The value of direct messaging

Direct secure messaging (DSM) is a way to send patient information in an encrypted form among physicians, among provider organizations, and to state agencies. Improving efficiency of communication between physicians through DSM also improves productivity-not only for physician users, but also for the practices and organizations they serve. However, use of DSM must expand for users and their organizations to achieve full benefits.

Nodular inflammatory foci are sites of T cell priming and control of murine cytomegalovirus infection in the neonatal lung

Neonates, including mice and humans, are highly susceptible to cytomegalovirus (CMV) infection. However, many aspects of neonatal CMV infections such as viral cell tropism, spatio-temporal distribution of the pathogen as well as genesis of antiviral immunity are unknown. With the use of reporter mutants of the murine cytomegalovirus (MCMV) we identified the lung as a primary target of mucosal infection in neonatal mice. Comparative analysis of neonatal and adult mice revealed a delayed control of virus replication in the neonatal lung mucosa explaining the pronounced systemic infection and disease in neonates. This phenomenon was supplemented by a delayed expansion of CD8⁺ T cell clones recognizing the viral protein M45 in neonates. We detected viral infection at the single-cell level and observed myeloid cells forming “nodular inflammatory foci” (NIF) in the neonatal lung. Co-localization of infected cells within NIFs was associated with their disruption and clearance of the infection. By 2-photon microscopy, we characterized how neonatal antigen-presenting cells (APC) interacted with T cells and induced mature adaptive immune responses within such NIFs. We thus define NIFs of the neonatal lung as niches for prolonged MCMV replication and T cell priming but also as sites of infection control.

Neonates are highly susceptible to a number of infections that usually cause disease only in immunocompromised individuals, most likely because of their incompletely developed immune system. Although this phenomenon has been frequently observed, immune responses of neonates remain largely undefined upon infections with viruses. There is lack of knowledge about the spatio-temporal dynamics of host-virus interaction, especially in comparative infection models of neonates and adults. In this study, with the use of virus reporter mutants, we provide elaborate insight into these aspects in the mouse model of CMV infection. We define hallmarks of virus tropism, early cellular immune responses and general infection dynamics, findings that are fundamental to understand neonatal antiviral immunity. Furthermore, we found that neonatal APCs induce T cell responses in nodular inflammatory foci of the lung, a process which was supposed to be restricted to lymphoid organs. However, the MCMV-specific T cell response was qualitatively different in neonates from that in adults, possibly explaining - in part - the higher susceptibility of newborns. These observations expand our understanding of where adaptive immunity can be initiated, highlights the importance of early local cellular immune responses and sheds more light on neonatal antiviral immunity.

Get set for the insurance marketplaces

Hospitals should prepare for the health insurance marketplaces by: Educating patient access staff and clinicians on how the marketplaces work, how to determine eligibility, and how to articulate the coverage options available. Working with other key stakeholders, such as community service organizations, to assess consumers eligibility for the marketplaces and assist with enrollment. Improving pricing transparency. Assessing opportunities to work with vendors on marketplace education and enrollment.

A peptide inhibitor of cytomegalovirus infection from human hemofiltrate

Naturally occurring substances with antimicrobial activity can serve as a starting point for the rational design of new drugs to treat infectious diseases. Here, we screened a library of peptides derived from human hemofiltrate for inhibitory effects on human cytomegalovirus (CMV) infection. We isolated a previously unknown derivative of the neutrophil-activating peptide 2, which we termed CYVIP, for CMV-inhibiting peptide. The peptide blocked infection with human and mouse CMV as well as with herpes simplex virus type 1 in different cell types. We found that CYVIP interferes with virus attachment to the cell surface, and structure-activity relationship studies revealed that positively charged lysine and arginine residues of CYVIP are essential for its inhibitory activity. The N-terminal 29 amino acids of the peptide were sufficient for inhibition, and substitution with an acidic residue further improved its activity. The target structure of CYVIP on the cell surface seems to be the sulfate residues of heparan sulfate proteoglycans, which are known to serve as herpesvirus attachment receptors. Our data suggest that O-sulfation of heparan sulfate is required for binding of CYVIP, and furthermore, that the initial interaction of CMV particles with cells takes place preferentially via 6-O-linked sulfate groups. These findings about CYVIP's mode of action lay the basis for further development of antivirals interfering with attachment of CMV to cells, a crucial step of the infection cycle.

Flashbulb memories in patients with temporal lobe epilepsy

PURPOSE

Flashbulb memories (FMs) are vivid and stable autobiographical memories associated with learning surprising news of high emotional impact. Patients with temporal lobe epilepsy (TLE) can have autobiographical memory deficits. This is the first investigation of FMs in TLE applying a consistency measure of FM quality controlling for confabulation.

METHOD

A sample of 12 patients with TLE and a matched group of 15 healthy controls (HCs) were tested on an FM test including a retest procedure. Scores of FM consistency were obtained by comparing answers across both testing occasions.

RESULTS

In patients with TLE, FM consistency scores were significantly lower than in HCs. Exploratory subgroup analyses revealed FM deficits in both patients with left TLE and patients with right TLE compared with HCs.

CONCLUSION

The present study indicates that the FMs of patients with TLE are less consistent than those of healthy control subjects. Future investigations with larger samples are desirable, especially regarding separate analyses of patients with left TLE and patients with right TLE.

The human cytomegalovirus UL51 protein is essential for viral genome cleavage-packaging and interacts with the terminase subunits pUL56 and pUL89

Cleavage of human cytomegalovirus (HCMV) genomes as well as their packaging into capsids is an enzymatic process mediated by viral proteins and therefore a promising target for antiviral therapy. The HCMV proteins pUL56 and pUL89 form the terminase and play a central role in cleavage-packaging, but several additional viral proteins, including pUL51, had been suggested to contribute to this process, although they remain largely uncharacterized. To study the function of pUL51 in infected cells, we constructed HCMV mutants encoding epitope-tagged versions of pUL51 and used a conditionally replicating virus (HCMV-UL51-ddFKBP), in which pUL51 levels could be regulated by a synthetic ligand. In cells infected with HCMV-UL51-ddFKBP, viral DNA replication was not affected when pUL51 was knocked down. However, no unit-length genomes and no DNA-filled C capsids were found, indicating that cleavage of concatemeric HCMV DNA and genome packaging into capsids did not occur in the absence of pUL51. pUL51 was expressed mainly with late kinetics and was targeted to nuclear replication compartments, where it colocalized with pUL56 and pUL89. Upon pUL51 knockdown, pUL56 and pUL89 were no longer detectable in replication compartments, suggesting that pUL51 is needed for their correct subnuclear localization. Moreover, pUL51 was found in a complex with the terminase subunits pUL56 and pUL89. Our data provide evidence that pUL51 is crucial for HCMV genome cleavage-packaging and may represent a third component of the viral terminase complex. Interference with the interactions between the terminase subunits by antiviral drugs could be a strategy to disrupt the HCMV replication cycle.

Comparative efficacy of 3 soluble epoxide hydrolase inhibitors in rat neuropathic and inflammatory pain models

Epoxy-fatty acids have been recognized as important cell signaling molecules with multiple biological effects including anti-nociception. The main degradation pathway of these signaling molecules is via the soluble epoxide hydrolase (sEH) enzyme. Inhibitors of sEH extend the anti-nociceptive effects of fatty acid epoxides. In this study two models of pain with different etiology, streptozocin induced type I diabetic neuropathic pain and lipopolysaccharide induced inflammatory pain were employed to test sEH inhibitors. A dose range of three sEH inhibitors with the same central pharmacophore but varying substituent moieties was used to investigate maximal anti-allodynic effects in these two models of pain. Inhibiting the sEH enzyme in these models successfully blocked pain related behavior in both models. The sEH inhibitors were more potent and more efficacious than celecoxib in reducing both diabetic neuropathic pain and lipopolysaccharide induced inflammatory pain. Because of their ability to block diabetic neuropathic pain sEH inhibition is a promising new approach to treat chronic pain conditions.

Biodegradation by immobilized bacteria in an airlift-loop reactor-influence of biofilm diffusion limitation

Naphthalene-2-sulfonate was degraded by submerse growing Pseudomonads in a chemostat culture. The kinetic parameters for the Monod equation, including Pirts maintenance energy, were calculated from these experiments regarding naphthalene-2-sulfonate as substrate and oxygene as cosubstrate. By immobilizing the bacteria on sand particles, the degradation of naphthalene-2-sulfonate was carried out in a specialy designed three-phase airlift-loop reactor in a completely fluidized state. From these experiments, the influence of biofilm diffusion limitation on reaction kinetics and criteria for stable biofilm formation on sand particles were obtained.

Improved Prediction of Body Fat by Measuring Skinfold Thickness, Circumferences, and Bone Breadths

OBJECTIVE

To develop improved predictive regression equations for body fat content derived from common anthropometric measurements.

RESEARCH METHODS AND PROCEDURES

117 healthy German subjects, 46 men and 71 women, 26 to 67 years of age, from two different studies were assigned to a validation and a cross-validation group. Common anthropometric measurements and body composition by DXA were obtained. Equations using anthropometric measurements predicting body fat mass (BFM) with DXA as a reference method were developed using regression models.

RESULTS

The final best predictive sex-specific equations combining skinfold thicknesses (SF), circumferences, and bone breadth measurements were as follows: BFM(New) (kg) for men = -40.750 + {(0.397 x waist circumference) + [6.568 x (log triceps SF + log subscapular SF + log abdominal SF)]} and BFM(New) (kg) for women = -75.231 + {(0.512 x hip circumference) + [8.889 x (log chin SF + log triceps SF + log subscapular SF)] + (1.905 x knee breadth)}. The estimates of BFM from both validation and cross-validation had an excellent correlation, showed excellent correspondence to the DXA estimates, and showed a negligible tendency to underestimate percent body fat in subjects with higher BFM compared with equations using a two-compartment (Durnin and Womersley) or a four-compartment (Peterson) model as the reference method.

DISCUSSION

Combining skinfold thicknesses with circumference and/or bone breadth measures provide a more precise prediction of percent body fat in comparison with established SF equations. Our equations are recommended for use in clinical or epidemiological settings in populations with similar ethnic background.

Leveraging existing technology to boost revenue cycle performance

Revenue cycle leaders can reduce the frequency or level of technology investment needed while maintaining strong service and payment accuracy by looking at four areas of opportunity: Applying output from existing technology in new ways Seeking new functionality from existing systems. Linking with external systems to provide greater capabilities. Supplementing limitations of existing technology with outside expertise.

Optimization of growth hormone dosing in children born small for gestational age: an open-label, randomized study of children during the fourth year of therapy

BACKGROUND

Optimal dosage for growth hormone (GH) therapy in short, prepubertal children born small for gestational age (SGA) is controversial.

METHODS

SGA OPTIMIS (NCT00249821) is a multicenter, open-label, parallel-group, pilot study of short children born SGA who had received recombinant human GH (r-hGH) (57 μg/kg/day) for 3 years. Children were randomized 1:1 to receive either 57 or 35 μg/kg/day r-hGH during year 4. The primary endpoint was height gain during year 4.

RESULTS

22 children were randomized (57 μg/kg/day, n = 10; 35 μg/kg/day, n = 12) and 21 completed the fourth year of therapy; 22 were included in efficacy analyses. During year 4, mean [standard deviation (SD)] height velocity was 6.4 (1.4) and 4.4 (1.2) cm/year (p = 0.001) and height velocity SD score (SDS) was 0.3 (0.3) and -0.1 (0.2) (p = 0.002) in the 57 and 35 μg/kg/day groups, respectively. The 57 μg/kg/day group continued with catch-up growth, had a significantly higher mean weight gain (p = 0.015) and significantly higher insulin-like growth factor-I levels at 12 months (p = 0.038). Five treatment-emergent adverse events were reported; none was serious or caused study withdrawal.

CONCLUSIONS

Children who continued receiving 57 μg/kg/day r-hGH in year 4 had significantly greater height gain than those receiving 35 μg/kg/day r-hGH.