Salem Hospital

Here, we describe an overview and update on GeneMatcher (http://www.genematcher.org), a freely accessible Web-based tool developed as part of the Baylor-Hopkins Center for Mendelian Genomics. We created GeneMatcher with the goal of identifying additional individuals with rare phenotypes who had variants in the same candidate disease gene. We also wanted to facilitate connections to basic scientists working on orthologous genes in model systems with the goal of connecting their work to human Mendelian phenotypes. Meeting these goals will enhance the identification of novel Mendelian genes. Launched in September, 2013, GeneMatcher now has 2,178 candidate genes from 486 submitters spread across 38 countries entered in the database (June 1, 2015). GeneMatcher is also part of the Matchmaker Exchange (http://matchmakerexchange.org/) with an Application Programing Interface enabling submitters to query other databases of genetic variants and phenotypes without having to create accounts and data entries in multiple systems.

Exosomes are nanovesicles secreted by cells and contain various molecules including protein, lipid, and DNA/RNA. They are crucial mediators of the intercellular communication and serve as promising vehicles for drug delivery and gene therapy. Recently, accumulating evidence suggests that microRNAs (miRNAs) may serve as new and potentially powerful targets for therapeutic interventions against various human diseases. However, steadily and effectively delivering miRNA mimics or inhibitors to target cells remains a major obstacle. To enhance the efficacy of exosome-mediated delivery of miRNA molecules, it is crucial to develop a convenient and efficient method to enrich specific miRNAs or antisense oligos in isolated exosomes. Here we report a novel method to prepare specific miRNA molecule-loaded exosomes. Using a modified calcium chloride-mediated transfection method, we successfully enhanced the designated miRNA mimics or inhibitors in isolated exosomes directly, instead of transfecting their mother cells. We also compared this method with direct transfection of exosomes using electroporation. Both methods confirmed that exosomes can serve as cargos to deliver a robustly increased amount of selected miRNA mimic(s) or inhibitor(s) to the recipient cells. Delivery of these miRNA molecule enriched-exosomes subsequently results in highly efficient overexpression or deletion of the designated miRNAs in the recipient cells both in vivo and in vitro. Additionally, we confirmed that exosome-delivered miRNA mimics or inhibitors are functional in the recipient cells. Collectively, we developed a novel protocol to conveniently manipulate exosomal miRNAs with high efficiency and successfully deliver the exosomal miRNA molecules to recipient cells.

The novelty of this present work is the investigation of the anti-bacterial, anti-arthritic, anti-oxidant and<italic>in vitro</italic>cytotoxicity activities of green synthesized Zinc Oxide Nanoparticles (ZnO NPs) using leaf aqueous extract of<italic>Tectona grandis</italic>(L.).

The Mobius cubes are hypercube variants that give better performance with the same number of links and processors. We show that the diameter of the Mobius cubes is about one half the diameter of the equivalent hypercube, and that the average number of steps between processors for a Mobius cube is about two-thirds of the average for a hypercube. We give an efficient routing algorithm for the Mobius cubes. This routing algorithm finds a shortest path and operates in time proportional to the dimension of the cube. We also give efficient broadcast algorithms for the Mobius cubes. We show that the Mobius cubes contain ring networks and other networks. We report results of simulation studies on the dynamic message-passing performance of the hypercube, the Twisted Cube of P.A.J. Hilbers et al. (1987), and the Mobius cubes. Our results are in agreement with S. Abraham (1990), showing that the Twisted Cube has worse dynamic performance than the hypercube, but our results show that the 1-Mobius cube has dynamic performance superior to that of the hypercube. This contradicts current literature, which implies that twisted cube variants will have worse dynamic performance.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>

This paper uses symbolic interactionist and structuralist perspectives to examine the social construction of some food objects as “comfort foods,” highlighting how cultural studies of food should take into account its social and physiological dimensions. This study's empirical findings are based upon the food items brought to class by 264 undergraduate students at a southeastern university in the United States. Comfort foods are classified into four categories: nostalgic foods, indulgence foods, convenience foods, and physical comfort foods. We describe how particular food objects come to be associated with the relief of distress and show how food objects are manipulated to modify or change emotional states or feelings. The practical implications of this work extend to understanding the role that mood plays in food selection and considering the use of comfort foods under certain circumstances, such as when individuals are experiencing illness.

Lymphangiomyomatosis (LAM) is characterized by the proliferation of abnormal smooth muscle cells and cystic degeneration of the lung. LAM affects almost exclusively young women. Although lung transplantation provides effective therapy for end-stage LAM, there are reports of LAM recurrence after lung transplantation. Whether these recurrent LAM cells arise from the patient or the lung transplant donor is an area of controversy. We used microsatellite marker fingerprinting and TSC2 gene mutational analysis to study a patient with recurrent LAM after single-lung transplantation. The DNA microsatellite marker pattern indicated the presence of patient-derived LAM cells in the allograft. A somatic one base pair deletion in exon 18 of the TSC2 gene was identified in pulmonary and lymph node LAM cells before transplantation. The same mutation was in the recurrent LAM, demonstrating that the recurrent LAM was derived from the patient. Fluorescence in situ hybridization revealed that cells immunoreactive with the monoclonal antibody HMB-45 did not contain a Y chromosome. These data indicate that histologically benign LAM cells can migrate or metastasize in vivo to the transplanted lung. In addition, the patient had no evidence of a renal angiomyolipoma at autopsy and therefore demonstrated for the first time that somatic TSC2 mutations cause LAM in patients without angiomyolipomas.

Offering an approach that focuses on the origins of mental health rather than the beginnings of mental illness, this book outlines how men and women can recognize the resilient traits they possess and foster the strength to overcome tragedy. An inspiring and invigorating book! I recommAnd it to the courageous women and men who struggle each day to overcome their own cruel pasts, to the therapists who work with them, and to anyone interested in the relationship between adult development and mental health.''--Robert Kegan, Harvard University and the Massachusetts School of Professional Psychology

BACKGROUND: Chronic kidney disease is a risk factor for cardiovascular disease (CVD); however, it is uncertain if CVD is a risk factor for progression or development of kidney disease. METHODS: Individual patient data were pooled from 2 longitudinal, community-based, limited-access studies, the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. Baseline CVD was defined by stroke, angina, claudication, transient ischemic attack, coronary angioplasty or bypass, and recognized or silent myocardial infarction. Study outcomes included kidney function decline, defined by an increase in serum creatinine level of at least 0.4 mg/dL (>or=35.4 micromol/L), and development of kidney disease, defined by an increase in serum creatinine level of at least 0.4 mg/dL (>or=35.4 micromol/L) in which the baseline serum creatinine level was less than 1.4 mg/dL (<123.8 micromol/L) in men and less than 1.2 mg/dL (<106.1 micromol/L) in women and the final serum creatinine levels exceeded these levels. Secondarily, kidney function decline was defined by an estimated glomerular filtration rate (eGFR) reduction of at least 15 mL/min per 1.73 m(2), and development of kidney disease was defined by an eGFR reduction of at least 15 mL/min per 1.73 m(2) in which the baseline eGFR was at least 60 mL/min per 1.73 m(2) and the final eGFR was below these levels. Multivariate logistic regression analysis was used to determine the association between CVD and outcomes. RESULTS: Among 13 826 individuals, the mean +/- SD baseline serum creatinine level was 0.9 +/- 0.2 mg/dL (79.6 +/- 17.7 micromol/L), and the mean +/- SD baseline eGFR was 89.8 +/- 20.1 mL/min per 1.73 m(2). In serum creatinine level-based models, 520 individuals (3.8%) experienced kidney function decline, and 314 individuals (2.3%) developed kidney disease during a mean +/- SD of 9.3 +/- 0.9 years of follow-up. Baseline CVD, present in 1787 individuals (12.9%), was associated with an increased risk of all outcomes (odds ratio, 1.70; 95% confidence interval, 1.36-2.13), an odds ratio of 1.75 (95% confidence interval, 1.32-2.32) for serum creatinine level, and odds ratios of 1.28 (95% confidence interval, 1.13-1.45) and 1.54 (95% confidence interval, 1.26-1.89) for eGFR for kidney function decline and development of kidney disease, respectively. CONCLUSION: Cardiovascular disease is independently associated with kidney function decline and with the development of kidney disease.

We have evaluated the economic costs to society for the two major types of inflammatory bowel disease, Crohn's disease and ulcerative colitis, using a medical decision algorithm costing methodology augmented by examination of 1988-89 claims data from a major U.S. commercial insurer. The average annual medical cost per patient with Crohn's disease was estimated at $6,561 (1990 U.S. dollars). The total annual medical costs for U.S. Crohn's disease patients in 1990 was estimated at $1.0-1.2 billion. The average annual medical cost per patient with ulcerative colitis was estimated at $1,488. The total annual medical costs for U.S. patients with ulcerative colitis in 1990 was estimated at $0.4-0.6 billion. Adjusting for productivity losses, we estimated the annual economic cost for both diseases at $1.8 billion to $2.6 billion. Analysis of insurance claims data for inflammatory bowel disease patients showed that the distribution of annual medical expenses charged and paid is highly uneven by patient. The top 2% of Crohn's disease patients accounted for 28.9% of total charges and 34.3% of the total amount paid. The top 2% of ulcerative colitis patients accounted for 36.2% of total charges and 39.0% of the total amount paid. We used a multivariate regression model to examine potential cost-effectiveness tradeoffs between different types of medical services in treatment of inflammatory bowel disease.

This article presents the effect of different calcination temperatures on the structural, morphological and capacitance of nickel phosphate (Ni₃(PO₄)₂) as an electrode material for supercapacitor applications.

In this work we report the green synthesis of silver nanoparticles (AgNPs) using the aqueous leaf extract of <italic>Lonicera japonica</italic>.

Plant-mediated synthesis of selenium nanoparticles (Se-NPs) was carried out by a simple precipitation method using the aqueous extract of <italic>Diospyros montana</italic>.

The purposes of this clinical report are 1) to document the distances and velocities that individuals must ambulate to function independently in their community and 2) to demonstrate the differences in travel distances and velocities among communities of various sizes. In seven communities of different sizes, we measured distances from a designated parking space to commonly frequented sites (eg, stores, post offices, banks, and medical buildings). We also measured street widths and the time allowed by crossing signals to cross streets safely. From these data, we calculated the velocities needed to safely cross streets in each community. The study results showed that ambulation distances and velocities vary depending on the size of the community and that for individuals to function independently within their community, they must ambulate at velocities and distances much greater than the ambulation objectives that may be set at most rehabilitation settings. Based on the results of this study, we suggest that they receive the majority of their patients to more accurately prepare patients for functional independence after rehabilitation discharge.

The validity of whiplash syndrome has been a source of debate in the medical literature for many years. Some authors have published articles suggesting that whiplash injuries are impossible at certain collision speeds; others have stated that the problem is psychological, or is feigned as a means to obtain secondary financial gain. These articles contradict the majority of the literature, which shows that whiplash injuries and their sequelae are a highly prevalent problem that affects a significant proportion of the population. The authors of the current literature critique reviewed the biomedical and engineering literature relating to whiplash syndrome, searching for articles that refuted the validity of whiplash injuries. Twenty articles containing nine distinct statements refuting the validity of whiplash syndrome were found that fit the inclusion criteria. The methodology described in these articles was evaluated critically to determine if the authors' observations regarding the validity of whiplash syndrome were scientifically sound. The authors of the current critique found that all of the articles contained significant methodologic flaws with regard to their respective authors' statements refuting the validity of whiplash syndrome. The most frequently found flaws were inadequate study size, nonrepresentative study sample, nonrepresentative crash conditions (for crash tests), and inappropriate study design. As a result of the current literature review, it was determined that there is no epidemiologic or scientific basis in the literature for the following statements: whiplash injuries do not lead to chronic pain, rear impact collisions that do not result in vehicle damage are unlikely to cause injury, and whiplash trauma is biomechanically comparable with common movements of daily living.

Exosomes (EXOs) are a type of extracellular nanovesicles released from living cells. Accumulating evidence suggests that EXOs are involved in the pathogenesis of human diseases, including lung conditions. In recent years, the potential of EXO-mediated drug delivery has gained increasing interest. In this report, we investigated whether inhaled EXOs serve as an efficient and practical delivery vehicle to activate or inhibit alveolar macrophages (AMs), subsequently modulating pulmonary immune responses. We first identified the recipient cells of the inhaled EXOs, which were labeled with PKH26. We found that only lung macrophages efficiently take up intratracheally instilled EXOs in vivo. Using modified calcium chloride-mediated transformation, we manipulated small RNA molecules in serum-derived EXOs, including siRNAs, microRNA (miRNA) mimics, and miRNA inhibitors. Via intratracheal instillation, we successfully delivered siRNA and miRNA mimics or inhibitors into lung macrophages using the serum-derived EXOs as vehicles. Furthermore, EXO siRNA or miRNA molecules are functional in modulating LPS-induced lung inflammation in vivo. Beneficially, serum-derived EXOs themselves do not trigger lung immune responses, adding more favorable features to serve as drug delivery agents. Collectively, we developed a novel protocol using serum-derived EXOs to deliver designated small RNA molecules into lung macrophages in vivo, potentially shedding light on future gene therapy of human lung diseases.

BACKGROUND: A mixture of wine and vinegar is more attractive than wine or vinegar to spotted wing drosophila, Drosophila suzukii (Matsumura) (Diptera: Drosophilidae), and ethanol and acetic acid are considered key to that attractiveness. In addition to ethanol and acetic acid, 13 other wine and vinegar volatiles are antennally active to D. suzukii and might be involved in food finding. RESULTS: Out of the 13 antennally active chemicals, acetoin, ethyl lactate and methionol increased fly response to a mixture of acetic acid and ethanol in field trapping experiments. A five-component blend of acetic acid, ethanol, acetoin, ethyl lactate and methionol was as attractive as the starting mixture of wine and vinegar in field tests conducted in the states of Oregon and Mississippi. Subtracting ethyl lactate from the five-component blend did not reduce the captures of flies in the trap. However, subtracting any other compound from the blend significantly reduced the numbers of flies captured. CONCLUSION: These results indicate that acetic acid, ethanol, acetoin and methionol are key olfactory cues for D. suzukii when attracted to wine and vinegar, which may be food-finding behavior leading flies to fermenting fruit in nature. It is anticipated that this four-component blend can be used as a highly attractive chemical lure for detection and management of D. suzukii. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

IMPORTANCE: A surge in severe cases of COVID-19 (coronavirus disease 2019) in children would present unique challenges for hospitals and public health preparedness efforts in the United States. OBJECTIVE: To provide evidence-based estimates of children infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and projected cumulative numbers of severely ill pediatric COVID-19 cases requiring hospitalization during the US 2020 pandemic. DESIGN: Empirical case projection study. MAIN OUTCOMES AND MEASURES: Adjusted pediatric severity proportions and adjusted pediatric criticality proportions were derived from clinical and spatiotemporal modeling studies of the COVID-19 epidemic in China for the period January-February 2020. Estimates of total children infected with SARS-CoV-2 in the United States through April 6, 2020, were calculated using US pediatric intensive care unit (PICU) cases and the adjusted pediatric criticality proportion. Projected numbers of severely and critically ill children with COVID-19 were derived by applying the adjusted severity and criticality proportions to US population data, under several scenarios of cumulative pediatric infection proportion (CPIP). RESULTS: By April 6, 2020, there were 74 children who had been reported admitted to PICUs in 19 states, reflecting an estimated 176 190 children nationwide infected with SARS-CoV-2 (52 381 infants and toddlers younger than 2 years, 42 857 children aged 2-11 years, and 80 952 children aged 12-17 years). Under a CPIP scenario of 5%, there would be 3.7 million children infected with SARS-CoV-2, 9907 severely ill children requiring hospitalization, and 1086 critically ill children requiring PICU admission. Under a CPIP scenario of 50%, 10 865 children would require PICU admission, 99 073 would require hospitalization for severe pneumonia, and 37.0 million would be infected with SARS-CoV-2. CONCLUSIONS AND RELEVANCE: Because there are 74.0 million children 0 to 17 years old in the United States, the projected numbers of severe cases could overextend available pediatric hospital care resources under several moderate CPIP scenarios for 2020 despite lower severity of COVID-19 in children than in adults.

One hundred twenty-seven patients were evaluated for the results of surgical stabilization in chronic anterior cruciate ligament instability. Eighty-four patients had been treated with intraarticular reconstruction alone, while 43 patients had been treated with a combination of intraarticular and extraarticular stabilization. Patients were evaluated by questionnaire to assess subjective and functional status by clinical examination of objective findings, and by roentgenograms and instrumented ligamentous stability testing. The follow-up interval averaged 45.2 months for the entire group (range, 24-90 months). Using a 200-point scale, the rating for the group treated with intraarticular reconstruction alone was 169.1, while the average rating for the group treated with combined intraarticular and extraarticular stabilization was 166.2. Overall, an excellent or good result was obtained in 67% of patients in the intraarticular only group and in 70% of the patients in the combined reconstruction group. There were no significant differences between the two groups in terms of changes seen on roentgenograms or in terms of residual laxity measured by instrumented testing. Thus, there is no demonstrable benefit derived from combined intraarticular and extraarticular stabilization procedures for chronic anterior cruciate ligament instability, provided that a well-placed intraarticular substitute of sufficient strength is functional.

We evaluated antimicrobial exposure, discharge diagnoses, or both to identify surgical site infections (SSI). This retrospective cohort study in 13 hospitals involved weighted, random samples of records from 8,739 coronary artery bypass graft (CABG) procedures, 7,399 cesarean deliveries, and 6,175 breast procedures. We compared routine surveillance to detection through inpatient antimicrobial exposure (> 9 days for CABG, > 2 days for cesareans, and > 6 days for breast procedures), discharge diagnoses, or both. Together, all methods identified SSI after 7.4% of CABG, 5.0% of cesareans, and 2.0% of breast procedures. Antimicrobial exposure had the highest sensitivity, 88%-91%, compared with routine surveillance, 38%-64%. Diagnosis codes improved sensitivity of detection of antimicrobial exposure after cesareans. Record review confirmed SSI after 31% to 38% of procedures that met antimicrobial surveillance criteria. Sufficient antimicrobial exposure days, together with diagnosis codes for cesareans, identified more postoperative SSI than routine surveillance methods. This screening method was efficient, readily standardized, and suitable for most hospitals.

In this study we describe medical cost estimates for the two major types of inflammatory bowel disease, Crohn's disease and ulcerative colitis, using a literature-based medical decision algorithm costing methodology. Surgery and inpatient costs were estimated to account for roughly half of inflammatory bowel disease medical costs. Outpatient medical care represented only 3.0-7.1% of average cost of medical care for inflammatory bowel disease; initial diagnostic workups were only 1.5-7.8% of medical costs. Long-term complications were estimated to average $439 for ulcerative colitis, nearly twice the average for Crohn's disease. Medications averaged about 10% of total costs. The average annual medical cost per patient with Crohn's disease was estimated at $6,561 (1990 U.S. dollars). The total annual medical costs for U.S. Crohn's disease patients in 1990 was estimated at $1.0-1.2 billion. The average annual medical cost per patient with ulcerative colitis was estimated at $1,488. The total annual medical costs for U.S. patients with ulcerative colitis in 1990 was estimated at $0.4-0.6 billion.