Influence of Surgeon Specialty on 30-day Outcomes Following Single-Level Cervical Disc Arthroplasty: A Propensity-Matched Analysis

STUDY DESIGN

Retrospective, propensity-matched analysis.

OBJECTIVES

Cervical disc arthroplasty (CDA) is being increasingly utilized for cervical disc generation. Surgeon specialty has been shown to influence the risk for postoperative complications in spine surgery, but this has not yet been explored for CDA. Thus, the purpose of this study is to determine whether there is any difference in 30-day complications between patients undergoing single-level CDA by neurosurgeons vs by orthopaedic surgeons.

METHODS

A retrospective, 1:1 propensity score matched analysis was performed using the NSQIP database from 2015 to 2020. Patient demographics, operative characteristics, and postoperative complications were recorded. Independent multivariate logistic regression models were constructed using the propensity-matched dataset to assess surgical specialty influence on any complication, any site complication, any operative infection, and any medical complications.

RESULTS

3179 single-level CDAs (28.8% orthopaedic surgery patients, 71.2% neurosurgery patients) were identified that met the inclusion criteria. Well-matched cohorts of 916 patients each were generated. After controlling for all possible confounders, orthopedic surgery specialty was not associated with a higher odds for any complication (OR: .87, 95% CI: .35 - 2.20, P = .7696), any site complication (OR: .32, 95% CI: .08 - 1.32, P = .1359), any operative infection (OR: .31, 95% CI: .07 - 1.34), P = .1172), nor any medical complication (OR: 2.11, 95% CI: .62 - 7.20, P = .2311) vs neurosurgery.

CONCLUSION

This is the first propensity-matched analysis to show that spine surgeon specialty does not influence the risk for any complication, any site complication, any operative infection, nor any medical complication following single-level CDA within the first 30 days after surgery.

Dual Implementation Guides in FHIR and CDA

BACKGROUND

The Fast Healthcare Interoperability Resources (FHIR) and Clinical Document Architecture (CDA) are standards for the healthcare industry, designed to improve the exchange of health data by interoperability. Both standards are constrained through what are known as Implementation Guides (IG) for specific use.

OBJECTIVES

Both of these two standards are widely in use and play an important role in the Austrian healthcare system. Concepts existing in CDA and FHIR must be aligned between both standards.

METHODS

Many existing approaches are presented and discussed, none are fully suited to the needs in Austria.

RESULTS

The IG Publisher has already been used for CDA IGs, beside of its intended FHIR support, but never for both in one IG. Even the International Patient Summary (IPS), existing as CDA and FHIR specification, does not solve the needed comparability between these two.

CONCLUSION

As the IG Publisher is widely used and supports CDA, it should be used for Dual Implementation Guides. Further work and extension of IG Publisher is necessary to enhance the readability of the resulting IGs.

Anterior cervical discectomy and fusion versus cervical disc arthroplasty: an epidemiological review of 433,660 surgical patients from 2011 to 2021

BACKGROUND CONTEXT

Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are commonly performed operations to address cervical radiculopathy and myelopathy. Trends in utilization and revision surgery rates warrant investigation.

PURPOSE

To explore the epidemiology, postoperative complications, and reoperation rates of ACDF and CDA DESIGN: Retrospective cohort study.

PATIENT SAMPLE

A total of 433,660 patients who underwent ACDF or CDA between 2011 and 2021 were included in this study.

OUTCOME MEASURES

The following data were observed for all cases: patient demographics, complications, and revisions.

METHODS

The PearlDiver database was queried to identify patients who underwent ACDF and CDA between 2011 and 2021. Epidemiological analyses were performed to examine trends in cervical procedure utilization by age group and year. After matching by age, sex, Charlson Comorbidity Index (CCI), levels of operation, and reason for surgery, the early postoperative (2-week), short-term (2-year), and long-term (5-year) complications of both cervical procedures were examined.

RESULTS

In total, 404,195 ACDF and 29,465 CDA patients were included. ACDF utilization rose by 25.25% between 2011 and 2014 while CDA utilization rose by 654.24% between 2011-2019 followed by relative plateauing in both procedures. Mann-Kendall trend test confirmed a significant but small rise in ACDF and large rise in CDA procedures from 2011 to 2021 (p<.001). After matching, ACDF and CDA had an overall complication rate of 12.20% and 8.77%, respectively, with the most common complications being subsequent anterior revision (4.96% and 3.35%) and dysphagia (3.70% and 2.98%). The ACDF cohort, especially multilevel ACDF patients, generally had more complications and higher revision rates than the CDA cohort (p<.05).

CONCLUSIONS

While ACDF utilization has plateaued since 2014, CDA rates have risen by a staggering 654.24% over the past decade. ACDF and CDA complication and revision rates were relatively low in comparison to previously published values, with significantly lower rates in CDA. Although a lack of radiographic data in this study limits its power to recommend either procedure for individual patients with cervical radiculopathy or myelopathy, CDA may be associated with minor improvement in the complication and revision profile.

Exploring retro-cue effects on visual working memory: insights from double-cue paradigm

In the realm of visual working memory research, the retro-cue paradigm helps us study retro-cue effects such as retro-cue benefit (RCB) and retro-cue cost (RCC). RCB reflects better performance with cued items, while RCC indicates poorer performance with uncued items. Despite consistent evidence for RCB, it's still uncertain whether it remains when previously uncued items are cued afterward. Additionally, research findings have been inconsistent. This study combines prior experiments by controlling the proportion of cue types and the number of memory items. Besides, using a CDA index to assess the status of items after the cue appeared. Results showed better performance under the double-cue condition (involving two cues pointing inconsistently with only the second cue being valid) compared to the neutral-cue condition, and better performance under the single-cue condition compared to double-cue. EEG data revealed that after the appearance of the second cue in the double-cue condition, there was a significant increase in CDA wave amplitude compared to the single-cue condition. Behavior results suggests that RCB occurs under double-cue but to a lesser extent than the single-cue. And EEG outcomes indicates that individuals did not remove the uncued item from their visual working memory after the first cue. Instead, they kept it in a passive state and then shifted it to an active state after the appearance of the second cue.

Geographical origin discriminatory analysis of onions: Chemometrics methods applied to ICP-OES and ICP-MS analysis

Geographical origin is an important determinant of agricultural product quality and safety. Herein, inductively coupled plasma (ICP) analysis was applied to determine the inorganic elemental content of onions and identify their geographical origin (Korean or Chinese). Chemometric, including principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and orthogonal partial least square discriminant analysis (OPLS-DA) were applied to the ICP results. OPLS-DA distinguished each group, and 17 elements with variable importance in projection (VIP) values of ≥ 1 were selected. The receiver operating characteristic (ROC) curve had an area under the curve (AUC) of 1, indicating excellent discriminatory power. Differences in elemental content between groups were visually observed in a heatmap, and the country of origin was determined with 100% accuracy using canonical discriminant analysis (CDA). This method accurately distinguishes between Korean and Chinese onions and is expected to be beneficial for identifying agricultural products.

A stepwise diagnostic approach for undiagnosed Anemia in children: A model for low-middle income country

BACKGROUND

Reaching a precise diagnosis in rare inherited anemia is extremely difficult and challenging, especially in areas with limited use of genetic studies, which makes undiagnosed anemia a unique clinical entity in tertiary hematology centers. In this study, we aim at plotting a stepwise diagnostic approach in children with undiagnosed anemia while identifying indications for genetic testing.

PATIENTS AND METHODS

A one-year cross-sectional study involved 44 children and adolescents with undiagnosed anemia after undergoing an initial routine panel of investigations. They were classified based on mean corpuscular volume (MCV) into 3 groups: microcytic (n = 19), normocytic (n = 14) and macrocytic (n = 11). An algorithm that included four levels of investigations was devised for each category.

RESULTS

After applying a systematic diagnostic approach, 33 patients (75 %) were diagnosed of whom 7 (15 %) had combined diagnoses, while 11 (25 %) patients remained undiagnosed. Based on the first, second, third and fourth levels of investigations, patients were diagnosed, respectively, as follows: of the 11 patients, 7 were microcytic, 3 normocytic and 1 macrocytic; of the 7 patients, 2 were microcytic, 2 normocytic, and 3 macrocytic; of 10 patients, 5 were microcytic, 4 normocytic and 1 macrocytic; finally, of the 16 patients, 8 were microcytic, 6 normocytic and 2 macrocytic. Numbers recorded appear higher than the actual number of the patients because some of them were diagnosed by more than one level of investigation. The diagnoses obtained in the microcytic group showed hemoglobinopathies, iron refractory iron deficiency anemia (IRIDA), membrane defects, sideroblastic anemia, hypo-transferrinemia, a combined diagnosis of sickle cell trait and pyropoikilocytosis. The diagnoses also showed a combined diagnosis of hereditary spherocytosis (HS) and alpha thalassemia minor, and a combined diagnosis of iron deficiency anemia and beta thalassemia minor, while 15 % remained undiagnosed. In the normocytic group, the diagnosis revealed autosomal recessive (AR) HS, vitamin B12 deficiency, pyruvate kinase deficiency (PKD), congenital dyserythropoietic anemia (CDA) type I, Diamond Blackfan anemia and beta thalassemia major. In addition, it showed a combined diagnosis of AR HS and CDA type II, a combined diagnosis of AR HS and PKD, and a combined diagnosis of dehydrated stomatocytosis (DHS) and G6PD carrier, meanwhile 20 % remained undiagnosed. Finally, the macrocytic group was diagnosed by vitamin B12 deficiency, sideroblastic anemia, PKD, a combined diagnosis of PKD and G6PD deficiency carrier, while 45 % remained undiagnosed.

CONCLUSION

Conducting a stepwise approach with different levels of investigations may help reach the diagnosis of difficult anemia without having to resort to unnecessary investigations. Combined diagnosis is an important cause of undiagnosed anemia, especially in countries with high frequency of consanguinity. The remaining 25 % of the patients continued to be undiagnosed, requiring more sophisticated investigations.

Visual short-term memory-related EEG components in a virtual reality setup

Virtual reality (VR) offers a powerful tool for investigating cognitive processes, as it allows researchers to gauge behaviors and mental states in complex, yet highly controlled, scenarios. The use of VR head-mounted displays in combination with physiological measures such as EEG presents new challenges and raises the question whether established findings also generalize to a VR setup. Here, we used a VR headset to assess the spatial constraints underlying two well-established EEG correlates of visual short-term memory: the amplitude of the contralateral delay activity (CDA) and the lateralization of induced alpha power during memory retention. We tested observers' visual memory in a change detection task with bilateral stimulus arrays of either two or four items while varying the horizontal eccentricity of the memory arrays (4, 9, or 14 degrees of visual angle). The CDA amplitude differed between high and low memory load at the two smaller eccentricities, but not at the largest eccentricity. Neither memory load nor eccentricity significantly influenced the observed alpha lateralization. We further fitted time-resolved spatial filters to decode memory load from the event-related potential as well as from its time-frequency decomposition. Classification performance during the retention interval was above-chance level for both approaches and did not vary significantly across eccentricities. We conclude that commercial VR hardware can be utilized to study the CDA and lateralized alpha power, and we provide caveats for future studies targeting these EEG markers of visual memory in a VR setup.

Genetic Variants in the Mitochondrial Thymidylate Biosynthesis Pathway Increase Colorectal Cancer Risk

We assess the contributions of genetic variants for the enzymes involved in capecitabine metabolism to colorectal cancer (CRC) development risk. In this case-control study, DNA samples were collected from 66 patients (King Abdulaziz University Hospital) and 65 controls (King Fahad General Hospital) between April and November 2022 to be used in PCR-RFLP. The chi-square (χ2) test at a significance level of p ˂ 0.05 was used to estimate genotype and allele frequencies. The Lys27Gln variant of cytidine deaminase (CDA) showed a risk ratio (RR) of 1.47 for heterozygous (AC) carriers, with genotype distributions for patients (χ2 = 1.97) and controls (χ2 = 14.7). Homozygous (AA) Ala70Thr carriers demonstrated a three-fold higher risk, with genotype distributions for patients (χ2 = 3.85) and controls (χ2 = 4.23). Genotype distributions of the 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T variant for patients were (χ2 = 22.43) and for controls were (χ2 = 0.07); for the MTHFR A1298C variant, they were (χ2 = 54.44) for patients and (χ2 = 4.58) for controls. Heterozygous (AC) carriers of the A1298C variant demonstrated highly significant protection against CRC development (RR = 0.2, p = 0.001), while a two-fold higher risk for CRC was estimated for homozygous genotype (CC) carriers. In conclusion, the heterozygous genotype of CDA Lys27Gln, the homozygous genotype of CDA Ala70Thr, and the homozygous genotype of MTHFR A1298C were associated with CRC development risk. The heterozygous genotype of MTHFR A1298C variant provided highly significant protection against CRC development. Further examinations using a larger population size are needed to reliably confirm our findings.

War on paper: A critical discourse analysis of war reporting in Ethiopia

This study aims to examine the construction of the war between Tigray People's Liberation Front (TPLF) and the central government, as well as its actors, in the local newspaper Bekur. Both a theoretical framework and a research methodology have been developed around critical discourse analysis (CDA). Methods for data analysis include Hodge's war discourse components and Van Dijk's ideological square. The findings indicate that Bekur constructed the war between TPLF forces and the central government as a war of existence. The stories portrayed the war in Ethiopia as a conflict between "country savers" and "dismantlers." Furthermore, the TPLF forces-the out-group-are portrayed as country destabilizers, while the central government is portrayed as the country's saviour. The newspaper also represented the PM as central to winning the battle. Lastly, the positive representation of us, the in-group, and the negative representation of them, the out-group, in the newspaper seem to blatantly support the continuation of unequal power relations among those involved in the war in Ethiopia.

The relationship between ensemble coding and individual representation of crowd facial emotion

In recent years, the processing mechanism of group expression has gradually gained the attention of researchers owing to its high ecological validity. However, research on the relationship between ensemble coding and individual representation is still in the early stage of the investigation, with many studies remaining at the behavioral level and findings varying widely. Based on our behavioral research (Experiment 1), we used EEG measures (Experiments 2A and 2B) to investigate the relationship between summary and object representations by manipulating the exposure time of crowd emotions. The behavioral results indicated that participants performed better in judging emotions of multiple faces compared to a single face during the shorter exposure time, whereas the reverse occurred during the long exposure time. Furthermore, ERP results revealed that the N2pc effect was not affected by the number of faces in the short exposure time; however, as the exposure time increased, the N2pc increased as a function of the number of faces. The findings of the current investigation align with time-dependent assumption, indicating that during short time of visual processing, although individual representations may not be fully developed, ensemble representations are initially established. With longer processing times, detailed individual representations become complete and take precedence.

Articulations of 'Funeral' in Swedish Newspapers During the Covid-19 Pandemic

This article explores how 'funeral' was articulated in Swedish newspapers during the Covid-19 pandemic and how such articulations relate to power and ideology. Articles from the six most prominent Swedish newspapers, published over 2 years, have been analyzed using critical discourse analysis and intersectionality. The study reveals three funeral discourses dominating during different periods of the pandemic: 'Funeral as a risk,' 'Funeral as an essential ritual,' and 'Funeral as a profession.' Altogether, the three discourses expose an ideal of 'the responsible mourner.' This rational woman follows the funeral restrictions and arranges a church funeral shortly after the death of a relative. The 'good funeral' is portrayed as a church funeral with physically present mourners, performed according to the deceased's will and in honor of the dead. The 'bad funeral,' described as the opposite of the 'good funeral,' dominates the understanding of the pandemic funeral situation.

Circadian Genes MBOAT2/CDA/LPCAT2/B4GALT5 in the Metabolic Pathway Serve as New Biomarkers of PACA Prognosis and Immune Infiltration

Pancreatic cancer (PACA) is a highly malignant tumor with a poor prognosis. Recent studies have discovered substantial differences in the expression levels of several circadian genes in PACA samples compared to normal samples. The goal of this research was to find differentially expressed rhythm genes (DERGs) in PACA samples and determine their role in the development of PACA. A total of 299 DERGs were identified in PACA, including 134 downregulated genes and 165 upregulated genes. DERGs were significantly abundant in the metabolic pathway and immune response pathways, according to GO and KEGG analyses. Survival analyses showed that PACA patients who had higher expression levels of MBOAT2/CDA/LPCAT2/B4GALT5 had shorter overall survival times. Using cell assay verification, the mRNA levels of MBOAT2/CDA/LPCAT2/B4GALT5 in Patu-8988 and PNAC-1 cells were found to be significantly higher than those in HPDE6-C7 cells, which was in line with previous studies on PACA patient data. Through conducting univariate Cox analysis, it was determined that MBOAT2/CDA/LPCAT2/B4GALT5 expression, age and grade were all high-risk factors. The MBOAT2/CDA/LPCAT2/B4GALT5 genes were independently correlated with overall survival, according to the multivariate Cox analysis. The proportion of immune cells in PACA and normal samples significantly changed, according to the immune infiltration analysis. Furthermore, MBOAT2/CDA/LPCAT2/B4GALT5 expression levels were significantly related to the level of immune cell infiltration. The protein-protein interaction network of the MBOAT2/CDA/LPCAT2/B4GALT5 genes included 54 biological nodes and 368 interacting genes. In conclusion, the finding of these DERGs adds to the investigation of the molecular processes underlying the onset and progression of PACA. In the future, DERGs may serve as prognostic and diagnostic biomarkers as well as drug targets for chronotherapy in PACA patients.

Pharmacogenetics of ABCB1, CDA, DCK, GSTT1, GSTM1 and outcomes in a cohort of pediatric acute myeloid leukemia patients from Colombia

BACKGROUND AND AIM

Different studies have shown pharmacogenetic variants related to drug toxicity in acute myeloid leukemia (AML) patients. Our aim was to identify the association between ABCB1, CDA, DCK, GSTT1, and GSTM1 variants with clinical outcomes and toxicity in pediatric patients with AML.

METHODS

Fifty-one confirmed de novo AML pediatric patients were included. A SNaPshot™ assay and conventional PCR were used to evaluate ABCB1, CDA, DCK, GSTT1, and GSTM1 variants. Clinical outcomes and toxicity associations were evaluated using odds ratios and Chi-square analysis.

RESULTS

Patients carrying ABCB1 (1236C > T, rs1128503) GG genotype in had a 6.8 OR (CI 95% 1.08-42.73, p = .044) for cardiotoxicity as compared to patients carrying either AA or GA genotypes 0.14 OR (CI 95% 0.023-0.92, p = .044). For ABCB1 (1236G > A rs1128503/2677C > A/T rs2032582/3435G > A rs1045642) AA/AA/AA combined genotypes had a strong association with death after HSTC OR 13.73 (CI 95% 1.94-97.17, p = .009). Combined genotypes GG/CC/GG with CDA (79A > C, rs2072671) CA genotype or CDA (-451G > A, rs532545) CT genotype, had a 4.11 OR (CI 95% 2.32-725, p = .007) and 3.8 OR (CI 95% 2.23-6.47, p = .027) with MRD >0.1% after first chemotherapy cycle, respectively.

CONCLUSION

Our results highlight the importance of pharmacogenetic analysis in pediatric AML, particularly in populations with a high degree of admixture, and might be useful as a future tool for patient stratification for treatment.

Rare congenital Dyserythropoietic anemia of childhood: A case report

Congenital dyserythropoietic anemias (CDA) is a heterogeneous class of anemia of varying degrees of ineffective erythropoiesis and secondary hemochromatosis. We reported a case of CDA and showed our approach to reaching a diagnosis, highlighting the importance of the typical morphological appearance of bone marrow erythroblasts to reach the diagnosis.

Investigation on Gold-Ligand Interaction for Complexes from Gold Leaching: A DFT Study

Gold leaching is an important process to extract gold from ore. Conventional alkaline cyanide process and alternative nontoxic lixiviants including thiosulfate, thiourea, thiocyanate, and halogen have been widely investigated. However, density functional theory (DFT) study on the gold complexes Au(CN)₂^-, Au(S₂O₃)₂^3-, Au[SC(NH₂)₂]₂⁺, Au(SCN)₂^-, and AuCl₂^- required for discovering and designing new highly efficient and environmentally friendly gold leaching reagents is lacking, which is expected to support constructive information for the discovery and designation of new high-efficiency and environmentally friendly gold leaching reagents. In this study, the structure information, electron-transferring properties, orbital interaction, and chemical bond composition for complexes Au(CN)₂^-, Au(S₂O₃)₂^3-, Au[SC(NH₂)₂]₂⁺, Au(SCN)₂^-, and AuCl₂^- depending on charge decomposition analysis (CDA), natural bond orbital (NBO), natural resonance theory (NRT), electron localization function (ELF), and energy decomposition analysis (EDA) were performed based on DFT calculation. The results indicate that there is not only σ-donation from ligand to Au⁺, but also electron backdonation from Au⁺ to ligands, which strengthens the coordinate bond between them. Compared with Cl^-, ligands CN^-, S₂O₃^2-, SC(NH₂)₂, and SCN^- have very large covalent contribution to the coordinate bond with Au⁺, which explains the special stability of Au-CN and Au-S bonds. The degree of covalency and bond energy in Au-ligand bonding decreases from Au(CN)₂^-, Au(S₂O₃)₂^3-, Au[SC(NH₂)₂]₂⁺, Au(SCN)₂^-, to AuCl₂^-, which interprets the stability of the five complexes: Au(CN)₂^- > Au(S₂O₃)₂^3- > Au[SC(NH₂)₂]₂⁺ > Au(SCN)₂^- > AuCl₂^-.

Is the Contralateral Delay Activity (CDA) a robust neural correlate for Visual Working Memory (VWM) tasks? A reproducibility study

Visual working memory (VWM) allows us to actively store, update, and manipulate visual information surrounding us. While the underlying neural mechanisms of VWM remain unclear, contralateral delay activity (CDA), a sustained negativity over the hemisphere contralateral to the positions of visual items to be remembered, is often used to study VWM. To investigate if the CDA is a robust neural correlate for VWM tasks, we reproduced eight CDA-related studies with a publicly accessible EEG data set. We used the raw EEG data from these eight studies and analyzed all of them with the same basic pipeline to extract CDA. We were able to reproduce the results from all the studies and show that with a basic automated EEG pipeline we can extract a clear CDA signal. We share insights from the trends observed across the studies and raise some questions about the CDA decay and the CDA during the recall phase, which surprisingly, none of the eight studies did address. Finally, we also provide reproducibility recommendations based on our experience and challenges in reproducing these studies.

Upholding justice through music: protesting betrayal in Oromo song, Wal Agarraa

The study aimed at explicating the linguistic choices subsumed in an Oromo protest song, Wal Agarraa by Galanaa Garoomsaa so as to shed light on the underlying messages as a form of political discourse. Music is considered one of the platforms for expressing discontent among the Oromo. In this research, we explored the textual instrumentality of the lyrics of the song as a form of political discourse in exposing the injustices perpetrated against the Oromo. We adopted Critical Discourse Analysis (CDA) framework to identify the discourses in the song. The study has made it evident that the song has got a number of underlying messages meant to raise the consciousness of the citizens regarding the injustices perpetrated against the Oromo. As such, the central theme of the song is that the Oromo quest for justice will be revealed eventually which the artist foreshadows using the title of the song Wal Agarraa/the time will come/. Furthermore, the functions of coercion, legitimization-delegitimization, and resistance, opposition and dissimulation have been subsumed in the song to convey the imbedded messages. The findings of the study also demonstrate that music goes far beyond simply reflecting and describing the state of affairs but it also becomes a platform through which discursive spaces are opened.

ELGA Outpatient Clinic Report and ELGA Telehealth Note: Two HL7-CDA®-Based Modular Electronic Documents

BACKGROUND

From 2022, the "Outpatient Clinic Report" and the "Telehealth Note" will complement the existing e-Reports in the Austrian Electronic Health Record system ELGA.

OBJECTIVES

The specification of two harmonized implementation guides with standardized structure for all types of outpatient clinics in hospitals on the one hand and for telemonitoring treatments on the other hand.

METHODS

With the participation of expert groups, the contents were harmonized, and a data model was created. Template specifications were modelled in ART-DECOR and approved in the course of an HL7 Austria ballot.

RESULTS

Two sets of freely selectable building blocks and machine-readable content were created.

CONCLUSION

The "Outpatient Clinic Report" and the "Telehealth Note" are currently being implemented. The use of these documents will be evaluated as well as if additional machine-readable content is needed.

Cross-modal contextual memory guides selective attention in visual-search tasks

Visual search is speeded when a target item is positioned consistently within an invariant (repeatedly encountered) configuration of distractor items ("contextual cueing"). Contextual cueing is also observed in cross-modal search, when the location of the-visual-target is predicted by distractors from another-tactile-sensory modality. Previous studies examining lateralized waveforms of the event-related potential (ERP) with millisecond precision have shown that learned visual contexts improve a whole cascade of search-processing stages. Drawing on ERPs, the present study tested alternative accounts of contextual cueing in tasks in which distractor-target contextual associations are established across, as compared to, within sensory modalities. To this end, we devised a novel, cross-modal search task: search for a visual feature singleton, with repeated (and nonrepeated) distractor configurations presented either within the same (visual) or a different (tactile) modality. We found reaction times (RTs) to be faster for repeated versus nonrepeated configurations, with comparable facilitation effects between visual (unimodal) and tactile (crossmodal) context cues. Further, for repeated configurations, there were enhanced amplitudes (and reduced latencies) of ERPs indexing attentional allocation (PCN) and postselective analysis of the target (CDA), respectively; both components correlated positively with the RT facilitation. These effects were again comparable between uni- and crossmodal cueing conditions. In contrast, motor-related processes indexed by the response-locked LRP contributed little to the RT effects. These results indicate that both uni- and crossmodal context cues benefit the same, visual processing stages related to the selection and subsequent analysis of the search target.

Validation of CRISPR targeting for proliferation and cytarabine resistance control genes in the acute myeloid leukemia cell line MOLM-13

Acute myeloid leukemia patients with FMS-like tyrosine kinase 3–internal tandem duplications and mixed lineage leukemia–protein AF9 fusion proteins suffer from poor clinical outcomes. The MOLM-13 acute myeloid leukemia cell line harbors both of these abnormalities and is used in CRISPR experiments to identify disease drivers. However, experimental observations may be biased or inconclusive in the absence of experimentally validated positive control genes. We validated sgRNAs for knockdown of TP53 for cell proliferation and for DCK knockdown and CDA upregulation for cytarabine resistance control genes in MOLM-13 cells. We have provided a detailed CRISPR protocol applicable to both gene knockdown or activation experiments and downstream leukemic phenotype analyses. Inclusion of these controls in CRISPR experiments will enhance the capacity to identify novel myeloid leukemia drivers in MOLM-13 cells.

CRISPR-Cas9 knockdown and upregulation approaches were used for changing the expression of control genes TP53, DCK, and CDA in the acute myeloid leukemia cell line MOLM-13. Lentivirus transduced cells were selected (sorted for green fluorescent protein positive cells or selected by antibiotic treatment), and knockdown or upregulation of genes in the stable cells was confirmed by real-time quantitative PCR and western blot analyses. EdU incorporation assay was used to measure cell proliferation. Colorimetric proliferation/survival assay and flow cytometric cell counting were used to measure cell growth and survival. Results from the experimental and control groups were compared using Student's t-test.

Are all real-world objects created equal? Estimating the "set-size" of the search target in visual working memory

Are all real-world objects created equal? Visual search difficulty increases with the number of targets and as target-related visual working memory (VWM) load increases. Our goal was to investigate the load imposed by individual real-world objects held in VWM in the context of search. Measures of visual clutter attempt to quantify real-world set-size in the context of scenes. We applied one of these measures, the number of proto-objects, to individual real-world objects and used contralateral delay activity (CDA) to measure the resulting VWM load. The current study presented a real-world object as a target cue, followed by a delay where CDA was measured. This was followed by a four-object search array. We compared CDA and later search performance from target cues containing a high or low number of proto-objects. High proto-object target cues resulted in greater CDA, longer search RTs, target dwell times, and reduced search guidance, relative to low proto-object targets. These findings demonstrate that targets with more proto-objects result in a higher VWM load and reduced search performance. This shows that the number of proto-objects contained within individual objects produce set-size like effects in VWM and suggests proto-objects may be a viable unit of measure of real-world VWM load. Importantly, this demonstrates that not all real-world objects are created equal.

Roles of LmCDA1 and LmCDA2 in cuticle formation in the foregut and hindgut of Locusta migratoria

Chitin deacetylases (CDAs, including CDA1 and CDA2) are considered key enzymes for body cuticle formation and tracheal morphogenesis in various insect species. However, their functions in the formation of the cuticular intima of the foregut and hindgut are unclear. Here, we investigated the roles of their respective genes LmCDA1 and LmCDA2 in this process, in the hemimetabolous insect Locusta migratoria. Transcripts of LmCDA1 and LmCDA2 were highly expressed both before and after molting in the foregut. In the hindgut, their expression was high only before molting. In both the foregut and hindgut, LmCDA1 protein was localized in the basal half of the chitin matrix (procuticle), whereas LmCDA2 was detected in the upper half of the procuticle. Knockdown of LmCDA1 by RNA interference (RNAi) in 5th-instar nymphs caused no visible defects of the hindgut cuticle. By contrast, the chitinous lamellae of the cuticular intima in the foregut of knockdown animals were less compact than in control animals. RNAi against LmCDA2 led to thickening of both the foregut and hindgut cuticles, with a greater number of thinner laminae than in the respective control cuticles. Taken together, our results show that LmCDA1 and LmCDA2 have distinct, but overlapping, functions in chitin organization in the foregut cuticle. However, in the hindgut, this process seems independent of LmCDA1 activity but requires LmCDA2 function. Thus, the CDAs reflect tissue-specific differences in cuticular organization and function, which need further detailed molecular and histological analyses for full comprehension.

Hybrid Anterior Cervical Discectomy and Fusion and Cervical Disc Arthroplasty: An Analysis of Short-Term Complications, Reoperations, and Readmissions

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

Although cervical disc arthroplasty (CDA) has become a well-established and effective treatment for symptomatic cervical degeneration, many patients with multilevel disease are not good candidates for CDA at all levels. For such patients, hybrid surgery (HS)-a combination of adjacent anterior cervical discectomy and fusion (ACDF) and CDA-may be more appropriate. Given the novelty of HS and the relative dearth of studies adequately assessing short-term perioperative complications, this current study sought to assess the short-term morbidity profile of HS, differences in operative duration, length of stay (LOS), and readmission and reoperation rates and reasons relative to a 2-level ACDF cohort.

METHODS

All patients who underwent HS and 2-level ACDF were identified between 2011 and 2018 using a large, prospectively collected registry. Baseline patient characteristics and postoperative complications were compared using bivariate and/or multivariate analysis.

RESULTS

A total of 390 patients undergoing HS were identified. Two-level procedures were the most common (74.9%). Patients undergoing HS were more likely to be younger, male, and have fewer comorbidities. There were no differences between HS and 2-level ACDF in rates of any postoperative complication, transfusion, readmissions, and operative duration. However, HS had a decreased LOS (0.5 days), relative to a 2-level ACDF. HS patients had low rates of reoperation (1.28%) with 1 case for hematoma evacuation and another for revision CDA.

CONCLUSIONS

This study represents one of the largest cohorts of patients undergoing HS reported to date. Patients undergoing HS are not at increased risk of perioperative complications relative to a 2-level ACDF and may benefit from shorter LOS.

The Fast Health Interoperability Resources (FHIR) Standard: Systematic Literature Review of Implementations, Applications, Challenges and Opportunities

Background

Information technology has shifted paper-based documentation in the health care sector into a digital form, in which patient information is transferred electronically from one place to another. However, there remain challenges and issues to resolve in this domain owing to the lack of proper standards, the growth of new technologies (mobile devices, tablets, ubiquitous computing), and health care providers who are reluctant to share patient information. Therefore, a solid systematic literature review was performed to understand the use of this new technology in the health care sector. To the best of our knowledge, there is a lack of comprehensive systematic literature reviews that focus on Fast Health Interoperability Resources (FHIR)-based electronic health records (EHRs). In addition, FHIR is the latest standard, which is in an infancy stage of development. Therefore, this is a hot research topic with great potential for further research in this domain.

Objective

The main aim of this study was to explore and perform a systematic review of the literature related to FHIR, including the challenges, implementation, opportunities, and future FHIR applications.

Methods

In January 2020, we searched articles published from January 2012 to December 2019 via all major digital databases in the field of computer science and health care, including ACM, IEEE Explorer, Springer, Google Scholar, PubMed, and ScienceDirect. We identified 8181 scientific articles published in this field, 80 of which met our inclusion criteria for further consideration.

Results

The selected 80 scientific articles were reviewed systematically, and we identified open questions, challenges, implementation models, used resources, beneficiary applications, data migration approaches, and goals of FHIR.

Conclusions

The literature analysis performed in this systematic review highlights the important role of FHIR in the health care domain in the near future.

Performance Analysis of Blended Membranes of Cellulose Acetate with Variable Degree of Acetylation for CO2/CH4 Separation

The separation and capture of CO₂ have become an urgent and important agenda because of the CO₂-induced global warming and the requirement of industrial products. Membrane-based technologies have proven to be a promising alternative for CO₂ separations. To make the gas-separation membrane process more competitive, productive membrane with high gas permeability and high selectivity is crucial. Herein, we developed new cellulose triacetate (CTA) and cellulose diacetate (CDA) blended membranes for CO₂ separations. The CTA and CDA blends were chosen because they have similar chemical structures, good separation performance, and its economical and green nature. The best position in Robeson’s upper bound curve at 5 bar was obtained with the membrane containing 80 wt.% CTA and 20 wt.% CDA, which shows the CO₂ permeability of 17.32 barrer and CO₂/CH₄ selectivity of 18.55. The membrane exhibits 98% enhancement in CO₂/CH₄ selectivity compared to neat membrane with only a slight reduction in CO₂ permeability. The optimal membrane displays a plasticization pressure of 10.48 bar. The newly developed blended membranes show great potential for CO₂ separations in the natural gas industry.

Selective treatment pressure in colon cancer drives the molecular profile of resistant circulating tumor cell clones

The characterization of circulating tumor cells (CTCs) holds promises for precision medicine because these cells are an important clinical indicator of treatment efficacy. We established the first and still only nine permanent colon CTC lines from peripheral blood samples of a patient with metastatic colon cancer collected at different time points during treatment and cancer progression. The study objectives were (i) to compare the gene expression profiles of these CTC lines, and (ii) to determine the main features acquired during treatment. The number of upregulated genes was higher in the CTC lines obtained after treatment, indicating that they acquired properties to escape treatment pressure. Among these upregulated genes, some are involved in the mTOR and PI3K/AKT signaling pathways. Moreover, cytidine deaminase expression was significantly increased in the CTC lines obtained after failure of the first- and second-line 5-fluorouracile-based treatments, suggesting that these CTCs can eliminate this specific drug and resist to therapy. Several enzymes involved in xenobiotic metabolism also were upregulated after treatment, suggesting the activation of detoxification mechanisms in response to chemotherapy. Finally, the significant higher expression of aldolase B in four of the six CTC lines obtained after treatment withdrawal and cancer progression indicated that these clones originated from liver metastases. In conclusion, these CTC lines generated at different time points during treatment of metastatic colon cancer in a single patient are characterized by the deregulation of different genes that promote (i) drug resistance, (ii) xenobiotic and energy metabolism, and (iii) stem cell properties and plasticity.

Visual Working Memory Guides Spatial Attention: Evidence from alpha oscillations and sustained potentials

Selective attention can facilitate performance by filtering irrelevant information and temporary maintaining limited information to accomplish the current task. However, the neural substrate how attentional selection can be guided by visual working memory (vWM) is not clear. Here, we recorded electrophysiological signals during vWM retention and investigated the relationship between objects held in memorial templates and the subsequent attentional selection during visual search. We observed that sustained posterior contralateral delay activity (CDA) was present and scaled with lateral vWM loads during the whole period of vWM retention, but that it was absent when objects were bilaterally held in vWM. Surprisingly, a strikingly similar pattern emerged for modulations in the averaged posterior alpha (8-12 Hz) power during the late period but not during the early period of retention. More importantly, it was the alpha modulation, but not the CDA, that strongly predicted the subsequent biomarker of attentional selection (the memorial template-induced N2pc) during visual search. We further observed the N2pc amplitudes decreased with increasing memory loads and predicted the same gradation of the final behavioral accuracy in visual search. All these results suggested that the subsequent memorial template-induced N2pc is response to the level of top-down attentional guiding effect caused by vWM. Our results provide neurophysiological evidence that keeping multiple templates in working memory simultaneously weakens the guiding effect to the following attentional selection.

Boosting working memory with accelerated clocks

Our perception of time varies with the degree of cognitive engagement in tasks. The perceived passage of time accelerates while working on demanding tasks, whereas time appears to drag during boring situations. Our experiment aimed at investigating whether this relationship is mutual: Can manipulated announcements of elapsed time systematically affect the attentional resources applied to a cognitive task? We measured behavioral performance and the EEG in a whole report working memory paradigm with six items of different colors that each had to be reported after a short delay period. The 32 participants were informed about the current time after each 20 trials, while the clock was running at either 100% (normal), 120% (fast), or 80% (slow) of normal clock speed depending on the experimental block. The mean number of correctly reported colors per trial was significantly increased in the fast as compared to the slow and normal clock conditions. In the EEG, we focused on neural oscillations during working memory encoding and storage. As an electrophysiological correlate of task engagement, frontal theta power during the storage interval was increased in the fast clock condition. Also, the power of frontal theta oscillations predicted the number of correctly reported colors on a single-trial basis. This shows that a covert manipulation of clock speed can lead to an improvement in cognitive performance, presumably mediated by a higher allocation of attentional resources resulting from an adaptation of the subjective passage of time during an experiment.

Methods to optimize conformal dynamic arcs in radiation therapy treatment planning

Conformal Dynamic Arcs (CDA) can provide a useful alternative in certain clinical situations which require a higher level of 3-dimensional (3D) conformation than shaped static fields but for which modulated fields (fixed or arc) are inappropriate. Due to lack of modulation, the quality of the dose distribution produced by a CDA is highly dependent on the specific patient geometry. The ideal geometry for a CDA, in terms of achievable conformation and uniformity, is a spherical target perfectly centered in a cylindrical medium or body and utilizing a full 360 degree of rotation. This manuscript will provide or review several methods a treatment planner may employ to improve dose distributions produced by CDA as the patient and/or target geometry or degrees of arc rotation vary from the ideal. These include: 1. Weighting arc segments to improve homogeneity. 2. Defining asymmetric margins for fitting leaves. 3. Hybrid static/CDA compensating for CDA with limited degrees of rotations. 4. Improving conformation in irregular target via use of pseudo-PTV. 5. Creating concave features via the use of avoidance structures. 6. Editing CDA multi-leaf collimator (MLC) to remove irregular hot spots.

Preparation of Defined Chitosan Oligosaccharides Using Chitin Deacetylases

During the past decade, detailed studies using well-defined 'second generation' chitosans have amply proved that both their material properties and their biological activities are dependent on their molecular structure, in particular on their degree of polymerisation (DP) and their fraction of acetylation (F_A). Recent evidence suggests that the pattern of acetylation (PA), i.e., the sequence of acetylated and non-acetylated residues along the linear polymer, is equally important, but chitosan polymers with defined, non-random PA are not yet available. One way in which the PA will influence the bioactivities of chitosan polymers is their enzymatic degradation by sequence-dependent chitosan hydrolases present in the target tissues. The PA of the polymer substrates in conjunction with the subsite preferences of the hydrolases determine the type of oligomeric products and the kinetics of their production and further degradation. Thus, the bioactivities of chitosan polymers will at least in part be carried by the chitosan oligomers produced from them, possibly through their interaction with pattern recognition receptors in target cells. In contrast to polymers, partially acetylated chitosan oligosaccharides (paCOS) can be fully characterised concerning their DP, F_A, and PA, and chitin deacetylases (CDAs) with different and known regio-selectivities are currently emerging as efficient tools to produce fully defined paCOS in quantities sufficient to probe their bioactivities. In this review, we describe the current state of the art on how CDAs can be used in forward and reverse mode to produce all of the possible paCOS dimers, trimers, and tetramers, most of the pentamers and many of the hexamers. In addition, we describe the biotechnological production of the required fully acetylated and fully deacetylated oligomer substrates, as well as the purification and characterisation of the paCOS products.

Modulating pyrimidine ribonucleotide levels for the treatment of cancer

By providing the necessary building blocks for nucleic acids and precursors for cell membrane synthesis, pyrimidine ribonucleotides are essential for cell growth and proliferation. Therefore, depleting pyrimidine ribonucleotide pools has long been considered as a strategy to reduce cancer cell growth. Here, we review the pharmacological approaches that have been employed to modulate pyrimidine ribonucleotide synthesis and degradation routes and discuss their potential use in cancer therapy. New developments in the treatment of myeloid malignancies with inhibitors of pyrimidine ribonucleotide synthesis justify revisiting the literature as well as discussing whether targeting this metabolic pathway can be effective and sufficiently selective for cancer cells to warrant an acceptable therapeutic index in patients.

Downregulation of GLI3 Expression Mediates Chemotherapy Resistance in Acute Myeloid Leukemia

Aberrant activation of the hedgehog (HH) pathway is observed in many neoplasms, including acute myeloid leukemia (AML). The glioma-associated oncogene homolog (GLI) transcription factors are the main downstream effectors of the HH signaling cascade and are responsible for the proliferation and maintenance of leukemic stem cells, which support chemotherapy resistance and leukemia relapse. Cytarabine (Ara-C)-resistant variants of AML cell lines were established through long-term cultivation with successively increasing Ara-C concentrations. Subsequently, differences in GLI expression were analyzed by RT-qPCR. GLI3 mRNA levels were detectable in parental Kasumi-1, OCI-AML3, and OCI-AML5 cells, whereas GLI3 expression was completely silenced in all resistant counterparts. Therefore, we generated GLI3-knockdown cell lines using small hairpin RNAs (shRNA) and evaluated their sensitivity to Ara-C in vitro. The knockdown of GLI3 partly abolished the effect of Ara-C on colony formation and induction of apoptosis, indicating that GLI3 downregulation results in Ara-C resistance. Moreover, we analyzed the expression of several genes involved in Ara-C metabolism and transport. Knockdown of GLI3 resulted in the upregulation of SAM and HD domain-containing protein 1 (SAMHD1), cytidine deaminase (CDA), and ATP-binding cassette C11 (ABCC11)/multidrug resistance-associated protein 8 (MRP8), each of which has been identified as a predictive marker for Ara-C response in acute myeloid leukemia. Our results demonstrate that GLI3 downregulation is a potential mechanism to induce chemotherapy resistance in AML.

Electrophysiological Measures of Visual Working Memory in Social Anxiety

Socially anxious individuals are very sensitive to threatening information in the environment, so visual working memory (VWM) is of great significance for them. However, the influence of social anxiety on VWM is unclear. In the present study, we aimed to investigate the VWM in individuals with social anxiety using electrophysiological techniques. Event-related potentials (ERPs) of high socially anxious (HSA) individuals and low socially anxious (LSA) individuals were recorded during a change-detection task with two memory conditions (two and four items). Electrophysiological results indicated that compared with the LSA individuals, the HSA individuals had significantly more active contralateral delay activity (CDA) in condition of memorizing four items. However, there was no significant difference between the HSA and LSA groups in response accuracy in the conditions memorizing two and four items. From the electrophysiological results, individuals with high social anxiety could maintain more information in VWM. However, maybe anxiety consumes the available cognitive resources to compensate for the supposed to be impaired effective performance, so that individuals with high social anxiety perform the same as individuals with low social anxiety in terms of behavioral outcomes.

Cervical disc arthroplasty for less-mobile discs

OBJECTIVE

The published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°-9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM.

METHODS

A series of consecutive patients who underwent CDA at the level of C5-6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5-6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5-6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed.

RESULTS

A total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups.

CONCLUSIONS

Preoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.

Messenger-RNA Expression of Five Gemcitabine Sensitivity-related Genes Predicting Outcome in Advanced-stage Non-small Cell Lung Cancer

BACKGROUND/AIM

Tumoural transcriptional levels of RRM1, RRM2, CDA, dCK and hENT1 genes are potential biomarkers for gemcitabine's efficacy in non-small cell lung cancer (NSCLC).

PATIENTS AND METHODS

We retrospectively analysed each gene's relative mRNA expression by quantitative, real-time polymerase chain reaction in microdissected, formalin-fixed, paraffin-embedded primary-tumour specimens from 219 chemonaïve patients with advanced-stage NSCLC, treated with gemcitabine-based regimens within clinical trials. The five genes' transcriptional patterns were integrated into an ordinal, five-level gemcitabine-susceptibility classifier (5L-GSC).

RESULTS

Treatment efficacy increased progressively across the five susceptibility levels, with the very-high chemosensitivity cases obtaining the most clinical benefit. 5L-GSC emerged as an independent prognosticator for overall response and disease control rates, time to progression and overall survival at p-values of 0.03, 0.004, <0.001 and <0.001, respectively, with results remaining significant after bootstrapping. Penalised, optimally-scaled, categorical-regression modelling of overall response identified 5L-GSC as the most stable predictor.

CONCLUSION

The proposed composite biomarker is promising for customising front-line chemotherapy in NSCLC.

Cytidine deaminase enables Toll-like receptor 8 activation by cytidine or its analogs

Toll-like receptor 8 (TLR8), a sensor for pathogen-derived single-stranded RNA (ssRNA), binds to uridine (Uri) and ssRNA to induce defense responses. We here show that cytidine (Cyd) with ssRNA also activated TLR8 in peripheral blood leukocytes (PBLs) and a myeloid cell line U937, but not in an embryonic kidney cell line 293T. Cyd deaminase (CDA), an enzyme highly expressed in leukocytes, deaminates Cyd to Uri. CDA expression enabled TLR8 response to Cyd and ssRNA in 293T cells. CDA deficiency and a CDA inhibitor both reduced TLR8 responses to Cyd and ssRNA in U937. The CDA inhibitor also reduced PBL response to Cyd and ssRNA. A Cyd analogue, azacytidine, is used for the therapy of myelodysplastic syndrome and acute myeloid leukemia. Azacytidine with ssRNA induced tumor necrosis factor-α expression in U937 and PBLs in a manner dependent on CDA and TLR8. These results suggest that CDA enables TLR8 activation by Cyd or its analogues with ssRNA through deaminating activity. Nucleoside metabolism might impact TLR8 responses in a variety of situations such as the treatment with nucleoside analogues.

Corrupted DNA-binding specificity and ectopic transcription underpin dominant neomorphic mutations in KLF/SP transcription factors

Background

Mutations in the transcription factor, KLF1, are common within certain populations of the world. Heterozygous missense mutations in KLF1 mostly lead to benign phenotypes, but a heterozygous mutation in a DNA-binding residue (E325K in human) results in severe Congenital Dyserythropoietic Anemia type IV (CDA IV); i.e. an autosomal-dominant disorder characterized by neonatal hemolysis.

Results

To investigate the biochemical and genetic mechanism of CDA IV, we generated murine erythroid cell lines that harbor tamoxifen-inducible (ER™) versions of wild type and mutant KLF1 on a Klf1^−/− genetic background. Nuclear translocation of wild type KLF1 results in terminal erythroid differentiation, whereas mutant KLF1 results in hemolysis without differentiation. The E to K variant binds poorly to the canonical 9 bp recognition motif (NGG-GYG-KGG) genome-wide but binds at high affinity to a corrupted motif (NGG-GRG-KGG). We confirmed altered DNA-binding specificity by quantitative in vitro binding assays of recombinant zinc-finger domains. Our results are consistent with previously reported structural data of KLF-DNA interactions. We employed 4sU-RNA-seq to show that a corrupted transcriptome is a direct consequence of aberrant DNA binding.

Conclusions

Since all KLF/SP family proteins bind DNA in an identical fashion, these results are likely to be generally applicable to mutations in all family members. Importantly, they explain how certain mutations in the DNA-binding domain of transcription factors can generate neomorphic functions that result in autosomal dominant disease.

Electronic supplementary material

The online version of this article (10.1186/s12864-019-5805-z) contains supplementary material, which is available to authorized users.

Contralateral delay activity during temporal order memory

In everyday life, we constantly need to remember the temporal sequence of visual events over short periods of time, for example, when making sense of others' actions or watching a movie. While there is increasing knowledge available on neural mechanisms underlying visual working memory (VWM) regarding the identity and spatial location of objects, less is known about how the brain encodes and retains information on temporal sequences. Here, we investigate whether the contralateral-delay activity (CDA), a well-studied electroencephalographic (EEG) component associated with VWM of object identity, also reflects the encoding and retention of temporal order. In two independent experiments, we presented participants with a sequence of four or six images, followed by a 1 s retention period. Participants judged temporal order by indicating whether a subsequently presented probe image was originally displayed during the first or the second half of the sequence. As a main novel result, we report the emergence of a contralateral negativity already following the presentation of the first item of the sequence, which increases over the course of a trial with every presented item, up to a limit of four items. We further observed no differences in the CDA during the temporal-order task compared to one obtained during a task concerning the spatial location of the presented items. Since the characteristics of the CDA appear to be highly similar between different encoded feature dimensions and increases as additional items are being encoded, we suggest this component might be a general characteristic of various types of VWM.

Safety and efficacy of cervical disc arthroplasty in preventing the adjacent segment disease: a meta-analysis of mid- to long-term outcomes in prospective, randomized, controlled multicenter studies

Objectives

Cervical disc arthroplasty (CDA) has become an alternative treatment for cervical radiculopathy and myelopathy. This technique preserves appropriate motion at both the index and adjacent disc levels and consequently may prevent adjacent segment degeneration (ASD). The authors performed a meta-analysis to compare the safety and efficacy of CDA to those of the gold standard, anterior cervical discectomy and fusion (ACDF). Both surgical and clinical parameters were employed to verify the hypothesis that CDA can reduce the risk of ASD.

Methods

The meta-analysis comprised high-quality randomized controlled trials that compared CDA and ACDF treatments of cervical degenerative disc disease. Included papers reported data for at least one of the following outcomes: 1) surgical parameters, 2) questionnaire clinical indices (pre- and postoperative values), and 3) complication rates at 24 months; in addition, for ASD we analyzed 60 month or longer follow-ups. We used mean differences (MDs) or ORs to compare treatment effects between CDA and ACDF.

Results

Twenty studies with 3,656 patients (2,140 with CDA and 1,516 with ACDF) met the inclusion criteria. CDA surgery, with mean duration longer than that of ACDF, was associated with higher blood loss. Visual analog scale neck pain score was significantly smaller for CDA (mean difference =−2.30, 95% CI [−3.72; −0.87], P=0.002). The frequency of dysphagia/dysphonia (OR =0.69, 95% CI [0.49; 0.98], P=0.04) as well as the long-term ASD rate for CDA was significantly smaller (OR =0.33, 95% CI [0.21; 0.50], P<0.0001).

Conclusion

A significantly lower probability of ASD reoperations in the CDA cohort after a 60-month or longer follow-up was the most important finding of this study. Despite the moderate quality of this evidence, the pooled data corroborated for the very first time that CDA was efficacious in preventing ASD.

Neural Processing of Repeated Search Targets Depends Upon the Stimuli: Real World Stimuli Engage Semantic Processing and Recognition Memory

Recent evidence has suggested that visual working memory (VWM) plays an important role in representing the target prior to initiating a visual search. The more familiar we are with the search target, the more refined the representation of the target (or "target template") becomes. This sharpening of the target template is thought to underlie the reduced response time (RT) and increased accuracy associated with repeatedly searching for the same target. Perhaps target representations transition from limited-capacity VWM to Long-Term Memory (LTM) as targets repeat. In prior work, amplitude of an event-related potential (ERP) component associated with VWM representation decreased with target repetition, broadly supporting this notion. However, previous research has focused on artificial stimuli (Landolt Cs) that are far removed from search targets in the real world. The current study extends this work by directly comparing target representations for artificial stimuli and common object images. We found VWM representation follows the same pattern for real and artificial stimuli. However, the initial selection of the real world objects follows a much different pattern than more typical artificial stimuli. Further, the morphology of nonlateralized waveforms was substantially different for the two stimulus categories. This suggests that the two types of stimuli were processed in fundamentally different ways. We conclude that object type strongly influences how we deploy attentional and mnemonic resources prior to search. Early attentional selection of familiar objects may facilitate additional LTM processes that lead to behavioral benefits not seen with more simplistic stimuli.

Gene expression of hENT1, dCK, CDA, dCMPD and topoisomerase IIα as an indicator of chemotherapy response in AML treated with cytarabine and daunorubicin

Purpose

Acute myeloid leukemia patients are commonly treated with cytarabine (Ara-C) and anthracyclines but the sustained remission rate is not very promising. We explored the role of drug-metabolizing enzymes and transporters in the therapeutic response.

Patients and methods

Bone marrow and peripheral blood samples of 90 newly diagnosed acute myeloid leukemia patients treated with standard 3+7 regimen were analyzed through real-time PCR for expression of human equilibrative nucleoside transporter 1, deoxycytidine kinase, cytidine deaminase (CDA), deoxycytidine monophosphate deaminase (dCMPD) and topoisomerase IIα (Topo-IIa). The expression of these markers was studied in relationship with good (persistent remission) and poor therapeutic response (relapse/resistance).

Results

High Topo-IIa expression in peripheral blood was associated with good response (P=0.006). Relapse was higher among low expressors of Topo-IIa in peripheral blood (OR: 26.25). Bone marrow Topo-IIa expression followed a similar trend but did not reach statistical significance. In contrast, patients with high bone marrow dCMPD expression had poor response (OR: 3; P=0.043). One-year disease-free survival (DFS) was better among those with high bone marrow Topo-IIa (P=0.04) or CDA (P=0.03) expression. High bone marrow Topo-IIa expression also had better DFS at 6 months (P=0.04) and at 12 months (P=0.04).

Conclusion

High expression of Topo-IIa in peripheral blood is a favorable indicator of persistent remission, good therapeutic response and DFS. High dCMPD and low CDA expression in bone marrow is associated with poor therapeutic outcome.

Retroactive Attentional Shifts Predict Performance in a Working Memory Task: Evidence by Lateralized EEG Patterns

Shifts of attention within working memory based on retroactive (retro-) cues were shown to facilitate performance in working memory tasks. Although posterior asymmetries in the EEG, such as the contralateral delay activity (CDA), have been used to study the active storage of lateralized working memory representations, results on the relation of such asymmetric effects to retro-cue benefits remain inconclusive. We recorded EEG in a retro-cue working memory task with lateralized items and a continuous performance response. Following either a selective or neutral retro-cue, participants adjusted the orientation of a central memory probe to the cued item. Selective retro-cues elicited an early posterior contralateral negativity (PCN), anterior directing attention negativity (ADAN) and a later modulation of CDA indicating that active storage was concentrated on the cued information. By dividing all trials into three within-condition performance quantiles, we could further show that high working memory accuracy was associated with a sustained increase of the CDA effect following the retro-cue. These results suggest that focusing resources on the active storage of relevant representations is an important factor regarding retro-cue benefits in working memory tasks.

Neural processing of working memory in adults with ADHD in a visuospatial change detection task with distractors

Individuals with Attention-Deficit Hyperactivity Disorder (ADHD) are often characterized by deficits in working memory (WM), which manifest in academic, professional, and mental health difficulties. To better understand the underlying mechanisms of these presumed WM deficits, we compared adults with ADHD to their peers on behavioral and neural indices of WM. We used a visuospatial change detection task with distractors which was designed to assess the brain’s ability to effectively filter out distractors from WM, in addition to testing for effects of WM load. Twenty-seven unmedicated adults with ADHD were compared to 27 matched peers on event-related potential (ERP) measures of WM, i.e., the contralateral delay activity (CDA). Despite severe impairments in everyday life functioning, findings showed no difference in deficits in behavioral tests of working memory for adults with ADHD compared to their peers. Interestingly, there were differences in neural activity between individuals with ADHD and their peers showing that the CDA of individuals with ADHD did not distinguish between high, distractor, and low memory load conditions. These data suggest, in the face of comparable behavioral performance, a difference in neural processing efficiency, wherein the brains of individuals with ADHD may not be as selective in the allocation of neural resources to perform a WM task.

Electronic Health Records: From the Management of Patients to the Research Use of Clinical Data

Paper based medical records are still widespread in Italian hospitals and the workflow to manage outpatients' visits is critical. Too many isolated software programs coexist in hospital wards and cause confusion and disorganization. A computerized medical record that unifies all the data contained in the various applications should be of fundamental importance in supporting physician's daily activities. Moreover, with the digital clinical record, data can be re-used for research purposes. The aim of this project is to create a web application for the management of outpatient visits to the Infectious Diseases Unit of the San Martino Hospital in Genoa. In order to orchestrate all the software programs acting in the visit workflow, a client application was developed to speed up the work of the medical staff at the time of the visits, ameliorating the quantity and quality of relevant information from a clinical point of view. A further extension allows standard data exchange between the developed application and the Ligurian HIV Network, which is the main regional research platform.

Synthetic biology, genome mining, and combinatorial biosynthesis of NRPS-derived antibiotics: a perspective

Combinatorial biosynthesis of novel secondary metabolites derived from nonribosomal peptide synthetases (NRPSs) has been in slow development for about a quarter of a century. Progress has been hampered by the complexity of the giant multimodular multienzymes. More recently, advances have been made on understanding the chemical and structural biology of these complex megaenzymes, and on learning the design rules for engineering functional hybrid enzymes. In this perspective, I address what has been learned about successful engineering of complex lipopeptides related to daptomycin, and discuss how synthetic biology and microbial genome mining can converge to broaden the scope and enhance the speed and robustness of combinatorial biosynthesis of NRPS-derived natural products for drug discovery.

MiR-608 regulating the expression of ribonucleotide reductase M1 and cytidine deaminase is repressed through induced gemcitabine chemoresistance in pancreatic cancer cells

PURPOSE

Gemcitabine resistance is the main problem in pancreatic adenocarcinoma patients. Hence, we aimed to identify the correlation between expression of RRM1 and CDA as the resistance genes and their predicted targeting miR-608 in the resistant pancreatic cancer cell lines to gemcitabine.

METHODS

Dual luciferase assay was performed to determine whether both RRM1 and CDA are targeted by miR-608 in 293T and pancreatic cancer cell lines. AsPC-1 and MIA PaCa-2 cell lines became gradually resistant to gemcitabine by exposing to the increasing doses of gemcitabine. After RNA and miRNAs extraction and cDNA conversion, the expressions of RRM1, CDA and miR-608 in all cell lines were studied by quantitative PCR. Pre-miR-608 transfection to the cell lines was done by calcium phosphate method. MTT assay was performed for analyzing the chemo sensitivity of different cell lines to gemcitabine.

RESULTS

Luciferase assays showed that miR-608 targeted RRM1 and CDA genes in 293T, AsPC-1 and MIA PaCa-2 cell lines. Compared to parental cell line, resistant MIA PaCa-2 and AsPC-1 cells demonstrated increased expression of RRM1 and CDA. On the other hand the expression of miR-608 in resistant MIA PaCa-2 and AsPC-1 cells was lower than parental cells. Furthermore, transfection of MIA PaCa-2 and AsPC-1 cells by miR-608 lead to decreased expression of RRM1 and CDA and lowered viability of the cells in comparison with scrambled microRNA transfected cells.

CONCLUSION

During resistance induction in pancreatic cancer cells, miR-608 which is targeting RRM1 and CDA is downregulated which leads to upregulation of these genes.

Single-nucleotide polymorphisms in the genes of CES2, CDA and enzymatic activity of CDA for prediction of the efficacy of capecitabine-containing chemotherapy in patients with metastatic breast cancer

We examined whether genetic polymorphisms (SNPs) in the capecitabine activation pathway and CDA enzymatic activity were associated with prognosis, benefit from capecitabine-containing treatment or capecitabine-related toxicities. The study population comprised 188 metastatic breast cancer patients of the ATX trial (EudraCT 2006-006058-83) randomized for first-line paclitaxel and bevacizumab with (ATX) or without capecitabine (AT). Cumulative capecitabine dose until grade ≥2 hand-foot syndrome or until first dose reduction were toxicity endpoints. We genotyped CDA c.-451C>T (rs532545), CDA c.-33delC (rs3215400) and CES2 c.-806C>G (rs11075646). CDA activity in baseline serum was measured with a spectrophotometric assay and values were analyzed using a median cut-off or as continuous variable. CDA c.-33delC was prognostic for overall survival (OS) independent of hormone receptor status. For the predictive analysis, progression-free survival benefit from ATX over AT was observed in patients with a CDA c.-33del/del or del/insC genotype, a CDA c.-451CC or CT genotype, and a CES2 c.-806CC genotype compared with their counterparts. There was a higher response rate for ATX over AT in patients with a CDA c.-451CT or TT genotype. Patients with high CDA enzymatic activity had more benefit from capecitabine, while this was marginally observed in the CDA low group. Toxicity endpoints were not associated with any candidate markers. In conclusion, CDA c.-33delC was associated with OS. Since particular SNPs in CDA and CES2 were associated with benefit from the addition of capecitabine to AT, their predictive value should be explored in a higher number of patients.

Type I IFN and not TNF, is Essential for Cyclic Di-nucleotide-elicited CTL by a Cytosolic Cross-presentation Pathway

Cyclic di-nucleotides (CDN) are potent stimulators of innate and adaptive immune responses. Cyclic di-AMP (CDA) is a promising adjuvant that generates humoral and cellular immunity. The strong STING-dependent stimulation of type I IFN represents a key feature of CDA. However, recent studies suggested that this is dispensable for adjuvanticity. Here we demonstrate that stimulation of IFN-γ-secreting CD8⁺ cytotoxic T lymphocytes (CTL) is significantly decreased after vaccination in the absence of type I IFN signaling. The biological significance of this CTL response was confirmed by the stimulation of MHC class I-restricted protection against influenza virus challenge. We show here that type I IFN (and not TNF-α) is essential for CDA-mediated cross-presentation by a cathepsin independent, TAP and proteosome dependent cytosolic antigen processing pathway, which promotes effective cross-priming and further CTL induction. Our data clearly demonstrate that type I IFN signaling is critical for CDN-mediated cross-presentation.

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Cyclic di-AMP is a potent adjuvant with a proven capacity to promote cellular and humoral immunity.

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It was postulated that type I IFN is irrelevant for CDA-generated immunity.

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We show that CDA-mediated IFN-α/β signaling is essential for cytosolic cross-presentation, generating CTL by cross-priming.

Antigen cross-presentation generates cross-priming of CD8 cytotoxic T cells (CTL), which kill intracellular pathogens and cancer cells. The generation of CTL is the main feature of cyclic di- nucleotide adjuvants (CDN). The production of type I IFN has been shown to be essential for the generation of CTL by other adjuvants, but not for cyclic di-AMP, a paramount CDN. Surprisingly, it was recently claimed that type I IFN is dispensable for the immunogenicity of CDN. We show here that type I IFN (and not TNF) is necessary for the cytosolic cross-presentation pathway activated by CDN, which results in CTL generation. This finding and the knowledge of the mechanism are of crucial importance for the safe development of CDN-adjuvanted vaccines.

Influence of cytarabine metabolic pathway polymorphisms in acute myeloid leukemia induction treatment

Cytarabine is considered the most effective chemotherapeutic option in acute myeloid leukemia (AML). The impact of 10 polymorphisms in cytarabine metabolic pathway genes were evaluated in 225 adult de novo AML patients. Variant alleles of DCK rs2306744 and CDA rs602950 showed higher complete remission (p = .024, p = .045), with lower survival rates for variant alleles of CDA rs2072671 (p = .015, p = .045, p = .032), rs3215400 (p = .033) and wild-type genotype of rs602950 (p = .039, .014). Induction death (p = .033) and lower survival rates (p = .021, p = .047) were correlated to RRM1 rs9937 variant allele. In addition, variant alleles of CDA rs532545 and rs602950 were related to skin toxicity (p = .031, p = .049) and mucositis to DCK rs2306744 minor allele (p = .046). Other toxicities associated to variant alleles were hepatotoxicity to NT5C2 rs11598702 (p = .032), lung toxicity (p = .031) and thrombocytopenia to DCK rs4694362 (p = .046). This study supports the interest of cytarabine pathway polymorphisms regarding efficacy and toxicity of AML therapy in a coherent integrated manner.