The invasive red seaweed, Dasysiphonia japonica, forms harmful algal blooms: Mortality in early life stage fish and bivalves and identification of putative toxins.

In recent decades, the rate of introduction of non-indigenous macroalgae has increased. While invasive seaweeds often outcompete native species for substrata, their direct effects on marine life are rarely described. Here, we describe 'red water' events caused by the decay of blooms of the invasive red seaweed, Dasysiphonia japonica, in Great South Bay, NY, USA, and the ability of water from such events to induce rapid and significant mortality in larval and juvenile fish (Menidia beryllina, Menidia menidia, and Cyprinodon variegatus) and larval bivalves (Mercenaria mercenaria and Crassostrea virginica). All species studied experienced significant (p<0.05) reductions in survival when exposed to macroalgae in a state of decay, seawater in which the alga was previously decayed, or both. Both bivalve species experienced 50-60% increases in mortality when exposed to decaying D. japonica for ∼ one week, despite normoxic conditions. Among fish, significant increases (40-80%) in mortality were observed after 24 h exposure to decayed D. japonica and one-week exposures caused, on average, 90% mortality in larval M. beryllina, 50% mortality in juvenile (∼3 cm) M. menidia, and 50% mortality in larval C. variegatus. All fish and bivalve mortality occurred under normoxic conditions (dissolved oxygen (DO) >7 mg L-1) and low ammonium levels (< 20 µM), with the exception of C. variegatus, which expired under conditions of decayed D. japonica coupled with reduced DO caused by the alga. Screening of water with decayed D. japonica using liquid chromatography-mass spectrometry revealed compounds with mass-to-charge ratios matching caulerpin, a known algal toxin that causes fish and shellfish mortality, and several other putative toxicants at elevated levels. Collectively, the high levels of mortality (50-90%) of larval and juvenile fish and bivalves exposed to decaying D. japonica under normoxic conditions coupled with the observation of 'red water' events in estuaries collectively indicate the red seaweed, D. japonica, can create harmful algal blooms (HABs).

Interpositional Arthroplasty of the First Metatarsophalangeal Joint with Bioresorbable Pldla Implant in the Treatment of Hallux Rigidus and Arthritic Hallux Valgus: A 9-Year Case Series Follow-Up.

BACKGROUND AND AIMS: The interpositional arthroplasty was developed to retain foot function and to relieve pain due to the arthritis of the first metatarsophalangeal joint. The bioabsorbable poly-L-D-lactic acid RegJoint® interpositional implant provides temporary support to the joint, and the implant is subsequently replaced by the patient's own tissue. In this study, we retrospectively examined the results of the poly-L-D-lactic acid interpositional arthroplasty in a 9-year follow-up study among patients with hallux valgus with end-stage arthrosis or hallux rigidus. MATERIAL AND METHODS: Eighteen patients and 21 joints underwent interpositional arthroplasty using the poly-L-D-lactic acid implant between February 1997 and October 2002 at Tampere University Hospital. Of these, 15 (83.3%) (21 joints) patients were compliant with clinical examination and radiographic examination in long-term (average 9.4 years) follow-up. The mean age of the patients was 48.3 (from 28 to 67) years at the time of the operation. Six patients underwent the operation due to arthritic hallux valgus and nine patients due to hallux rigidus. RESULTS: The mean Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale and visual analogue scale (VAS) for pain scores improved after the operation in all patients. The decrease of pain (visual analogue scale) after the operation was statistically significant (77.5 vs 10.0; p < 0.001). Postoperative complications were observed in 3 (14.3%) joints of two hallux rigidus patients. For these patients, surgery had only temporarily relieved the pain, and they underwent reoperation with arthrodesis. CONCLUSION: In conclusion, interpositional arthroplasty using a poly-L-D-lactic acid implant yielded good results. This study indicates that the poly-L-D-lactic acid interpositional implant may be a good alternative for arthrodesis for treatment of end-stage degeneration of the first metatarsophalangeal joint.

Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women.

CLINICAL QUESTION: In menopausal women who experience regular hot flashes, does treatment with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) reduce the frequency and/or severity of hot flashes? ANSWER: Yes. Review of the literature suggests that treatment with SSRIs or SNRIs reduces the frequency and severity of hot flashes in menopausal and post-menopausal women. Studies demonstrated that paroxetine (Paxil), citalopram (Celexa) and escitolapram (Lexapro) were the most effective SSRIs, and venlafaxine (Effexor) was the most effective first line SNRI, with desvenlafaxine as a second option. The most common side effects reported for both SSRIs and SNRIs are nausea and constipation, with most resolving within the first week of treatment. SNRIs have been associated with increased blood pressure in some patients and should be used with caution in women with hypertension. Women with a history of breast cancer and taking tamoxifen should avoid SSRIs, which have been shown to interfere with tamoxifen metabolism. SNRIs are the safest drugs for this population. Treatment choice should be patient-specific and begin with the lowest dose available. LEVEL OF EVIDENCE FOR THE ANSWER: A. SEARCH TERMS: SSRI, SNRI, hot flashes, vasomotor symptoms, menopause. SEARCH CONDUCTED: August 2014, February 2016 and August 2016. INCLUSION CRITERIA: menopausal, perimenopausal or postmenopausal women 18 years of age or older with frequent and/or severe vasomotor symptoms, meta-analyses, systematic reviews, randomized controlled trials, cohort studies. EXCLUSION CRITERIA: pre-menopause, anxiety, depression, panic disorder, bipolar disorder, co-morbid conditions.

Yoga and other meditative movement therapies to reduce chronic pain.

CLINICAL QUESTION: In adults with chronic pain, do yoga and other meditative movement therapies to improvement in chronic pain symptoms? ANSWER: Yes. However, in each of the studies reviewed, yoga classes were included as part of the pain management regime, sometimes alone and sometimes in tandem with DVDs or audiotapes. We feel that no exercise therapy program should be undertaken without professional coaching from certified, registered and qualified instructors. DATE ANSWER WAS DETERMINED: August 2014, June, 2015, August 2015. LEVEL OF EVIDENCE FOR THE ANSWER: A. SEARCH TERMS: chronic pain, yoga, exercise therapy, meditative movement therapy. INCLUSION CRITERIA: Adults; meta-analyses; systematic reviews; cohort studies; randomized controlled trials; practice guidelines; articles from 2010 to present. EXCLUSION CRITERIA: Children younger than 18 years of age, Pilates.

Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ.

Congestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department (ED) with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP may also have a "gray zone" in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of 87% and specificity of 74% at a cutoff of 400 pg/ml. Studies investigating the sensitivity and specificity of bedside ultrasound (US) inferior vena cava (IVC) measurements for identifying CHF report a specificity of 84% to 96% and sensitivity values ranging from 37% to 93%, depending on the study. Given that US IVC measurements are performed at bedside and results are available rapidly, it is reasonable to evaluate whether US IVC measurements, taken by appropriately trained ED clinicians, alone or in combination with BNP, may increase diagnostic accuracy of congestive heart failure.

Clinical Question: Nasal saline or intranasal corticosteroids to treat allergic rhinitis in children.

CLINICAL QUESTION: In pediatric populations, is nasal saline irrigation as effective as intranasal corticosteroids at relieving allergic rhinitis symptoms? ANSWER: No. Intranasal steroids are more effective than nasal saline alone to reduce symptoms of allergic rhinitis (AR) in children. Combination therapy further improves symptom reduction. LEVEL OF EVIDENCE FOR THE ANSWER: B SEARCH TERMS: Allergic Rhinitis, Nasal Saline, Nasal corticosteroids, children younger than age 18. DATE SEARCH WAS CONDUCTED: August and September 2014, October 2015. INCLUSION CRITERIA: Meta-analyses, randomized controlled trials, systematic reviews, cohort studies, nasal spray, hypertonic saline solution, nasal lavage, rhinitis, intranasal administration, nasal saline, human, English language. EXCLUSION CRITERIA: Antihistamines, Adults, Articles older than 2008.

What Are the Recommended Timing and Screening Modalities in Women at Higher Risk for Developing Breast Cancer? A Clin-IQ.

Early detection of breast cancer is desirable to prevent progression to advanced disease. This subject has been one of significant study and debate for women at normal risk, and recommendations continue to evolve. However, with regard to women at high risk, the recommendations from various health care professional organizations, including the recent recommendations from the United States Preventative Services Task Force, are different and also inconsistent concerning when to begin screening and which modalities should be used. We review several randomized controlled trials and consensus opinions regarding when to begin screening for breast cancer and how to best screen women at high risk. Specifically, we address women with known personal history of breast cancer, prior mantle radiation, or specific family history (including genetic family history) of breast cancer. The purpose of this inquiry is to present current evidence and suggest a clinical pathway regarding the screening of women at high risk for breast cancer.

Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis.

CLINICAL QUESTION: In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? ANSWER: Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer: A Search Terms: Plantar fasciitis, heel pain, treatment, orthotics, Limits: Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted: January 16, 2014; updated January 20, 2015 INCLUSION CRITERIA: Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. EXCLUSION CRITERIA: Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis.

In adult smokers unwilling or unable to quit, does changing from tobacco cigarettes to electronic cigarettes decrease the incidence of negative health effects associated with smoking tobacco? A Clin-IQ.

Data from a randomized controlled trial and systematic review support the claim that switching from tobacco cigarettes to electronic cigarettes (e-cigarettes) can reduce the short-term negative health effects of smoking. In adult smokers unwilling or unable to quit, exhaled carbon monoxide levels, total number of cigarettes smoked, and exposure to nitrosamine chemicals were reduced within a 12-month period. While the electronic cigarette industry remains largely unregulated thus far, these studies provide encouraging hope in the uphill battle toward helping patients make informed and healthy choices.

Are at-home sleep studies performed using portable monitors (PMs) as effective at diagnosing obstructive sleep apnea (OSA) in adults as sleep laboratory-based polysomnography (PSG)?

UNLABELLED: RESIDENCY PROGRAM: University of Oklahoma Health Sciences Center, Department of Family and Preventive Medicine, Oklahoma City, OK. ANSWER: In patients with suspected OSA, it is reasonable to use PMs if the patient has a high pretest probability (based on an Epworth Sleepiness Scale (ESS) ≥10 and clinical symptoms*) without significant co-morbid heart disease or other sleep disorders and he/she is able to prove competency in setting up the home equipment properly without assistance. However, if the patient has a negative PM, it is standard to perform PSG as it appears approximately 20% will have a false negative PM. (*Clinical symptoms include snoring, witnessed apneas, obesity, pulmonary hypertension, refractory hypertension, morning headaches, increased neck circumference-->17 inches in men, >16 inches in women--daytime sleepiness.) LEVEL OF EVIDENCE FOR THE ANSWER: A. SEARCH TERMS: obstructive sleep apnea, polysomnography, portable home monitors, efficacy. INCLUSION CRITERIA: polysomnography, ambulatory, adults, humans. ESCLUSION CRITERIA: children.

Improving colorectal cancer screening in family medicine: an Oklahoma Physicians Resource/Research Network (OKPRN) study.

PURPOSE: The purpose of this study was to describe colorectal cancer screening (CRCS) practices across a variety of primary care clinics and identify the methods used by primary care physicians (PCPs) with higher rates of CRCS ("exemplars"). METHODS: Physician questionnaires, structured interviews, medical record abstractions, and practice observations were conducted for 48 PCPs in 25 practices within a regional practice-based research network followed by secondary in-depth interviews to further investigate the practices of PCPs in the top quartile of CRCS rates ("exemplars"). RESULTS: We abstracted 3596 medical records (mean of 75 records per PCP). Overall, exemplars had higher CRCS rates (median, 57.2% vs. 27.6%; P < .001). Patients of exemplars had higher screening rates for fecal occult blood testing (FOBT) and colonoscopy but not for flexible sigmoidoscopy or double-contrast barium enemas. Exemplars adopted few of the system-based innovations proposed by researchers to improve CRCS. Colonoscopy was promoted as the preferred CRCS method. FOBT was recommended for patients who could not afford or did not want colonoscopy. Flexible sigmoidoscopy or barium enemas were rarely recommended. Exemplars used brief CRCS promotion scripts that informally paralleled theory-driven counseling techniques. CONCLUSIONS: Experienced PCPs use brief CRCS promotion scripts including counseling techniques that improve CRCS performance. Future research should be directed toward whether these techniques can be used to create an intervention aimed at PCPs to improve CRCS.

Polyreactive antibodies plus complement enhance the phagocytosis of cells made apoptotic by UV-light or HIV.

Polyreactive antibodies are a major component of the natural antibody repertoire and are capable of binding a variety of structurally unrelated antigens. Many of the properties attributed to natural antibodies, in fact, are turning out to be due to polyreactive antibodies. In humans, each day, billions of cells undergo apoptosis. In the present experiments, we show by ImageStream technology that although polyreactive antibodies do not bind to live T cells they bind to both the plasma membrane and cytoplasm of late apoptotic cells, fix complement, generate the anaphylatoxin C5a and increase by as much as 5 fold complement-mediated phagocytosis by macrophages. Of particular importance, T cells undergoing apoptosis following infection with HIV also bind polyreactive antibodies and are phagocytosed. We conclude that the polyreactive antibodies in the natural antibody repertoire contribute in a major way to the clearance of cells made apoptotic by a variety of natural and infectious processes.

Do older people benefit from having a confidant? An Oklahoma Physicians Resource/Research Network (OKPRN) study.

OBJECTIVE: The objective was to determine whether having a confidant was associated with improved health-related quality of life (HRQoL) or survival in older, community-dwelling individuals. METHODS: This prospective cohort study included 23 family physician members of the Oklahoma Physicians Research/Resource Network in 9 practices and 852 community-dwelling adults 65 or older participating in the Oklahoma Longitudinal Assessment of Health Outcomes of Mature Adults Studies. Longitudinal models analyzed changes in self-administered Quality of Well-Being (QWB-SA) scores over an average (S.D.) of 2.51 (1.28) years. Cox proportional hazards models assessed variables possibly associated with mortality over an average survival time (+/-S.D.) of 9.22 (3.24) years. We controlled for chronic illnesses, baseline age, gender, marital status, income, race, BMI, education and specified Medical Outcomes Study Short Form-36 (SF-36) domain scores. RESULTS: Initially, 740 participants (87%) had a confidant. Being married was strongly associated with having a confidant (91.9% vs. 77.8%, p<0.0001). A confidant was associated with better SF-36 domain scores (p<0.0001), less morbidity, higher baseline QWB-SA scores and favorable changes in QWB-SA (p<0.0001). Unadjusted risk of death (37.8% vs 46.4%, p=0.08) was not lower. Kaplan-Meier confidant status survival curves were not statistically different (p=0.16). CONCLUSIONS: Older people with a confidant demonstrated enhanced HRQoL maintenance over the short term, but not greater survival.

Gianotti-Crosti syndrome following childhood vaccinations.

A 19-month-old boy was evaluated for a skin eruption after recent vaccinations. Clinical and histopathologic findings supported a diagnosis of Gianotti-Crosti syndrome (GCS). This case report examines the link between GCS and vaccinations, particularly the diphtheria, tetanus, and pertussis vaccine and the varicella virus live vaccine.

The interaction of blood flow, insulin, and bradykinin in regulating glucose uptake in lower-body adipose tissue in lean and obese subjects.

CONTEXT: Impaired adipose tissue (AT) blood flow has been implicated in the pathogenesis of insulin resistance in obesity. Insulin and bradykinin are meal-stimulated promoters of AT blood flow and glucose metabolism. OBJECTIVE: We tested whether blood flow regulates glucose metabolism in AT, insulin and bradykinin exert additive effects on AT blood flow and metabolism, and any of these actions explains the insulin resistance observed in obese individuals. DESIGN: Perfusion and glucose metabolism in the AT of the thighs were studied by positron emission tomography and H(2)(15)O (flow tracer) and (18)F-2-fluoro-2-deoxyglucose. Study I included five subjects in whom positron emission tomography imaging was performed in the fasting state during intraarterial infusion of bradykinin in the left leg; the right leg served as a control. Study II included seven lean and eight obese subjects in whom the imaging protocol was performed during euglycemic hyperinsulinemia. RESULTS: Bradykinin alone doubled fasting AT blood flow without modifying glucose uptake. Hyperinsulinemia increased AT blood flow (P ≤ 0.05) similarly in lean and obese individuals. In the lean group, bradykinin increased insulin-mediated AT glucose uptake from 8.6 ± 1.6 to 12.3 ± 2.4 µmol/min · kg (P = 0.038). In the obese group, AT glucose uptake was impaired (5.0 ± 1.0 µmol/min · kg, P = 0.05 vs. the lean group), and bradykinin did not exert any metabolic action (6.0 ± 0.8 µmol/min · kg, P = 0.01 vs. the lean group). CONCLUSION: AT blood flow is not an independent regulator of AT glucose metabolism. Insulin is a potent stimulator of AT blood flow, and bradykinin potentiates the hemodynamic and metabolic actions of insulin in lean but not in obese individuals.

Gianotti-Crosti syndrome after childhood vaccination.

A 19-month-old boy was evaluated for a skin eruption after recent vaccinations. Clinical and histopathologic findings supported a diagnosis of Gianotti-Crosti syndrome (GCS). This case report examines the link between GCS and vaccinations, particularly the diphtheria, tetanus, and pertussis vaccine and the varicella virus live vaccine.

Paraneoplastic pemphigus and Castleman's disease in the setting of herpes simplex virus infection.

A 14-year-old girl presented with a 3-week history of mucosal erosions, injected conjunctiva, dehydration, and respiratory distress. She had been treated with intravenous acyclovir for herpes simplex infection with positive herpes simplex virus immunoglobulin M and immunoglobulin G. Physical examination and imaging revealed a large abdominal mass. Incisional biopsy was obtained, and pathology demonstrated angiofollicular hyperplasia with hyalinized germinal centers and Castleman's syndrome-like features. Based on the mucosal erosions, herpes simplex virus serology and positive herpes simplex virus-1 direct fluorescent antibody, Castleman's disease secondary to overwhelming herpes simplex virus infection was the initial impression. The poor response to antivirals and subsequent development of a bullous eruption on the hands resulted in dermatology consultation. Skin biopsy was obtained from a bullae and revealed suprabasilar acantholysis with necrosis as well as upper dermal, perivascular, and interface infiltrate of lymphocytes and eosinophils. No viropathic changes were present. Direct immunofluorescence was significant for immunoglobulin G deposition intercellularly and along the dermoepidermal junction and focal trace C3 deposition along the dermoepidermal junction consistent with paraneoplastic pemphigus, later confirmed by indirect immunofluorescence. We report this case of paraneoplastic pemphigus secondary to Castleman's syndrome confounded by herpes simplex virus-1 positive mucosal erosions.