Dyke-Davidoff-Masson syndrome: Imaging diagnosis in an asymptomatic adult.

Dyke-Davidoff-Masson syndrome (DDMS) was first described in 1933 as a cerebral condition of hemispheric atrophy characterized clinically by contralateral hemiparesis, facial-asymmetry, seizures, and mental retardation. Neuroimaging findings include asymmetric thickening of the calvarium and enlargement of frontal and ethmoid sinuses. There have been 21 reported cases described in the literature with the syndrome undiagnosed until adult age, likely due to less severe or absent clinical findings or symptoms as described in the case presented in this report. This article describes a case where the Dyke-Davidoff-Masson imaging features were identified as an incidental finding on a CT scan of the brain performed for non-seizure related symptoms. A 54-year-old woman presented with weakness and gait difficulty and only upon further evaluation was she found to have cranial deformities. CT and MRI demonstrate encephalomalacia in the right frontal lobe anteriorly with gliosis and moderate unilateral cerebral atrophy, and extensive hypertrophy of the right frontal calvarium, right ethmoid cells and frontal sinuses.

Functional Isolation: Understanding Isolation in Trafficking Survivors.

The study of sexual exploitation of trafficked victims cannot be done without understanding their enforced isolation. To better understand the dynamics of isolation, this study examined how traffickers used different elements of isolation and how such tactics may have contributed to the traffickers' success in maintaining control over the victim(s). We examined in-depth narratives from 14 women between the ages of 20 to 53, primarily immigrants, who were recruited from an agency serving victims of sex trafficking in a large metropolitan city. The tactics used by traffickers varied and included not only the commonly defined structural isolation in which victims are restricted physically and socially, but also included a shrinking of safe social space and an elimination of privacy and social support. The latter, which we label as functional isolation, refers to instances when survivors are surrounded by peers who are either unreliable or aligned with the trafficker and thus are unable to give true social support. Survivors reported a combination of isolation tactics (i.e., both structural isolation and functional isolation). The different interwoven types and patterns of isolation reported by former victims of trafficking help address a dearth in the coercive control and abuse literature, providing a richer understanding of isolation in trafficking survivors.

Protocol of a randomized controlled trial to test the effects of client-centered Representative Payee Services on antiretroviral therapy adherence among marginalized people living with HIV.

BACKGROUND: Client-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries' bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress. METHODS: PLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized ("choice") study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators. DISCUSSION: The aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103) .

A precision oncology approach to the pharmacological targeting of mechanistic dependencies in neuroendocrine tumors.

We introduce and validate a new precision oncology framework for the systematic prioritization of drugs targeting mechanistic tumor dependencies in individual patients. Compounds are prioritized on the basis of their ability to invert the concerted activity of master regulator proteins that mechanistically regulate tumor cell state, as assessed from systematic drug perturbation assays. We validated the approach on a cohort of 212 gastroenteropancreatic neuroendocrine tumors (GEP-NETs), a rare malignancy originating in the pancreas and gastrointestinal tract. The analysis identified several master regulator proteins, including key regulators of neuroendocrine lineage progenitor state and immunoevasion, whose role as critical tumor dependencies was experimentally confirmed. Transcriptome analysis of GEP-NET-derived cells, perturbed with a library of 107 compounds, identified the HDAC class I inhibitor entinostat as a potent inhibitor of master regulator activity for 42% of metastatic GEP-NET patients, abrogating tumor growth in vivo. This approach may thus complement current efforts in precision oncology.

Effect of Curriculum Changes on Student Performance During General Surgical Clerkship.

INTRODUCTION: Good clinical knowledge of anatomy, taught in medical school, is necessary for practicing physicians. It is a key feature of performance on the United States Medical Licensing Examination Step 1 score. Student performance on anatomy is also an early indicator of overall medical student performance. Unfortunately, curricular time provided for the teaching of anatomy has declined significantly over the last 30 years, leading to growing concerns that the anatomical knowledge of new medical graduates may not be adequate. Data regarding the impact of these changes to the medical school curriculum are lacking, with studies often being limited in number of medical students or time. METHODS: This study examined the anatomy knowledge of students on third-year clinical rotations at Tulane University Medical School. Oral examinations were administered at the conclusion of the junior surgical clerkship. Data on performance were collected over a 5-year period from 690 medical students tested in their knowledge of anatomy, and the other basic sciences collectively considered as pathophysiology. RESULTS: Over the 5-year period, student total scores by year increased in all categories tested. However, during the course of the students' third-year clerkships, the later in the year the students rotated on surgery, the more their scores progressively declined. Unfortunately, this fall was most severe in the knowledge of anatomy. DISCUSSION: Although it is possible to teach anatomy in increasingly shorter periods of time, such that the students achieve high test scores in the standardized short answer examinations, it is clear that their knowledge, as applied to clinical care, rapidly declines the further they get away from Step 1 studying. Further study is necessary to elucidate the weaknesses in the current basic science curricula as they pertain to anatomy and to devise mechanisms to assure retention of this critical science during clinical rotations and beyond into practice.

Analysis of Transurethral Resection of the Prostate Costs across New York State Hospitals Using Severity of Illness Score.

INTRODUCTION: Using data on surgical treatment for benign prostatic hyperplasia we evaluated the effect of beneficiary health status on hospital reported costs. METHODS: We examined the records of 9,895 patients in the New York State Hospital Inpatient Cost Transparency database who underwent surgical treatment for benign prostatic hyperplasia, including laser prostatectomy and traditional transurethral resection of the prostate, in New York State from 2009 to 2011. RESULTS: Using the 3M™ APR-DRG (All Patient Refined Diagnosis Related Group) severity of illness index as a measure of patient preoperative health we found a significant increase in the cost of transurethral resection of the prostate for patients with higher severity of illness scores. We confirmed an increase in the cost and the cost variability of transurethral resection of the prostate for patients with higher severity of illness scores. CONCLUSIONS: Our findings illustrate the inherent unpredictability of cost forecasting and budgeting for these patients.

The meaning of food and eating among home parenteral nutrition-dependent adults with intestinal failure: a qualitative inquiry.

Using content and interpretative phenomenological analysis, we explored the meaning of food and eating from the perspective of adults receiving home parenteral nutrition (PN). The aim of this research was to obtain a deeper understanding of how issues related to food and eating influence quality of life (QOL). Semistructured telephone interviews were conducted between May 2006 and January 2007 with 24 adults with intestinal failure and home PN dependency. The analysis revealed themes relevant to eating behaviors, hunger and thirst, strategies for dining in restaurants, and a perception of wasting money because of malabsorbed food. Three patterns of eating emerged: eating for survival, eating for health benefits, and eating for socialization. A proposed model illustrates how these eating patterns are linked to QOL. Being able to eat and enjoy food is an important ingredient for good self-reported QOL. Measurements of QOL for this population may be enhanced with inclusion of a food and eating domain. The social and emotional context of food and mealtimes is an important component to address in the nutrition care plan for PN-dependent adults.

An exploration of quality of life and the experience of living with home parenteral nutrition.

INTRODUCTION: The aim of this research was to achieve a deeper understanding of the experience of adults living with home parenteral nutrition (PN) and to define their quality of life (QOL). METHODS: The research design was qualitative, using content and interpretative phenomenological analysis. The sample included adults with intestinal failure, stratified by length of home PN dependency. Sampling continued until data saturation was achieved. A second reviewer independently coded a subset of narratives (kappa = 0.684). RESULTS: Participants included 24 adults receiving home PN because of short bowel syndrome (95.8%) and pseudo-obstruction (4.2%). Twenty-five percent received PN for < 2 years, 20.8% for 2-5 years, 25% for 5-10 years, and 29.2% for > 10 years. Respondents viewed home PN as a "lifeline" and "nutritional safety net." QOL was defined as "enjoying life"; "being happy, satisfied, or content with life"; and "being able to do what you want to do, when you want to do it." Participants described their QOL as "good" to "wonderful." Lifestyle was affected by health, stamina, diarrhea, having an ostomy, and the amount of flexibility there was with the infusion schedule. There was a strong desire to achieve normalcy in life among all participants. CONCLUSIONS: Qualitative methodology provides new insights and richness of data regarding adults receiving home PN. The positive description of QOL in this study contrasts with the published nutrition literature. It is important for healthcare practitioners to understand and discuss the realities of home PN and lifestyle adaptation.

XPA impacts formation but not proteasome-sensitive repair of DNA-protein cross-links induced by chromate.

DNA-protein cross-links (DPCs) are caused by a large number of human carcinogens and anti-cancer drugs. However, cellular processes involved in decreasing a burden of these genotoxic lesions remain poorly understood. Here, we examined the impact of nucleotide excision repair (NER), which is a principal repair pathway for bulky DNA adducts, and the main cellular reducers on removal of chromium(VI)-induced DPC. We found that standard and ascorbate-restored cultures of isogenic XPA-null (NER deficient) and XPA-complemented human fibroblasts had very similar repair of Cr-DPC (60-65% average DPC removal after 24 h). However, XPA absence caused depletion of G1 and accumulation of G2 cells at low Cr(VI) doses, suggesting that Cr-DPC were not a significant cause of cell cycle perturbations. Interestingly, although pro-oxidant metabolism of Cr(VI) in glutathione-depleted cells generated significantly fewer DPC, they were repair resistant irrespective of the NER status of cells. Inhibition of proteasome activity by MG132 abolished DPC repair in both XPA-null and XPA-complemented cells. XPA loss caused two to three times higher initial DPC formation, demonstrating the importance of NER in removal of the precursor lesions. Our results indicate that human NER is not involved in removal of Cr-DPC containing non-histone proteins but it acts as a defence mechanism against these large lesions by preventing their formation. Therefore, individual differences in NER activity are expected to alter sensitivity but not persistence of DPC as a biomarker of hexavalent Cr.

Mechanism of DNA-protein cross-linking by chromium.

Hexavalent chromium is a known inducer of DNA-protein cross-links (DPCs) that contribute to repression of inducible genes and genotoxicity of this metal. Lymphocytic DPCs have also shown potential utility as biomarkers of human exposure to Cr(VI). Here, we examined the mechanism of DPC formation by Cr(VI) and the impact of its main cellular reducers. In vitro reactions of Cr(VI) with one-electron reducing thiols (glutathione and cysteine) or two-electron donating ascorbate were all efficient at DPC production, indicating a dispensable role of Cr(V). No Cr(VI) reducer was able to generate DPC in the presence of Cr(III)-chelating EDTA or phosphate. A critical role of Cr(III) in DNA-protein linkages was further confirmed by dissociation of Cr(VI)-induced DPC by phosphate. EDTA was very inefficient in DPC dissociation, indicating its poor suitability for testing of Cr(III)-mediated bridging and reversal of complex DPC. Reactions containing only one Cr-modified component (protein or DNA) showed that Cr(III)-DNA adduction was the initial step in DPC formation. Cross-linking proceeded slowly after the rapid formation of Cr-DNA adducts, indicating that protein conjugation was the rate-limiting step in DPC generation. Experiments with depletion of glutathione and restoration of ascorbate levels in human lung A549 cells showed that high cellular reducing capacity promotes DPC yield. Overall, our data provide evidence for a three-step cross-linking mechanism involving (i) reduction of Cr(VI) to Cr(III), (ii) Cr(III)-DNA binding, and (iii) protein capture by DNA-bound Cr(III) generating protein-Cr(III)-DNA cross-links.

WRN helicase promotes repair of DNA double-strand breaks caused by aberrant mismatch repair of chromium-DNA adducts.

Recent studies in yeast have found that processing of DNA double-strand breaks (DSB) for recombination repair involves Sgs1 helicase. Human cells have five Sgs1 homologues with unknown selectivity and significance for repair of different DSB types. Here we examined the importance of WRN helicase in repair of G(2)-specific DSB caused by abnormal mismatch repair (MMR) of ternary Cr-DNA adducts. We found that Cr(VI) induced a rapid dispersal of WRN from the nucleolus resulting in its prolonged retention in the nucleoplasm. The loss of MSH2 or MLH1 MMR proteins abolished the long-term but not the initial WRN relocalization. WRN-deficient fibroblasts were hypersensitive to Cr(VI)-induced clonogenic death and contained high levels of persistent DSB detected by gamma-H2AX/53BP1 foci and pulsed-field gel electrophoresis. WRN was involved in recombination repair of Cr-induced DNA damage, as evidenced by WRN-RAD51 colocalization and defective formation of RAD51 foci in the absence of WRN. The accumulation of unrepaired DSB in WRN-depleted cells was rescued by the inactivation of MMR, indicating that MMR-generated DSB were a key substrate for WRN action in Cr(VI)-treated cells. Competition for the limited amounts of WRN in primary cells between G(2) processes of telomere rebuilding and recombinational repair is expected to increase persistence of Cr-induced DSB and may cause telomeric abnormalities in tissues of chronically chromate-exposed workers. Our work provides the first demonstration of the major importance of WRN in repair of a specific class of DSB in human cells.