleen ratio (ASR), the signal intensity index (SII), volume and the assessment of the association between pathological, radiological and hormonal findings in surgically treated patients.

Results

Percentage of clear cells was correlated with ASR (r= -.525, p=0.01), SII (r=.465, p=0.025), post-DST cortisol (r= -.711, p<0.001) and ACTH (r=.475, p=0.046). By ANOVA and post hoc analysis patients with CS and five subjects with a post-DST cortisol greater than 137nmol/l differed significantly in ASR and SII from those with a post-DST cortisol less than 50nmol/l. An ASR level higher than 0.245 (OR 19.7, 95% CI 1.5–257.5; P=.023) and a SII level lower than 78.37 (OR 15.6, 95% CI 1.2–20; P=.034) remained as the independent predictors for SCH while age, presence of arterial hypertension or tumour volume did not make significant contribution to the models.

Conclusions

Cortisol hypersecretion by adrenal adenomas is associated with distinctive MRI characteristics. The quantitative assessment of intracellular lipid in an AI could help distinguish patients with a clear phenotype of SCH.

This article is protected by copyright. All rights reserved.

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Associations of insulin-like growth factor-I and insulin-like growth factor binding protein-3 with bone quality in the general adult population

Summary

Objective

Growth hormone (GH) and its main mediator, insulin-like growth factor-I (IGF-I) play a significant role in bone metabolism. The relations between IGF-I and bone mineral density (BMD) or osteoporosis have been assessed in previous studies but whether the associations are sex-specific remains uncertain. Moreover, only few studies examined bone quality assessed by quantitative ultrasound (QUS). We aimed to investigate these associations in the general population of northeast Germany.

Design and Measurements

Data from 1759 men and 1784 women who participated in the baseline examination of the Study of Health in Pomerania (SHIP)-Trend were used. IGF-I and IGF-binding protein-3 (IGFBP-3) concentrations were measured on the IDS-iSYS multidiscipline automated analyzer (Immunodiagnostic Systems Limited). QUS measurements were performed at the heel (Achilles InSight, GE Healthcare). Sex-specific linear and multinomial logistic regression models adjusted for potential confounders were calculated.

Results

Linear regression analyses revealed significant positive associations between IGF-I and IGF-I/IGFBP-3 ratio, a marker for free IGF-I, with all QUS parameters in men. Among women, we found an inverse association between IGF-I and the QUS-based fracture risk but no association with any other QUS parameter. There was no association between IGFBP-3 and the QUS-based fracture risk.

Conclusions

Our data suggest an important role of IGF-I on bone quality in men. The observed association of IGF-I with the QUS-based stiffness index and QUS-based fracture risk in the present study might animate clinicians to refer patients with low IGF-I levels, particularly men, to a further evaluation of risk factors for osteoporosis and a detailed examination of the skeletal system.

This article is protected by copyright. All rights reserved.

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Copyright

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Contributors

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Improving Perioperative Care: What Are the Tools That Lead to Sustainable Change?

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Lee A. Fleisher




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Quality Improvement and Implementation Science

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Lee A. Fleisher




http://ift.tt/2HVJnkf

Quality Improvement and Implementation Science: Different Fields with Aligned Goals

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Lee A. Fleisher




http://ift.tt/2oJeWVL

Implementation Science in Perioperative Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Benjamin T. Cobb, Crystal Wiley Cené, Rinad S. Beidas

Teaser

There is a 17-year gap between the initial publication of scientific evidence and its uptake into widespread practice in health care. The field of implementation science (IS) emerged in the 1990s as an answer to this "evidence-to-practice gap." In this article, we present an overview of implementation science, focusing on the application of IS principles to perioperative care. We describe opportunities for additional training and discuss strategies for funding and publishing IS work. The objective is to demonstrate how IS can improve perioperative patient care, while highlighting perioperative IS studies and identifying areas in need of additional investigation.


http://ift.tt/2HWFCLB

Quality Improvement in Anesthesiology — Leveraging Data and Analytics to Optimize Outcomes

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Elizabeth A. Valentine, Scott A. Falk

Teaser

Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Dashboards can facilitate rapid analysis of data and drive decision making. Large data sets can be useful to establish benchmarks and compare performance against other providers, practices, or institutions. Audit and feedback strategies are effective in facilitating positive change.


http://ift.tt/2HZ0u4D

Emergency Manuals

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Sara N. Goldhaber-Fiebert, Carl Macrae

Teaser

How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care.


http://ift.tt/2oI6DcP

Handovers in Perioperative Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Atilio Barbeito, Aalok V. Agarwala, Amanda Lorinc

Teaser

Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication.


http://ift.tt/2HUXKoS

Developing Capacity to Do Improvement Science Work

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Irene McGhee, Yehoshua Gleicher

Teaser

Developing capacity to do improvement science starts with prioritizing quality improvement training in all health professions curricula so that a common knowledge base and understanding are created. Educational programs should include opportunities for colearning with patients, health professionals, and leaders. In this way, knowledge translation (also called implementation) is more effective and better coordinated when applied across organizations. Key factors that enable and drive behavior change are reviewed, as is the importance of influence and leadership. A comprehensive approach that accounts for these factors hardwires quality improvement into the health care systems and creates a culture that enables its ongoing development.


http://ift.tt/2HVsfLq

Diffusing Innovation and Best Practice in Health Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Philip E. Greilich, Mary Eleanor Phelps, William Daniel

Teaser

Diffusing innovation and best practices in healthcare are among the most challenging aspects of advancing patient safety and quality improvement. Recommendations from the Baldrige Foundation, Institute for Healthcare Improvement, and The Joint Commission provide guidance on the principles for successful diffusion. Perioperative leaders are encouraged to applying these principles to high priority areas such as handovers, enhanced recovery and patient blood management. Completing a successful pilot project can be exciting, however, effective diffusion is essential to achieving meaningful and lasting impact on the service line and health system.


http://ift.tt/2oJeDKB

Copyright

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





http://ift.tt/2oNiDd8

Contributors

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





http://ift.tt/2HUXMx0

Contents

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





http://ift.tt/2oHExOM

Forthcoming Issues

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





http://ift.tt/2HXzIK7

Improving Perioperative Care: What Are the Tools That Lead to Sustainable Change?

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Lee A. Fleisher




http://ift.tt/2oIT9O0

Quality Improvement and Implementation Science

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Lee A. Fleisher




http://ift.tt/2HVJnkf

Quality Improvement and Implementation Science: Different Fields with Aligned Goals

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Lee A. Fleisher




http://ift.tt/2oJeWVL

Implementation Science in Perioperative Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Benjamin T. Cobb, Crystal Wiley Cené, Rinad S. Beidas

Teaser

There is a 17-year gap between the initial publication of scientific evidence and its uptake into widespread practice in health care. The field of implementation science (IS) emerged in the 1990s as an answer to this "evidence-to-practice gap." In this article, we present an overview of implementation science, focusing on the application of IS principles to perioperative care. We describe opportunities for additional training and discuss strategies for funding and publishing IS work. The objective is to demonstrate how IS can improve perioperative patient care, while highlighting perioperative IS studies and identifying areas in need of additional investigation.


http://ift.tt/2HWFCLB

Human Factors Applied to Perioperative Process Improvement

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Joseph R. Keebler, Elizabeth H. Lazzara, Elizabeth Blickensderfer, Thomas D. Looke

Teaser

This article discusses some of the major theories of the science of human factors/ergonomics (HF/E) in relation to perioperative medicine, with a focus on safety and errors within these systems. The discussion begins with human limitations based in cognition, decision making, stress, and fatigue. Given these limitations, the importance of measuring human performance is discussed. Finally, using the HF/E perspective on safety, high-level recommendations are provided for increasing safety within the perioperative environment.


http://ift.tt/2oJeRkV

Quality Improvement in Anesthesiology — Leveraging Data and Analytics to Optimize Outcomes

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Elizabeth A. Valentine, Scott A. Falk

Teaser

Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Dashboards can facilitate rapid analysis of data and drive decision making. Large data sets can be useful to establish benchmarks and compare performance against other providers, practices, or institutions. Audit and feedback strategies are effective in facilitating positive change.


http://ift.tt/2HZ0u4D

Emergency Manuals

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Sara N. Goldhaber-Fiebert, Carl Macrae

Teaser

How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care.


http://ift.tt/2oI6DcP

Use of Simulation in Performance Improvement

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Amanda Burden, Erin White Pukenas

Teaser

Human error and system failures continue to play a substantial role in preventable errors that lead to adverse patient outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. Anesthesiologists pioneered the use of simulation for medical education in an effort to improve physician performance and patient safety. This article explores the use of simulation for performance improvement. Educational theories that underlie effective simulation programs are described as driving forces behind the advancement of simulation in performance improvement.


http://ift.tt/2HTh7ih

Developing Multicenter Registries to Advance Quality Science

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Laura E. Schleelein, Kathleen A. Harris, Elizabeth M. Elliott

Teaser

There are several benefits to clinical registries as an information repository tool, ultimately lending itself to the acquisition of new knowledge. Registries have the unique advantage of garnering much data quickly and are, therefore, especially helpful for niche populations or low-prevalence diseases. They can be used to inform on the ideal structure, process, or outcome involving an identified population. The data can be used in many ways, for example, as an observational tool to reveal associations or as a basis for framing future research studies or quality improvement projects.


http://ift.tt/2oJeXsN

Handovers in Perioperative Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Atilio Barbeito, Aalok V. Agarwala, Amanda Lorinc

Teaser

Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication.


http://ift.tt/2HUXKoS

Rethinking Clinical Workflow

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Joseph J. Schlesinger, Kendall Burdick, Sarah Baum, Melissa Bellomy, Dorothee Mueller, Alistair MacDonald, Alex Chern, Kristin Chrouser, Christie Burger

Teaser

The concept of clinical workflow borrows from management and leadership principles outside of medicine. The only way to rethink clinical workflow is to understand the neuroscience principles that underlie attention and vigilance. With any implementation to improve practice, there are human factors that can promote or impede progress. Modulating the environment and working as a team to take care of patients is paramount. Clinicians must continually rethink clinical workflow, evaluate progress, and understand that other industries have something to offer. Then, novel approaches can be implemented to take the best care of patients.


http://ift.tt/2oHvz3S

Developing Capacity to Do Improvement Science Work

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Irene McGhee, Yehoshua Gleicher

Teaser

Developing capacity to do improvement science starts with prioritizing quality improvement training in all health professions curricula so that a common knowledge base and understanding are created. Educational programs should include opportunities for colearning with patients, health professionals, and leaders. In this way, knowledge translation (also called implementation) is more effective and better coordinated when applied across organizations. Key factors that enable and drive behavior change are reviewed, as is the importance of influence and leadership. A comprehensive approach that accounts for these factors hardwires quality improvement into the health care systems and creates a culture that enables its ongoing development.


http://ift.tt/2HVsfLq

Diffusing Innovation and Best Practice in Health Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Philip E. Greilich, Mary Eleanor Phelps, William Daniel

Teaser

Diffusing innovation and best practices in healthcare are among the most challenging aspects of advancing patient safety and quality improvement. Recommendations from the Baldrige Foundation, Institute for Healthcare Improvement, and The Joint Commission provide guidance on the principles for successful diffusion. Perioperative leaders are encouraged to applying these principles to high priority areas such as handovers, enhanced recovery and patient blood management. Completing a successful pilot project can be exciting, however, effective diffusion is essential to achieving meaningful and lasting impact on the service line and health system.


http://ift.tt/2oJeDKB

The role of efflux pumps in Bacteroides fragilis resistance to antibiotics

Publication date: Available online 1 March 2018
Source:Microbiological Research
Author(s): Reza Ghotaslou, Mina Yekani, Mohammad Yousef Memar
The resistance of Bacteroides fragilis to the most antimicrobial agents has been reported in the world. Identification of the microbial resistance mechanisms can play an important role in controlling these resistances. Currently, B. fragilis is resistant to most antibiotics. The multi-drug efflux pumps have been shown to underlie the antimicrobial resistance in B. fragilis strains. Two types of these efflux pumps including RND and MATE can be regarded as main structures responsible for antibiotic resistance. Therefore, the strategy for suppressing of this efflux system may be useful in the treatment and control of the multidrug-resistant B. fragilis. The purpose of this study is to review the B. fragilis efflux pumps and their functions in the resistance to antibiotics.



http://ift.tt/2F736vm

Control of hyperglycemia in male mice by leflunomide: mechanisms of action

p70 S6 kinase (S6K1) is a serine/threonine kinase that phosphorylates the insulin receptor substrate-1 (IRS-1) at serine 1101 and desensitizes insulin receptor signaling. S6K1 hyperactivation due to overnutrition leads to hyperglycemia and type 2 diabetes. Our recent study showed that A77 1726, the active metabolite of the anti-rheumatoid arthritis (RA) drug leflunomide, is an inhibitor of S6K1. Whether leflunomide can control hyperglycemia and sensitize the insulin receptor has not been tested. Here we report that A77 1726 increased AKT^S473/T308 and S6K1^T389 phosphorylation but decreased S6^S235/236 and IRS-1^S1101 phosphorylation in 3T3-L1 adipocytes, C2C12 and L6 myotubes. A77 1726 increased insulin receptor tyrosine phosphorylation and binding of the p85 subunit of the PI-3 kinase to IRS-1. A77 1726 enhanced insulin-stimulated glucose uptake in L6 myotubes and 3T3-L1 adipocytes, and enhanced insulin-stimulated glucose transporter type 4 (GLUT4) translocation to the plasma membrane of L6 cells. Finally, we investigated the anti-hyperglycemic effect of leflunomide on ob/ob and high-fat diet (HFD)-induced diabetes mouse models. Leflunomide treatment normalized blood glucose levels and overcame insulin resistance in glucose and insulin tolerance tests in ob/ob and HFD-fed mice but had no effect on mice fed a normal chow diet (NCD). Leflunomide treatment increased AKT^S473/T308 phosphorylation in the fat and muscle of ob/ob mice but not in normal mice. Our results suggest that leflunomide sensitizes the insulin receptor by inhibiting S6K1 activity in vitro, and that leflunomide could be potentially useful for treating patients with both RA and diabetes.

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Do we choose control diets wisely?

Publication date: Available online 1 March 2018
Source:Trends in Endocrinology & Metabolism
Author(s): Ana D. Mandić, Michael Blaut
In a recent article in Cell Reports, Dalby and colleagues convincingly demonstrate that choosing an inadequate control diet in animal experiments that investigate the interaction of nutrition, gut microbiota, and obesity development may lead to the wrong conclusions. The authors systematically compared the effects of refined high- and low-fat diets (rHFD and rLFD) with those of a standard chow diet on mouse physiology, microbiota composition, cecal fermentation, and intestinal morphology. The results obtained in this study question the conclusions drawn from animal studies that compared the effects of HFDs with those of chow diets.



http://ift.tt/2CQzd0B

"Vestn Otorinolaringol"[jour]; +19 new citations

19 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Vestn Otorinolaringol"[jour]

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PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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PARP1 interacts with STAT3 and retains active phosphorylated-STAT3 in nucleus during pathological myocardial hypertrophy

Publication date: Available online 1 March 2018
Source:Molecular and Cellular Endocrinology
Author(s): Luping Wang, Zhuoming Li, Yinzi Tan, Qian Li, Hanwei Yang, Panxia Wang, Jing Lu, Peiqing Liu
The activation of signal transducer and activator of transcription 3 (STAT3) positively regulates myocardial hypertrophy, and its transcriptional activity is finely conditioned by diverse extracellular growth factors and cytokines. Here, we introduce novel evidence that poly(ADP-ribose) polymerase 1 (PARP1) interacts with STAT3 and promotes its activation in cardiomyocytes and rat heart tissues. PARP1 activity and phosphorylated STAT3 were augmented by hypertrophic stimuli both in vitro and in vivo. Infection of PARP1 adenovirus induced cardiomyocyte hypertrophy, which could be prevented by STAT3 knockdown or inhibition. Additionally, PARP1 enhanced STAT3 phosphorylation level, nuclear accumulation and transcriptional activity. Mechanistically, PARP1 interacts with STAT3 and retains active phosphorylated-STAT3 in nucleus. In conclusion, our findings provide the first evidence that PARP1 exacerbates cardiac hypertrophy by stabilizing active phosphorylated-STAT3, which suggests that multi-target therapeutic strategies counteracting PARP1 activity and STAT3 activation would be potential for treating cardiovascular diseases.



http://ift.tt/2t9AXCn

Assessment of focal laser photocoagulations’ early effect on polypoidal choroidal vasculopathy with optical coherence tomography angiography

Abstract

Polypoidal choroidal vasculopathy (PCV) is seen with polypoidal lesions and branching vascular networks (BVNs) (Spaide et al. in Retina 15(2):100–110, 1995; Yannuzzi et al. in Retina 10(1):1–8, 1990). There are reports about laser photocoagulation for PCV (Yuzawa et al. in Japan J Ophthalmol 47(4):379–384, 2003; Lee et al. in Eye 23(1):145–148, 2009); however, all these reports are about final vision and frequent relapses. Therefore, this treatment merits rigorous scrutiny using optical coherence tomography angiography (OCTA).

http://ift.tt/2t8NyWt

Identification and Screening of Potent Antimicrobial Peptides in Arthropod Genomes

Publication date: Available online 1 March 2018
Source:Peptides
Author(s): Deepesh Duwadi, Anishma Shrestha, Binyam Yilma, Itamar Kozlovski, Munaya Sa-eed, Nikesh Dahal, James Jukosky
Using tBLASTn and BLASTp searches, we queried recently sequenced arthropod genomes and expressed sequence tags (ESTs) using a database of known arthropod cecropins, defensins, and attacins. We identified and synthesized 6 potential AMPs and screened them for antimicrobial activity. Using radial diffusion assays and microtiter antimicrobial assays, we assessed the in vitro antimicrobial effects of these peptides against several human pathogens including Gram-positive and Gram-negative bacteria and fungi. We also conducted hemolysis assays to examine the cytotoxicity of these peptides to mammalian cells. Four of the six peptides identified showed antimicrobial effects in these assays. We also created truncated versions of these four peptides to assay their antimicrobial activity. Two cecropins derived from the monarch butterfly genome (Danaus plexippus), DAN1 and DAN2, showed minimum inhibitory concentrations (MICs) in the range of 2–16 μg/ml when screened against Gram-negative bacteria. HOLO1 and LOUDEF1, two defensin-like peptides derived from red flour beetle (Tribolium castaneum) and human body louse (Pediculus humanus humanus), respectively, exhibited MICs in the range of 13–25 μg/mL against Gram-positive bacteria. Furthermore, HOLO1 showed an MIC less than 5 μg/mL against the fungal species Candida albicans. These peptides exhibited no hemolytic activity at concentrations up to 200 μg/ml. The truncated peptides derived from DAN2 and HOLO1 showed very little antimicrobial activity. Our experiments show that the peptides DAN1, DAN2, HOLO1, and LOUDEF1 showed potent antimicrobial activity in vitro against common human pathogens, did not lyse mammalian red blood cells, and indicates their potential as templates for novel therapeutic agents against microbial infection.



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