Siah2‐deficient mice show impaired skin wound repair

Hypoxia is associated with the dermal wound healing process and hypoxia signaling is presumed to be crucial for normal wound repair. The Siah2 ubiquitin ligase controls the abundance of hypoxia‐inducible factor‐1 alpha, and loss of Siah2 results in destabilization of hypoxia‐inducible factor‐1 alpha under hypoxia. Utilizing Siah2^?/? mice we demonstrate that cutaneous wound healing is impaired in these mice. Wounds in Siah2^?/? mice heal slower and are associated with delayed induction of myofibroblast infiltration and reduced collagen deposition. This coincides with delayed angiogenesis and reduced macrophage infiltration into the wounds of Siah2^?/? mice. We furthermore demonstrate that primary Siah2^?/? dermal fibroblasts have reduced migratory capacities and produce less collagen than wild‐type fibroblasts. Additionally, Siah2^?/? fibroblasts showed conserved responses to transforming growth factor‐β at the receptor level (pSmad 2C activation) but reduced responses downstream. Together, our data show, for the first time, that Siah2 is involved as a positive regulator in the wound healing response. Understanding the role of hypoxia signaling in tissue repair and fibrosis and interference with the hypoxia signaling pathway via regulation of Siah2 may provide new targets for clinical regulation of fibrosis and scarring.     

Autonomic dysfunction in adult-onset alexander disease

Background

Alexander disease (AxD) is an astrogliopathy, resulting from a mutation in the glial fibrillary astrocytic protein gene. Different clinical subtypes have been described, including infantile, juvenile, and adult onset, based upon the age at which symptoms begin. Patients with the adult-onset form, develop a progressive, spastic paraparesis, palatal myoclonus, ataxia, and bulbar weakness. Autonomic nervous system (ANS) dysfunction has been reported as a potential manifestation of adult-onset AxD, but has not been well characterized.

Objective

We report a case of adult-onset AxD with symptomatic orthostatic hypotension (OH) and heat intolerance that underwent formal autonomic testing. In addition, a comprehensive literature search was conducted to review the frequency and pattern of autonomic dysfunction in this patient population.

Results

A 51-year-old patient was diagnosed with AxD at the age of 47, following an 8-year history of vertigo, intermittent diplopia, and sleep disturbance. The patient developed symptoms of OH, erectile dysfunction, and heat intolerance soon after his diagnosis. Autonomic testing demonstrated OH on tilt-table testing (47 mmHg decrease in BP with 18 BPM heart rate increment) with absent late phase II and IV responses during the Valsalva maneuver, severe cardiovagal impairment, and preserved postganglionic sympathetic sudomotor function. These findings were interpreted as being consistent with central autonomic failure. The most common autonomic symptoms reported in other AxD cases include constipation, urinary incontinence, and sphincter dysfunction. To our knowledge, this is the first report of formal autonomic testing in AxD.

Conclusion

Signs and symptoms of ANS impairment can occur in patients with AxD, and can include orthostatic hypotension and bowel/bladder dysfunction. Autonomic testing in our patient suggests impairment in central autonomic pathways.     

Eating Disorders “Mental Health Literacy” in Low Risk,High Risk and Symptomatic Women: Implications for Health Promotion Programs

Attitudes and beliefs concerning the nature and treatment of bulimia nervosa (BN) were compared among young adult women at low risk of an eating disorder (n = 332), at high risk (n = 83), or already showing symptoms (n = 94). Participants completed a self-report questionnaire that included a measure of eating disorder symptoms. A vignette of a fictional person suffering from BN was presented, followed by a series of questions addressing the nature and treatment of the problem described. High-risk and symptomatic participants were more likely than low-risk participants to report that they would not approach anyone for advice or help, were they to have BN or a similar problem, because they would not want anyone to know. Symptomatic participants were more likely to believe that someone with BN would be discriminated against, more likely to consider bulimic behaviors to be acceptable, and more likely to view BN as being common among women in the community, than low-risk participants, participants in the high-risk group being intermediate on each of these questions. The findings suggest that the attitudes and beliefs of individuals with eating disorder symptoms differ systematically from those of individuals at high risk, but who do not yet have symptoms, and from those at low risk. They also indicate specific attitudes and beliefs that may need to be addressed in prevention and early intervention programs. The potential benefits of assessing individuals' attitudes and beliefs concerning the nature and treatment of eating-disordered behaviour and tailoring program content accordingly may be worthy of investigation.     

Certification in Medical Physics Imaging,The Workforce and Training Models

The pathway to becoming a qualified medical physicist (QMP) in the imaging physics disciplines includes several certification organizations. Imaging QMPs play an essential role in the safe practice of the diagnostic disciplines, and their qualifications are necessary for compliance with federal bodies and professional accreditation organizations. The future demand for imaging QMPs is largely unknown, but professional organizations that represent these groups agree that efforts should be made to increase the number of matriculating trainees. The number of imaging residency programs that provide the necessary professional experience to enter the certification pathway has increased substantially in recent years. Most of these programs follow a traditional academic hospital-based training model, but guidance on program construction from the accrediting body permits flexibility. Existing training models for medical physics imaging also include consortiums of affiliate partners and private consulting service groups. In this article, the authors briefly review the certification pathways for imaging QMPs, workforce estimates, and training models.     

A resilience intervention involving mindfulness training for transplant patients and their caregivers

Solid organ and stem cell transplant patients and their caregivers report a substantial level of distress. Mindfulness‐based stress reduction has been shown to alleviate distress associated with transplant, but there is limited experience in this population with other mindfulness‐based interventions, or with combined transplant patient and caregiver interventions. We evaluated a novel, 6‐week mindfulness‐based resilience training (MBRT) class for transplant patients and their caregivers that incorporates mindfulness practice, yoga, and neuroscience of stress and resilience. Thirty‐one heart, liver, kidney/pancreas, and stem cell transplant patients and 18 caregivers at Mayo Clinic in Arizona participated. Measures of stress, resilience, depression, anxiety, health‐related quality of life, positive and negative affect, and sleep were completed at baseline, 6 weeks, and 3 months postintervention. At 6 weeks and 3 months, patients demonstrated significant (P<.005) improvements from baseline in measures of perceived stress, depression, anxiety, and negative affect. Quality‐of‐life mental component (P=.006) and positive affect (P=.02) also improved at follow‐up. Most participants adhered to the program, were satisfied with class length and frequency, and reported improved well‐being as a result of the class. MBRT holds promise as an intervention to enhance resilience and manage stress for transplant patients and their caregivers.     

Organ and effective doses in infants undergoing upper gastrointestinal (UGI) fluoroscopic examination

To provide more detailed data on organ and effective doses in digital upper gastrointestinal (UGI) fluoroscopy studies of newborns and infants, the present study was conducted employing the time-sequence videotape-analysis technique used in a companion study of newborn and infant voiding cystourethrograms (VCUG). This technique was originally pioneered [O. H. Suleiman, J. Anderson, B. Jones, G. U. Rao, and M. Rosenstein, Radiology 178, 653-658 (1991)] for adult UGI examinations. Individual video frames were analyzed to include combinations of field size, field center, x-ray projection, image intensifier, and magnification mode. Additionally, the peak tube potential and the mA or mAs values for each segment/subsegment or digital photospot were recorded for both the fluoroscopic and radiographic modes of operation. The data from videotape analysis were then used in conjunction with a patient-scalable newborn tomographic computational phantom to report both organ and effective dose values via Monte Carlo radiation transport. The study includes dose estimates for five simulated UGI examinations representative of patients ranging from three to six months of age. Effective dose values for UGI examinations ranged from 1.17 to 6.47 mSv, with a mean of 3.14 mSv and a large standard deviation of 2.15 mSv. The colon, lungs, stomach, liver, and esophagus absorbed doses in sum were found to constitute between 63 and 75% of the effective dose in these UGI studies. Representing 23-30% of the effective dose, the lungs were found to be the most significant organ in the effective dose calculation. Approximately 80-95% of the effective dose is contributed by the dynamic fluoroscopy segments with larger percentages found in longer studies. The mean effective dose for newborn UGI examinations was not found to be statistically different from that seen in newborn VCUG examinations.     

Health Halo Effects from Product Titles and Nutrient Content Claims in the Context of “Protein” Bars

Research on front-of-package (FOP) labeling demonstrates that nutrient content claims (e.g., “low fat”) can lead consumers to perceive foods as healthier in general—effects that have been interpreted using halo effect theories of impression formation. Extending this work, the present study investigates whether these effects may depend on whether nutrient information comes in the form of a nutrient content claim (“good source of protein”) or embedded within the product title itself (“protein” bar)—an important question given the popularity of energy/nutrition bars and ongoing policy debates over food-labeling regulation. Results from a between-subjects experiment (n = 274) revealed that although both conditions increased perceived protein content for a nutritional bar, only the product title condition increased overall perceptions of product healthfulness—an effect mediated by increased perceptions of additional non-claimed “healthy” nutrients (fiber, iron). Finally, although the presence of a traffic light warning label increased perceived sugar and calorie content, it did not counteract the effect of the product title on perceived healthfulness. We conclude with a discussion focused on implications for policy and health halo effects in the context of food labeling.     

Comparison of Intravenous versus Topical Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

The purpose of this study was to compare the efficacy of topical Tranexamic Acid (TXA) versus Intravenous (IV) Tranexamic Acid for reduction of blood loss following primary total knee arthroplasty (TKA). This prospective randomized study involved 89 patients comparing topical administration of 2.0 g TXA, versus IV administration of 10 mg/kg. There were no differences between the two groups with regard to patient demographics or perioperative function. The primary outcome measure, perioperative change in hemoglobin level, showed a decrease of 3.06 ± 1.02 in the IV group and 3.42 ± 1.07 in the topical group (P = 0.108). There were no statistical differences between the groups in preoperative hemoglobin level, lowest postoperative hemoglobin level, or total drain output. One patient in the topical group required blood transfusion (P = 0.342). Based on our study, topical Tranexamic Acid has similar efficacy to IV Tranexamic Acid for TKA patients.