Arthrocentesis versus occlusal coverage splints in the management of disc displacement without reduction: a systematic review and meta-analysis

Disc displacement without reduction (DDwoR) can cause pain and limitations in mouth opening, with a significant impact on function. The optimal management strategy for DDwoR is unclear. Treatments include conservative management such as mandibular manipulation, occlusal splints, and patient education/self-management, as well as arthrocentesis, which is a minimally invasive procedure. The aim of this systematic review and meta-analysis was to ascertain whether there is a role for arthrocentesis in the management of DDwoR. Studies analysing the outcomes pain and maximum mouth opening (MMO) in patients with DDwoR treated by arthrocentesis or occlusal coverage devices were eligible for inclusion. Following a database search, six studies with a total of 343 participants were found to be eligible for analysis (three prospective observational studies, one retrospective observational study, one non-randomized single-blind clinical trial, and one unblinded randomized clinical trial). When compared to occlusal coverage splints, arthrocentesis demonstrated a slight improvement in pain, although this was statistically non-significant (standardized mean difference (SMD) -0.50, 95% confidence interval (CI) -1.04 to 0.05, P = 0.07; I2 = 81%), and a significant improvement in MMO (SMD 0.79 mm, 95% CI 0.24-1.35 mm, P = 0.005; I2 = 79%). However, due to the significant heterogeneity between studies and the high risk of bias, along with the paucity of double-blind randomized controlled clinical trials, definitive conclusions cannot be drawn for this clinical question.

Effectiveness of SplashGuard Caregiver prototype in reducing the risk of aerosol transmission in intensive care unit rooms of SARS-CoV-2 patients: a prospective and simulation study

BACKGROUND

The contagiousness of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is known to be linked to the emission of bioaerosols. Thus, aerosol-generating procedures (AGPs) could increase the risk of infection among healthcare workers (HCWs).

AIM

To investigate the impact of an aerosol protection box, the SplashGuard Caregiver (SGGC) with suction system, by direct analysis of the presence of viral particles after an AGP, and by using the computational fluid dynamics (CFD) simulation method.

METHODS

This prospective observational study investigated HCWs caring for patients with SARS-CoV-2 admitted to an intensive care unit (ICU). Rooms were categorized as: SGCG present and SGCG absent. Virus detection was performed through direct analysis, and using a CFD model to simulate the movement dynamics of airborne particles produced by a patient's respiratory activities.

FINDINGS

Of the 67 analyses performed, three samples tested positive on quantitative polymerase chain reaction: one of 33 analyses in the SCCG group (3%) and two of 34 analyses in the non-SGCG group (5.9%). CFD simulations showed that: (1) reduction of the gaps of an SGCG could decrease the number of emitted particles remaining airborne within the room by up to 70%; and (2) positioning HCWs facing the opposite direction to the main air flow would reduce their exposure.

CONCLUSIONS

This study documented the presence of SARS-CoV-2 among HCWs in a negative pressure ICU room of an infected patient with or without the use of an SGCG. The simulation will help to improve the design of the SGCG and the positioning of HCWs in the room.

Surgical Outcomes of Obese Patients With Adolescent Idiopathic Scoliosis From Endemic Areas of Obesity in the United States

BACKGROUND

Obesity rates continue to rise among children and adolescents across the globe. A multicenter research consortium composed of institutions in the Southern US, located in states endemic for childhood obesity, was formed to evaluate the effect of obesity on pediatric musculoskeletal disorders. This study evaluates the effect of body mass index (BMI) percentile and socioeconomic status (SES) on surgical site infections (SSIs) and perioperative complications in patients with adolescent idiopathic scoliosis (AIS) treated with posterior spinal fusion (PSF).

METHODS

Eleven centers in the Southern US retrospectively reviewed postoperative AIS patients after PSF between 2011 and 2017. Each center contributed data to a centralized database from patients in the following BMI-for-age groups: normal weight (NW, 5th to <85th percentile), overweight (OW, 85th to <95th percentile), and obese (OB, ≥95th percentile). The primary outcome variable was the occurrence of an SSI. SES was measured by the Area Deprivation Index (ADI), with higher scores indicating a lower SES.

RESULTS

Seven hundred fifty-one patients were included in this study (256 NW, 235 OW, and 260 OB). OB and OW patients presented with significantly higher ADIs indicating a lower SES (P<0.001). In addition, SSI rates were significantly different between BMI groups (0.8% NW, 4.3% OW, and 5.4% OB, P=0.012). Further analysis showed that superficial and not deep SSIs were significantly different between BMI groups. These differences in SSI rates persisted even while controlling for ADI. Wound dehiscence and readmission rates were significantly different between groups (P=0.004 and 0.03, respectively), with OB patients demonstrating the highest rates. EBL and cell saver return were significantly higher in overweight patients (P=0.007 and 0.002, respectively).

CONCLUSION

OB and OW AIS patients have significantly greater superficial SSI rates than NW patients, even after controlling for SES.

LEVEL OF EVIDENCE

Level III.

Perceptions of anonymised data use and awareness of the NHS data opt-out amongst patients, carers and healthcare staff

BACKGROUND

England operates a National Data Opt-Out (NDOO) for the secondary use of confidential health data for research and planning. We hypothesised that public awareness and support for the secondary use of health data and the NDOO would vary by participant demography and healthcare experience. We explored patient/public awareness and perceptions of secondary data use, grouping potential researchers into National Health Service (NHS), academia or commercial. We assessed awareness of the NDOO system amongst patients, carers, healthcare staff and the public. We co-developed recommendations to consider when sharing unconsented health data for research.

METHODS

A patient and public engagement program, co-created and including patient and public workshops, questionnaires and discussion groups regarding anonymised health data use.

RESULTS

There were 350 participants in total. Central concerns for health data use included unauthorised data re-use, the potential for discrimination and data sharing without patient benefit. 94% of respondents were happy for their data to be used for NHS research, 85% for academic research and 68% by health companies, but less than 50% for non-healthcare companies and opinions varied with demography and participant group. Questionnaires showed that knowledge of the NDOO was low, with 32% of all respondents, 53% of all NHS staff and 29% of all patients aware of the NDOO. Recommendations to guide unconsented secondary health data use included that health data use should benefit patients; data sharing decisions should involve patients/public. That data should remain in close proximity to health services with the principles of data minimisation applied. Further, that there should be transparency in secondary health data use, including publicly available lists of projects, summaries and benefits. Finally, organisations involved in data access decisions should participate in programmes to increase knowledge of the NDOO, to ensure public members were making informed choices about their own data.

CONCLUSION

The majority of participants in this study reported that the use of healthcare data for secondary purposes was acceptable when accessed by NHS. Academic and health-focused companies. However, awareness was limited, including of the NDOO. Further development of publicly-agreed recommendations for secondary health data use may improve both awareness and confidence in secondary health data use.

Recommendations on vaccination for Latin American small animal practitioners: a report of the WSAVA Vaccination Guidelines Group

The World Small Animal Veterinary Association Vaccination Guidelines Group has produced global guidelines for small companion animal practitioners on best practice in canine and feline vaccination. Recognising that there are unique aspects of veterinary practice in certain geographical regions of the world, the Vaccination Guidelines Group undertook a regional project in Latin America between 2016 and 2019, culminating in the present document. The Vaccination Guidelines Group gathered scientific and demographic data during visits to Argentina, Brazil and Mexico, by discussion with national key opinion leaders, visiting veterinary practices and review of the scientific literature. A questionnaire survey was completed by 1390 veterinarians in five Latin American countries and the Vaccination Guidelines Group delivered continuing education at seven events attended by over 3500 veterinarians.

The Vaccination Guidelines Group recognised numerous challenges in Latin America, for example: (1) lack of national oversight of the veterinary profession, (2) extraordinary growth in private veterinary schools of undetermined quality, (3) socioeconomic constraints on client engagement with preventive health care, (4) high regional prevalence of some key infectious diseases (e.g. feline leukaemia virus infection, canine visceral leishmaniosis), (5) almost complete lack of minimal antigen vaccine products as available in other markets, (6) relative lack of vaccine products with extended duration of immunity as available in other markets, (7) availability of vaccine products withdrawn from other markets (e.g. Giardia vaccine) or unique to Latin America (e.g. some Leishmania vaccines), (8) accessibility of vaccines directly by pet owners or breeders such that vaccination is not delivered under veterinary supervision, (9) limited availability of continuing education in veterinary vaccinology and lack of compulsion for continuing professional development and (10) limited peer‐reviewed published scientific data on small companion animal infectious diseases (with the exception of leishmaniosis) and lack of support for such academic research.

In this document, the Vaccination Guidelines Group summarises the findings of this project and assesses in evidence‐based fashion the scientific literature pertaining to companion animal vaccine‐preventable diseases in Latin America. The Vaccination Guidelines Group makes some recommendations on undergraduate and postgraduate education and academic research. Recognising that current product availability in Latin America does not permit veterinarians in these countries to vaccinate according to the global World Small Animal Veterinary Association guidelines, the Vaccination Guidelines Group makes a series of “pragmatic” recommendations as to what might be currently achievable, and a series of “aspirational” recommendations as to what might be desirable for the future. The concept of “vaccine husbandry” is addressed via some simple guidelines for the management of vaccine products in the practice. Finally, the Vaccination Guidelines Group emphasises the global trend towards delivery of vaccination as one part of an “annual health check” or “health care plan” that reviews holistically the preventive health care needs of the individual pet animal. Latin American practitioners should transition towards these important new practices that are now well embedded in more developed veterinary markets.

The document also includes 70 frequently asked questions and their answers; these were posed to the Vaccination Guidelines Group during our continuing education events and small group discussions and should address many of the issues surrounding delivery of vaccination in the Latin American countries. Spanish and Portuguese translations of this document will be made freely available from the on‐line resource pages of the Vaccination Guidelines Group.

The Nab experiment: A precision measurement of unpolarized neutron beta decay

Neutron beta decay is one of the most fundamental processes in nuclear physics and provides sensitive means to uncover the details of the weak interaction. Neutron beta decay can evaluate the ratio of axial-vector to vector coupling constants in the standard model, λ = gA/gV, through multiple decay correlations. The Nab experiment will carry out measurements of the electron-neutrino correlation parameter a with a precision of δa/a = 10−3 and the Fierz interference term b to δb = 3 × 10−3 in unpolarized free neutron beta decay. These results, along with a more precise measurement of the neutron lifetime, aim to deliver an independent determination of the ratio λ with a precision of δλ/λ = 0.03% that will allow an evaluation of Vud and sensitively test CKM unitarity, independent of nuclear models. Nab utilizes a novel, long asymmetric spectrometer that guides the decay electron and proton to two large area silicon detectors in order to precisely determine the electron energy and an estimation of the proton momentum from the proton time of flight. The Nab spectrometer is being commissioned at the Fundamental Neutron Physics Beamline at the Spallation Neutron Source at Oak Ridge National Lab. We present an overview of the Nab experiment and recent updates on the spectrometer, analysis, and systematic effects.

The neutron electric dipole moment experiment at the Spallation Neutron Source

Novel experimental techniques are required to make the next big leap in neutron electric dipole moment experimental sensitivity, both in terms of statistics and systematic error control. The nEDM experiment at the Spallation Neutron Source (nEDM@SNS) will implement the scheme of Golub & Lamoreaux [Phys. Rep., 237, 1 (1994)]. The unique properties of combining polarized ultracold neutrons, polarized 3He, and superfluid 4He will be exploited to provide a sensitivity to ∼ 10−28 e · cm. Our cryogenic apparatus will deploy two small (3 L) measurement cells with a high density of ultracold neutrons produced and spin analyzed in situ. The electric field strength, precession time, magnetic shielding, and detected UCN number will all be enhanced compared to previous room temperature Ramsey measurements. Our 3He co-magnetometer offers unique control of systematic effects, in particular the Bloch-Siegert induced false EDM. Furthermore, there will be two distinct measurement modes: free precession and dressed spin. This will provide an important self-check of our results. Following five years of “critical component demonstration,” our collaboration transitioned to a “large scale integration” phase in 2018. An overview of our measurement techniques, experimental design, and brief updates are described in these proceedings.

New search for mirror neutron regeneration

The possibility of relatively fast neutron oscillations into a mirror neutron state is not excluded experimentally when a mirror magnetic field is considered. Direct searches for the disappearance of neutrons into mirror neutrons in a controlled magnetic field have previously been performed using ultracold neutrons, with some anomalous results reported. We describe a technique using cold neutrons to perform a disappearance and regeneration search, which would allow us to unambiguously identify a possible oscillation signal. An experiment using the existing General Purpose-Small Angle Neutron Scattering instrument at the High Flux Isotope Reactor at Oak Ridge National Laboratory will have the sensitivity to fully explore the parameter space of prior ultracold neutron searches and confirm or refute previous claims of observation. This instrument can also conclusively test the validity of recently suggested oscillation-based explanations for the neutron lifetime anomaly.

The n2EDM experiment at the Paul Scherrer Institute

We present the new spectrometer for the neutron electric dipole moment (nEDM) search at the Paul Scherrer Institute (PSI), called n2EDM. The setup is at room temperature in vacuum using ultracold neutrons. n2EDM features a large UCN double storage chamber design with neutron transport adapted to the PSI UCN source. The design builds on experience gained from the previous apparatus operated at PSI until 2017. An order of magnitude increase in sensitivity is calculated for the new baseline setup based on scalable results from the previous apparatus, and the UCN source performance achieved in 2016.

Neutron spin rotation measurements

The neutron spin rotation (NSR) collaboration used parity-violating spin rotation of transversely polarized neutrons transmitted through a 0.5 m liquid helium target to constrain weak coupling constants between nucleons. While consistent with theoretical expectation, the upper limit set by this measurement on the rotation angle is limited by statistical uncertainties. The NSR collaboration is preparing a new measurement to improve this statistically-limited result by about an order of magnitude. In addition to using the new high-flux NG-C beam at the NIST Center for Neutron Research, the apparatus was upgraded to take advantage of the larger-area and more divergent NG-C beam. Significant improvements are also being made to the cryogenic design. Details of these improvements and readiness of the upgraded apparatus are presented. We also comment on how recent theoretical work combining effective field theory techniques with the 1/Nc expansion of QCD along with previous NN weak measurements can be used to make a prediction for dϕ/dz in 4He.

An experiment using the same apparatus with a room-temperature target was carried out at LANSCE to place limits on parity-conserving rotations from possible fifth-force interactions to complement previous studies. We sought this interaction using a slow neutron polarimeter that passed transversely polarized slow neutrons by unpolarized slabs of material arranged so that this interaction would tilt the plane of polarization and develop a component along the neutron momentum. The results of this measurement and its impact on the neutron-matter coupling gA2 from such an interaction are presented. The NSR collaboration is also preparing a new measurement that uses an upgraded version of the room-temperature target to be run on the NG-C beamline; and it is expected to constrain gA2 by at least two additional orders of magnitude for λc between 1 cm and 1 μm.

Measurement of the Vector and Tensor Asymmetries at Large Missing Momentum in Quasielastic (e[over →],e^{'}p) Electron Scattering from Deuterium

We report the measurement of the beam-vector and tensor asymmetries A_{ed}^{V} and A_{d}^{T} in quasielastic (e[over →],e^{'}p) electrodisintegration of the deuteron at the MIT-Bates Linear Accelerator Center up to missing momentum of 500  MeV/c. Data were collected simultaneously over a momentum transfer range 0.1<Q^{2}<0.5  (GeV/c)^{2} with the Bates Large Acceptance Spectrometer Toroid using an internal deuterium gas target polarized sequentially in both vector and tensor states. The data are compared with calculations. The beam-vector asymmetry A_{ed}^{V} is found to be directly sensitive to the D-wave component of the deuteron and has a zero crossing at a missing momentum of about 320  MeV/c, as predicted. The tensor asymmetry A_{d}^{T} at large missing momentum is found to be dominated by the influence of the tensor force in the neutron-proton final-state interaction. The new data provide a strong constraint on theoretical models.

An apparatus for studying electrical breakdown in liquid helium at 0.4 K and testing electrode materials for the neutron electric dipole moment experiment at the Spallation Neutron Source

We have constructed an apparatus to study DC electrical breakdown in liquid helium at temperatures as low as 0.4 K and at pressures between the saturated vapor pressure and ∼600 Torr. The apparatus can house a set of electrodes that are 12 cm in diameter with a gap of 1-2 cm between them, and a potential up to ±50 kV can be applied to each electrode. Initial results demonstrated that it is possible to apply fields exceeding 100 kV/cm in a 1 cm gap between two electropolished stainless steel electrodes 12 cm in diameter for a wide range of pressures at 0.4 K. We also measured the current between two electrodes. Our initial results, I < 1 pA at 45 kV, correspond to a lower bound on the effective volume resistivity of liquid helium of ρV > 5 × 10(18) Ω cm. This lower bound is 5 times larger than the bound previously measured. We report the design, construction, and operational experience of the apparatus, as well as initial results.

Ancestral Mechanisms in Modern Environments : Impact of Competition and Stressors on Body Image and Dieting Behavior

It is commonly assumed that the desire for a thin female physique and its pathological expression in eating disorders result from a social pressure for thinness. However, such widespread behavior may be better understood not merely as the result of arbitrary social pressure, but as an exaggerated expression of behavior that may have once been adaptive. The reproductive suppression hypothesis suggests that natural selection shaped a mechanism for adjusting female reproduction to socioecological conditions by altering the amount of body fat. In modern Western culture, social and ecological cues, which would have signaled the need for temporary postponement of reproduction in ancestral environments, may now be experienced to an unprecedented intensity and duration.

A slow neutron polarimeter for the measurement of parity-odd neutron rotary power

We present the design, description, calibration procedure, and an analysis of systematic effects for an apparatus designed to measure the rotation of the plane of polarization of a transversely polarized slow neutron beam as it passes through unpolarized matter. This device is the neutron optical equivalent of a crossed polarizer/analyzer pair familiar from light optics. This apparatus has been used to search for parity violation in the interaction of polarized slow neutrons in matter. Given the brightness of existing slow neutron sources, this apparatus is capable of measuring a neutron rotary power of dϕ/dz = 1 × 10(-7) rad/m.

The effects of feeding rations that differ in neutral detergent fiber and starch concentration within a day on rumen digesta nutrient concentration, pH, and fermentation products in dairy cows

There is a daily pattern of feed intake in the dairy cow, and feeding a single total mixed ration results in variation in the amount of fermentable substrate entering the rumen over the day. The object of this study was to determine if feeding multiple rations over the day that complement the pattern of feed intake would stabilize rumen pool sizes and fermentation. Nine ruminally cannulated cows were used in a 3×3 Latin square design with 23-d periods. Diets were a control diet [33.3% neutral detergent fiber (NDF)], a low-fiber diet (LF; 29.6% NDF), and a high-fiber diet (HF; 34.8% NDF). The LF and HF diets were balanced to provide the same nutrient composition as the control diet when cows were fed 3 parts of LF and 7 parts of HF. Cows on the control treatment (CON) were fed at 0900h, cows on the high/low treatment (H/L) were fed HF at 70% of daily offering at 0900h and LF at 30% of daily offering at 2200h, and cows on the low/high (L/H) treatment were fed LF at 30% of daily offering at 0900h and HF at 70% of daily offering at 1300h. All treatments were fed at 110% of daily intake. Preplanned contrasts compared CON with H/L and H/L with L/H. Feeding the LF diet in the evening resulted in a large increase in the amount of feed consumed immediately after feed delivery at that feeding. Rumen digesta starch concentration increased and NDF concentration decreased following feeding of the LF diet in both the L/H and H/L treatments. Starch pool size also increased following feeding of the LF diet in the evening and tended to increase after feeding the LF diet in the morning. Rumen ammonia concentration was increased following feeding of the HF diet in the morning and the LF diet in the evening in the H/L treatment. Additionally, cis-9 C18:1 and cis-9,cis-12 18:2 are higher in concentrate feeds and were increased after feeding the LF diet in both treatments. Trans fatty acid isomers of the normal and alternate biohydrogenation pathways followed a daily pattern, and the H/L treatment increased isomers of the alternate pathway during the overnight period following the evening feeding of the LF diet. Additionally, C17:0 decreased during the overnight period in the H/L treatment. Feeding multiple rations over the day changed feeding behavior, and the combined effect of diet composition and feeding pattern resulted in a change in rumen nutrient pool sizes and fermentation products. Feeding the low-fiber diet in the evening resulted in a large increase in feed intake after feed delivery and did not increase starch intake during the overnight period. The H/L treatment failed to stabilize rumen fermentation because of the shift in the feeding pattern. Feeding strategies that feed multiple diets over the day must integrate diet composition and feeding behavior to achieve the desired effect on rumen nutrient pools and fermentation.

A lifting line model to investigate the influence of tip feathers on wing performance

Bird wings have been studied as prototypes for wing design since the beginning of aviation. Although wing tip slots, i.e. wings with distinct gaps between the tip feathers (primaries), are very common in many birds, only a few studies have been conducted on the benefits of tip feathers on the wing's performance, and the aerodynamics behind tip feathers remains to be understood. Consequently most aircraft do not yet copy this feature. To close this knowledge gap an extended lifting line model was created to calculate the lift distribution and drag of wings with tip feathers. With this model, is was easily possible to combine several lifting surfaces into various different birdwing-like configurations. By including viscous drag effects, good agreement with an experimental tip slotted reference case was achieved. Implemented in C++ this model resulted in computation times of less than one minute per wing configuration on a standard notebook computer. Thus it was possible to analyse the performance of over 100 different wing configurations with and without tip feathers. While generally an increase in wing efficiency was obtained by splitting a wing tip into distinct, feather-like winglets, the best performance was generally found when spreading more feathers over a larger dihedral angle out of the wing plane. However, as the results were very sensitive to the precise geometry of the feather fan (especially feather twist) a careless set-up could just as easily degrade performance. Hence a detailed optimization is recommended to realize the full benefits by simultaneously optimizing feather sweep, twist and dihedral angles.

Laundry detergents and skin irritancy--a comprehensive review

Surface-active agents (surfactants) form the foundation of an effective detergent formulation. As such, surfactants are a major component of laundry detergents. Depending on multiple factors, the amount of residual detergent surfactants in clothing after washing varies but may be sufficient to elicit skin irritation in susceptible individuals and in patients with existing dermatologic disorders. The goal of this review is to examine the relationship between surfactants commonly used in laundry detergent formulations and their potential for skin irritancy. In this context, the role of surfactants in achieving broad-spectrum cleaning performance in laundry is discussed, and currently available methodologies to evaluate and measure the effect of surfactant exposure on the skin are reviewed.

Abstract P1-07-12: Kaiso is a novel regulator of epithelial-to-mesenchymal transition in triple negative breast cancer cells

Introduction:

Breast cancer (BC) is the most frequent form of female cancer and a principal cause of female deaths worldwide. Most BC deaths are attributed to tumor metastasis to vital organs, and many studies have proposed a role for epithelial-to-mesenchymal transition (EMT) in BC metastasis especially the Triple Negative BC (TNBC) subtype. This theory is further strengthened by the observation that many triple-negative tumors display low E-cadherin expression, which is a hallmark of EMT. The TNBC subtype lack expression of the estrogen-receptor (ER), progesterone-receptor (PR) and human epidermal growth factor receptor-2, HER2. These tumors are highly aggressive with limited treatment options or targeted-therapies, and consequently TNBC patients have poor outcomes. Recently, increased nuclear expression of the transcription factor Kaiso was significantly correlated with high grade, BRCA1-related and basal/TNBCs. Kaiso is a novel transcription factor that we originally identified as a binding partner of p120-catenin (p120), a Src Kinase substrate and regulator of E-cadherin stability and turnover.

Rationale and Research Objective:

Though not much is known about the function of Kaiso in breast tumor progression and metastasis, Kaiso has been implicated in regulating E-cadherin expression, which raised the possibility that Kaiso might play a role in EMT. Thus we sought to elucidate the role of Kaiso in EMT and TNBC metastasis.

Results:

To achieve this goal, we created a stable Kaiso-depleted TNBC cell line (MDA-MB-231) to analyze the consequences of Kaiso-depletion on features attributed to metastasis, using immunoblot, wound healing and Matrigel invasion assays among other techniques. Interestingly, Kaiso-depletion led to reduced transcript and expression levels of the EMT markers Snail, Slug, ZEB1/2, TGFbRII, vimentin, and up-regulation of E-cadherin. Kaiso-depleted MDA-MB-231 cells also showed a gradual change in morphology from a mesenchymal to an epithelial phenotype referred to as mesenchymal to epithelial transition (MET). Loss of Kaiso further resulted in reduced cell motility and invasion. Ongoing studies seek to evaluate the effect of Kaiso-depletion on metastasis in vivo. Since there is evidence that the TGFβ signaling pathway drives EMT, and Kaiso-depletion resulted in reduced transcript levels of TGFβRII, future studies will determine if Kaiso plays a role in EMT/MET via promotion of the TGFβ signaling pathway.

Overall Significance:

Our study is the first to demonstrate a link between Kaiso and EMT/MET of TNBC cells and suggest that Kaiso may be a novel regulator of EMT in TNBC. Consequently, Kaiso might be useful as a therapeutic or prognostic tool in the treatment of TNBC.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-07-12.

Sympathetic nerve-derived ATP regulates renal medullary vasa recta diameter via pericyte cells: a role for regulating medullary blood flow?

Pericyte cells are now known to be a novel locus of blood flow control, being able to regulate capillary diameter via their unique morphology and expression of contractile proteins. We have previously shown that exogenous ATP causes constriction of vasa recta via renal pericytes, acting at a variety of membrane bound P2 receptors on descending vasa recta (DVR), and therefore may be able to regulate medullary blood flow (MBF). Regulation of MBF is essential for appropriate urine concentration and providing essential oxygen and nutrients to this region of high, and variable, metabolic demand. Various sources of endogenous ATP have been proposed, including from epithelial, endothelial, and red blood cells in response to stimuli such as mechanical stimulation, local acidosis, hypoxia, and exposure to various hormones. Extensive sympathetic innervation of the nephron has previously been shown, however the innervation reported has focused around the proximal and distal tubules, and ascending loop of Henle. We hypothesize that sympathetic nerves are an additional source of ATP acting at renal pericytes and therefore regulate MBF. Using a rat live kidney slice model in combination with video imaging and confocal microscopy techniques we firstly show sympathetic nerves in close proximity to vasa recta pericytes in both the outer and inner medulla. Secondly, we demonstrate pharmacological stimulation of sympathetic nerves in situ (by tyramine) evokes pericyte-mediated vasoconstriction of vasa recta capillaries; inhibited by the application of the P2 receptor antagonist suramin. Lastly, tyramine-evoked vasoconstriction of vasa recta by pericytes is significantly less than ATP-evoked vasoconstriction. Sympathetic innervation may provide an additional level of functional regulation in the renal medulla that is highly localized. It now needs to be determined under which physiological/pathophysiological circumstances that sympathetic innervation of renal pericytes is important.

Renal pericytes: regulators of medullary blood flow

Regulation of medullary blood flow (MBF) is essential in maintaining normal kidney function. Blood flow to the medulla is supplied by the descending vasa recta (DVR), which arise from the efferent arterioles of juxtamedullary glomeruli. DVR are composed of a continuous endothelium, intercalated with smooth muscle-like cells called pericytes. Pericytes have been shown to alter the diameter of isolated and in situ DVR in response to vasoactive stimuli that are transmitted via a network of autocrine and paracrine signalling pathways. Vasoactive stimuli can be released by neighbouring tubular epithelial, endothelial, red blood cells and neuronal cells in response to changes in NaCl transport and oxygen tension. The experimentally described sensitivity of pericytes to these stimuli strongly suggests their leading role in the phenomenon of MBF autoregulation. Because the debate on autoregulation of MBF fervently continues, we discuss the evidence favouring a physiological role for pericytes in the regulation of MBF and describe their potential role in tubulo-vascular cross-talk in this region of the kidney. Our review also considers current methods used to explore pericyte activity and function in the renal medulla.

Fluorescence imaging of intracellular calcium signals in intact kidney tissue

BACKGROUND

Intracellular calcium (Ca(2+)) plays an important role in normal renal physiology and in the pathogenesis of various kidney diseases; however, the study of Ca(2+) signals in intact tissue has been limited by technical difficulties, including achieving adequate loading of Ca(2+)-sensitive fluorescent dyes. The kidney slice preparation represents a model whereby three-dimensional tissue architecture is preserved and structures in both the cortex and medulla can be imaged using confocal or multiphoton microscopy.

METHODS

Ca(2+)-sensitive dyes Rhod-2, Fura-red and Fluo-4 were loaded into tubular and vascular cells in rat kidney slices using a re-circulating perfusion system and real-time imaging of Ca(2+) signals was recorded by confocal microscopy. Kidney slices were also obtained from transgenic mice expressing the GCaMP2 Ca(2+)-sensor in their endothelial cells and real time Ca(2+) transients stimulated by physiological stimuli.

RESULTS

Wide spread loading of Ca(2+) indicators was achieved in the tubular and vascular structures of both the medulla and cortex. Real time Ca(2+) signals were successfully recorded in different intracellular compartments of both rat and mouse cortical and medullary tubules in response to physiological stimuli (ATP and angiotensin II). Glomerular Ca(2+) transients were similarly recorded in kidney slices taken from the transgenic mouse expressing the GCaMP2 Ca(2+)-sensor.

CONCLUSION

We present new approaches that can be adopted to image cytosolic and mitochondrial Ca(2+) signals within various cell types in intact kidney tissue. Moreover, techniques described in this study can be used to facilitate future detailed investigations of intracellular Ca(2+) homeostasis in renal health and disease.

Brief mitochondrial inhibition causes lasting changes in motor behavior and corticostriatal synaptic physiology in the Fischer 344 rat

The striatum is particularly vulnerable to mitochondrial dysfunction and this problem is linked to pathology created by environmental neurotoxins, stimulants like amphetamine, and metabolic disease and ischemia. We studied the course of recovery following a single systemic injection of the mitochondrial complex II inhibitor 3-nitropropionic acid (3-NP) and found 3-NP caused lasting changes in motor behavior that were associated with altered activity-dependent plasticity at corticostriatal synapses in Fischer 344 rats. The changes in synapse behavior varied with the time after exposure to the 3-NP injection. The earliest time point studied, 24h after 3-NP, revealed 3-NP-induced an exaggeration of D1 Dopamine (DA) receptor dependent long-term potentiation (LTP) that reversed to normal by 48 h post-3-NP exposure. Thereafter, the likelihood and degree of inducing D2 DA receptor dependent long-term depression (LTD) gradually increased, relative to saline controls, peaking at 1 month after the 3-NP exposure. NMDA receptor binding did not change over the same post 3-NP time points. These data indicate even brief exposure to 3-NP can have lasting behavioral effects mediated by changes in the way DA and glutamate synapses interact.

An intact kidney slice model to investigate vasa recta properties and function in situ

Background

Medullary blood flow is via vasa recta capillaries, which possess contractile pericytes. In vitro studies using isolated descending vasa recta show that pericytes can constrict/dilate descending vasa recta when vasoactive substances are present. We describe a live kidney slice model in which pericyte-mediated vasa recta constriction/dilation can be visualized in situ.

Methods

Confocal microscopy was used to image calcein, propidium iodide and Hoechst labelling in ‘live’ kidney slices, to determine tubular and vascular cell viability and morphology. DIC video-imaging of live kidney slices was employed to investigate pericyte-mediated real-time changes in vasa recta diameter.

Results

Pericytes were identified on vasa recta and their morphology and density were characterized in the medulla. Pericyte-mediated changes in vasa recta diameter (10–30%) were evoked in response to bath application of vasoactive agents (norepinephrine, endothelin-1, angiotensin-II and prostaglandin E₂) or by manipulating endogenous vasoactive signalling pathways (using tyramine, L-NAME, a cyclo-oxygenase (COX-1) inhibitor indomethacin, and ATP release).

Conclusions

The live kidney slice model is a valid complementary technique for investigating vasa recta function in situ and the role of pericytes as regulators of vasa recta diameter. This technique may also be useful in exploring the role of tubulovascular crosstalk in regulation of medullary blood flow.

Evaluation of the potential airborne release of carbon nanofibers during the preparation, grinding, and cutting of epoxy-based nanocomposite material

The National Institute for Occupational Safety and Health conducted an initial, task-based comparative assessment to determine the potential for release of carbon nanofibers (CNFs) during dry material handling, wet cutting, grinding, and sanding (by machine and hand) of plastic composite material containing CNFs. Using a combination of direct-reading instruments and filter-based air sampling methods for airborne mass and transmission electron microscopy (TEM), concentrations were measured and characterized near sources of particle generation, in the breathing zone of the workers, and in the general work area. Tasks such as surface grinding of composite material and manually transferring dry CNFs produced substantial increases in particle number concentration (range = 20,000-490,000 1-cm(-3)). Concomitant increases in mass concentration were also associated with most tasks. Nearly 90% of all samples examined via TEM indicated that releases of CNFs do occur and that the potential for exposure exists. These findings also indicate that improperly designed, maintained, or installed engineering controls may not be completely effective in controlling releases. Unprotected skin exposure to CNFs was noted in two instances and indicated the need for educating workers on the need for personal protective equipment. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a PDF file containing information on materials, evaluated processes, personal protective equipment, and existing ventilation/engineering controls.].

Field application of the Nanoparticle Emission Assessment Technique (NEAT): task-based air monitoring during the processing of engineered nanomaterials (ENM) at four facilities

In early 2006, the National Institute for Occupational Safety and Health created a field research team whose mission is to visit a variety of facilities engaged in the production, handling, or use of engineered nanomaterials (ENMs) and to conduct initial emission and exposure assessments to identify candidate sites for further study. To conduct the assessments, the team developed the Nanoparticle Emission Assessment Technique (NEAT), which has been used at numerous facilities to sample multiple engineered nanomaterials. Data collected at four facilities, which volunteered to serve as test sites, indicate that specific tasks can release ENMs to the workplace atmosphere and that traditional controls such as ventilation can be used to limit exposure. Metrics such as particle number concentration (adjusted for background), airborne mass concentration, and qualitative transmission electron microscopy were used to determine the presence, nature, and magnitude of emissions and whether engineered nanomaterials migrated to the workers' breathing zone. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a PDF file containing information on facilities, a description of processes/tasks, existing controls, and sampling strategy, and a PDF file containing TEM images according to facility and task.].

Precise measurement of deuteron tensor analyzing powers with BLAST

We report a precision measurement of the deuteron tensor analyzing powers T(20) and T(21) at the MIT-Bates Linear Accelerator Center. Data were collected simultaneously over a momentum transfer range Q=2.15-4.50 fm(-1) with the Bates Large Acceptance Spectrometer Toroid using a highly polarized deuterium internal gas target. The data are in excellent agreement with calculations in a framework of effective field theory. The deuteron charge monopole and quadrupole form factors G(C) and G(Q) were separated with improved precision, and the location of the first node of G(C) was confirmed at Q=4.19±0.05 fm(-1). The new data provide a strong constraint on theoretical models in a momentum transfer range covering the minimum of T(20) and the first node of G(C).

Comparison of community residential supports on measures of information & planning; access to & delivery of supports; choice & control; community connections; satisfaction; and, overall perception of outcomes

BACKGROUND

This paper reports on some of the findings of a large-scale survey (n = 852) of family members and support staff of adults with intellectual disabilities receiving community living services in British Columbia, Canada, concentrating on comparison of outcomes across four types of community residential settings: group homes, family model homes, independent home or apartment, and family home.

METHOD

Comparisons were conducted on six domains: information and planning; access to and delivery of supports; choice and control; community connections; satisfaction; and, overall perception of outcomes. Where applicable, further multivariate analyses were undertaken to determine the effect of the degree of help required by the residents and the respondent type.

RESULTS

Findings indicate that on all measures other than choice and control, group homes and family model homes showed better outcomes than either independent settings or family homes.

CONCLUSION

The findings may indicate that the move to more independent living settings is not being accompanied by appropriate supports.

Adjacent-level cervical ossification after Bryan cervical disc arthroplasty compared with anterior cervical discectomy and fusion

BACKGROUND

Ossification of the anterior longitudinal ligament and the anulus adjacent to an anterior cervical arthrodesis has been termed adjacent-level ossification development. Initial studies suggested an association with the placement of plates <5 mm from an adjacent disc space. A follow-up study demonstrated that this ossification rarely occurs in association with arthrodeses without plate fixation. In the present study, our goal was to determine the incidence of adjacent-level ossification in patients who underwent cervical arthrodesis with plate fixation as compared with that in patients who underwent cervical arthroplasty.

METHODS

We performed a post hoc analysis of prospectively collected data. Radiographic data for all patients from a single site were used. All postoperative, two-year, and four-year follow-up lateral cervical spine radiographs were collected and formatted to occlude the surgical level, blinding the readers as to the procedure performed. Three independent blinded surgeons graded the cephalad adjacent level for the degree of ossification at each time point. The data were statistically analyzed for significant ossification grade differences between arthrodesis and arthroplasty.

RESULTS

A total of forty-six patients (twenty-one with a Bryan total disc arthroplasty and twenty-five with an arthrodesis) were included. Both cohorts were derived from previous participation in a Level-I multicenter prospective randomized controlled trial stratified by site. Ossification scores based on independent assessment by three readers at multiple follow-up times were used. The arthrodesis group had significantly higher ossification scores than the arthroplasty group at both the two-year (p = 0.003) and the four-year follow-up interval (p = 0.004). Both cohorts showed significant increases in ossification from the two-year follow-up to the latest follow-up (p = 0.001 for the anterior cervical arthrodesis group and p = 0.008 for the arthroplasty group).

CONCLUSIONS

Our data conclusively demonstrate that cervical intervertebral arthroplasty is associated with a significantly lower incidence of adjacent-level ossification than arthrodesis with plate fixation at both the two-year and the four-year follow-up. Arthroplasty has the advantage of not being associated with adjacent-level ossification, which may decrease cervical spine motion above and below the surgical level.

Extracellular nucleotides affect pericyte-mediated regulation of rat in situ vasa recta diameter

AIM

We hypothesized that extracellular nucleotides, established as being released from renal tubular epithelial cells, act at pericytes to regulate vasa recta capillary diameter.

METHODS

A rat live kidney slice model and video imaging techniques were used to investigate the effects of extracellular nucleotides on in situ (subsurface) vasa recta diameter at pericyte and non-pericyte sites. In addition, RT-qPCR was used to quantify P2 receptor mRNA expression in isolated vasa recta.

RESULTS

Extracellular ATP, UTP, benzylbenzyl ATP (BzATP) or 2-methylthioATP (2meSATP) evoked a significantly greater vasoconstriction of subsurface vasa recta at pericytes than at non-pericyte sites. The rank order of agonist potency was BzATP = 2meSATP > ATP = UTP. The vasoconstriction evoked at pericyte sites by ATP was significantly attenuated by the P2 receptor antagonists suramin, pyridoxal phosphate-6-azo(benzene-2,4-disulfonic acid) (PPADS) or Reactive Blue-2 (RB-2). UTP-evoked vasoconstriction at pericytes was attenuated by suramin or RB-2 but not PPADS. Interestingly, suramin or PPADS, when applied in the absence of a P2 receptor agonist, evoked a weak but significant vasoconstriction of vasa recta at pericyte sites, suggesting tonic vasodilation by nucleotides. Significant levels of P2X(1, 3 and 7) and P2Y(4 and 6) receptor mRNA were detected in vasa recta.

CONCLUSION

Extracellular nucleotides act at pericytes to cause vasoconstriction of in situ vasa recta. Pharmacological characterization, supported by RT-qPCR data, suggests that P2X(1 and 7) and P2Y(4) receptors mediate nucleotide-evoked vasoconstriction of vasa recta by pericytes. We propose that nucleotides released from renal tubular epithelial cells, in close proximity to vasa recta capillaries, are key in regulating renal medullary blood flow.

Inter- and intraobserver reliability in radiographic assessment of degenerative disk disease

Clinicians use descriptive classification systems when treating patients with low back pain as an adjunct to surgical decision making. Magnetic resonance imaging (MRI) changes, including Modic changes, the presence of a high-intensity zone, and internal disk desiccation, are commonly used descriptors. The question remains whether different clinicians interpret these terms similarly. This study evaluated the inter- and intraobserver reliability of commonly used MRI classifications in patients presenting with low back pain.Sixty-six patients who underwent lumbar spine fusion surgery at a single multiphysician spine specialty practice for degenerative disk disease were identified. For each surgical level, the following MRI variables were determined independently by 3 fellowship-trained spine surgeons: presence or absence of high-intensity zone and/or internal disk desiccation, presence and classification of disk herniation, Modic grade, and disk height. Each surgeon reviewed the same set of MRI studies a second time at least 2 weeks from the first reading. Inter- and intraobserver reliability was determined using multiobserver Kappa coefficients. Intraobserver reliability ranged from 0.563 to 0.988, with greatest agreement in determining disk height. The greatest interobserver agreement was for determining Modic changes (0.819).Controversy remains on the criteria for diagnosing degenerative disk disease. In patients presenting with low back pain diagnosed with degenerative disk disease, the inter- and intraobserver reliability with use of several common MRI diagnostic tools was substantial. These data imply that clinicians interpret these findings in a reproducible fashion and interpret these terms similarly.

Expression of a functional single-chain antibody via Corynebacterium pseudodiphtheriticum

Antibody-based therapeutics are effective against conditions ranging from acute infections to malignancy. They may prove crucial in combating bioterrorism and responding to drug-resistant and emerging pathogens. At present the cost of producing therapeutic monoclonal antibodies is between $1,000 to $6,000 per gram. The need to administer antibodies parenterally at frequent intervals further drives the cost of this treatment. Here we present an antibody delivery system, termed paratransgenesis, with the potential to overcome these limitations. The paratransgenic approach involves genetically transforming a commensal or symbiont bacterium to express foreign molecules that target pathogens. We describe transformation of Corynebacterium pseudodiptheriticum, a commensal bacterium found in the human respiratory tract, to express a murine single-chain antibody binding progesterone. The antibody was functional and bound specifically to progesterone in a concentration-dependent manner. This marker antibody system is the precursor to development of expression systems producing recombinant humanized single-chain antibodies. Studies are in progress evaluating fitness, transgene stablility, and pathogenecity of the genetically engineered C. pseudodiptheriticum. We anticipate developing a repertoire of expressed molecules targeting infectious agents and surface epitopes of pulmonary mass lesions. If expression systems for anti-pathogen molecules in C. pseudodiptheriticum and other respiratory commensal bacteria can be optimized, these bacteria have the potential for a range of therapeutic and prophylactic applications.

Anatomic double bundle ACL reconstruction: a literature review

With the abundance of anatomic double bundle ACL reconstruction techniques that currently exist and limited patient outcome data, one has to ask whether or not they should be used and if so, which one, and what is the learning curve for the average knee surgeon to become competent with the technique that they select? The purpose of this literature review is to summarize existing anatomic double bundle ACL reconstruction surgical and rehabilitation techniques and the clinical and biomechanical study evidence that currently exists. In choosing to perform anatomic double bundle ACL reconstruction we suggest that the knee surgeon should look for evidence of: (1) control of the pivot shift phenomenon, (2) improved transverse plane rotatory knee control during the performance of sports type movements, (3) a decreased likelihood of revision procedures either for ACL reconstruction or for treatment of associated primary or recurrent meniscal injuries, (4) improved patient self-reports of perceived function, satisfaction, and quality of life, and (5) radiographic evidence of a lower incidence and/or magnitude of osteoarthritic changes compared to conventional single bundle ACL reconstruction.

Dietary fructan carbohydrate increases amine production in the equine large intestine: implications for pasture-associated laminitis

Pasture-induced laminitis in the horse is associated with the overconsumption of fermentable carbohydrate, in the form of simple sugars, fructans, or starch. The fermentation of carbohydrate in the cecum and large intestine results in the production of lactic acid and other toxins or "laminitis trigger factors." Vasoactive amines have been suggested as possible initiating factors. The aim of this study was to feed a commercially available form of fructan carbohydrate (inulin, 3 g/kg of BW per day) to normal ponies and to ponies predisposed to laminitis, to mimic a change from a basal hay diet to lush spring-summer pasture. Five normal and 6 laminitis-prone, native-breed ponies were acclimated to a basal hay diet before the inclusion of inulin and chopped dried grass. Blood samples, fecal samples, and foot temperature measurements were taken throughout the study. Amines were measured in the feces and plasma by HPLC and liquid chromatography-mass spectrometry, respectively. The pH of the fecal samples decreased from 6.89 +/- 0.11 on the hay diet to a minimum of 6.18 +/- 0.11 with the addition of inulin (P <0.05). An increase was observed in the fecal concentrations of a number of amines, including tryptamine (2.5-fold increase, P <0.05) and tyramine (2-fold increase, P <0.05). No changes were noted in plasma amine concentrations or plasma D- or L-lactate, indicating that there may be a threshold of hindgut pH change before mucosal damage can result in the release of these factors into the circulation. No differences in pH or any of the measured compounds were observed between the group of normal ponies and those predisposed to laminitis. This indicates that differences in the intestinal microflora do not account for this predisposition. However, the results from this study indicate that moderate increases in dietary fructan carbohydrate can produce increases in bacterial fermentation products and other compounds in the large intestine, which may be relevant to the pathogenesis of acute laminitis in ponies on pasture.