40S Ribosomal Protein S6 Kinase Integrates Daylength Perception and Growth Regulation in Arabidopsis thaliana.

Plant growth occurs via the interconnection of cell growth and proliferation in each organ following specific developmental and environmental cues. Therefore, different photoperiods result in distinct growth patterns due to the integration of light and circadian perception with specific Carbon (C) partitioning strategies. In addition, the TARGET OF RAPAMYCIN (TOR) kinase pathway is an ancestral signaling pathway that integrates nutrient information with translational control and growth regulation. Recent findings in Arabidopsis (Arabidopsis thaliana) have shown a mutual connection between the TOR pathway and the circadian clock. However, the mechanistical network underlying this interaction is mostly unknown. Here, we show that the conserved TOR target, the 40S ribosomal protein S6 kinase (S6 K) is under circadian and photoperiod regulation both at the transcriptional and post-translational level. Total S6 K (S6K1 and S6K2) and TOR-dependent phosphorylated-S6 K protein levels were higher during the light period and decreased at dusk especially under short day conditions. Using chemical and genetic approaches we found that the diel pattern of S6 K accumulation results from 26S proteasome-dependent degradation and is altered in mutants lacking the circadian F-box protein ZEITLUPE (ZTL), further strengthening our hypothesis that S6 K could incorporate metabolic signals via TOR, which are also under circadian regulation. Moreover, under short days when C/energy levels are limiting, changes in S6K1 protein levels affected starch, sucrose and glucose accumulation and consequently impacted root and rosette growth responses. In summary, we propose that S6K1 constitutes a missing molecular link where day-length perception, nutrient availability and TOR pathway activity converge to coordinate growth responses with environmental conditions.

Development, characterization, and evaluation of the antioxidant activity of nanocarriers based on surfactant swollen micelles that encapsulate essential oils.

This work aimed to compare the performance of two relatively underexplored methods for the swollen micelles (SMs) production as nanocarriers for essential oils (EOs). Origanum vulgare and Thymus vulgaris EOs were examined. The first method (SMs-1), involved a self-assembly process, while the second one (SMs-2), employed titration operation of an emulsion into a surfactant solution for SMs formation. Tween 80 and ethanol were used as surfactant and co-surfactant, respectively. The solubilization kinetics and the saturation concentration of EOs were determined. Particle size (measured by DLS) and encapsulation efficiency (EE) were the control parameters assessed, along with the EOs-loaded SMs' stability during 30 days of storage. Additionally, the EOs-loaded SMs' morphology was analyzed using atomic force microscopy (AFM). Finally, the antioxidant activity through the ABTS+ radical scavenging and the reducing power of EOs encapsulated in SMs was determined. The results showed that the solubilization of EOs in SMs was a rapid process with high EE. EOs-loaded SMs-2 systems exhibited greater colloidal stability and higher EE compared to EOs-loaded SMs-1 systems, showing smaller and more homogeneous particle sizes. Moreover, EOs-loaded SMs-2 systems maintained constant EE throughout the storage period. AFM imaging confirmed the rounded and heterogeneous morphology of EOs-loaded SMs-1 and the smaller, more homogeneous, and spherical morphology of EOs-loaded SMs-2. EOs-loaded SMs-2 showed high ABTS+ radical scavenging and reducing power when encapsulated in SMs. In conclusion, the SMs-2 method emerged as an effective approach for producing efficient nanocarriers for EOs, signifying a promising path for future developments in antioxidant delivery systems.

Interface fails and Young's module approximation of multilayer flexible devices through finite element method.

Electronic flexible devices are prone to degrade their electrical performance or lose functionality when subjected to deformations. Brittle fracture is a common damaging effect observed in devices composed of low-thickness layered materials stacked onto a flexible substrate by dissimilar mechanical properties interaction. This work studies the mechanical behavior of Organic Flexible Solar Cells (OFSC) with a heterostructure PET/ITO/P3HT:PCBM/Ag subjected to uniaxial displacements through an experimental and numeric point of view. Experimental showed that damage proceeds in two ways. First, the formation of a grid crack pattern begins at the ITO layer, and second, the delamination in the ITO/P3HT:PCBM interface. The numerical model analyzed the force and displacements and the absorption/dissipation of strain energy on layers and interfaces of the device. The comparison of the global Young's module for experimental and numeric studies validated the numeric analysis, with results of 4.16 ± 0.05 GPa for experimental and 4.36 ± 0.15 GPa for numeric. Additionally, the model associates the ITO layer with the highest strain energy dissipation or the most prone to failure, which agrees with the experiments. Then, the model successfully predicts the mechanical behavior of OFSC and represents a valuable tool for studying flexible devices and predicting the appearance of mechanical damage when subjected to uniaxial deformations, even being able to avoid potential damage changing parameters such as the thickness of the layers.

Generation of precision preclinical cancer models using regulated in vivo base editing.

Although single-nucleotide variants (SNVs) make up the majority of cancer-associated genetic changes and have been comprehensively catalogued, little is known about their impact on tumor initiation and progression. To enable the functional interrogation of cancer-associated SNVs, we developed a mouse system for temporal and regulatable in vivo base editing. The inducible base editing (iBE) mouse carries a single expression-optimized cytosine base editor transgene under the control of a tetracycline response element and enables robust, doxycycline-dependent expression across a broad range of tissues in vivo. Combined with plasmid-based or synthetic guide RNAs, iBE drives efficient engineering of individual or multiple SNVs in intestinal, lung and pancreatic organoids. Temporal regulation of base editor activity allows controlled sequential genome editing ex vivo and in vivo, and delivery of sgRNAs directly to target tissues facilitates generation of in situ preclinical cancer models.

Aerial monitoring of atmospheric particulate matter produced by open-pit mining using low-cost airborne sensors.

Mining is an economic activity that entails the production and displacement of significant amounts of atmospheric particulate matter (PM) during operations involving intense earthcrushing or earthmoving. As high concentrations of PM may have adverse effects on human health, it is necessary to monitor and control the fugitive emissions of this pollutant. This paper presents an innovative methodology for the online monitoring of PM10 concentrations in air using a low-cost sensor (LCS, <300 USD) onboard an unmanned aerial vehicle. After comprehensive calibration, the LCS was horizontally flown over seven different areas of the large Riotinto copper mine (Huelva, Spain) at different heights to study the PM10 distribution at different longitudes and altitudes. The flights covered areas of zero activity, intense mining, drilling, ore loading, waste discharge, open stockpiling, and mineral processing. In the zero-activity area, the resuspension of PM10 was very low, with a weak wind speed (3.6 m/s). In the intense-mining area, unhealthy concentrations of PM10 (>51 µgPM10/m3) could be released, and the PM10 can reach surrounding populations through long-distance transport driven by several processes being performed simultaneously. Strong dilution was also observed at high altitudes (> 50 m). Mean concentrations were found to be 22-89 µgPM10/m3, with peaks ranging from 86 to 284 µgPM10/m3. This study demonstrates the potential applicability of airborne LCSs in the high-resolution online monitoring of PM in mining, thus supporting environmental managers during decision-making against fugitive emissions in a cost-effective manner.

Potential benefits of microalgae intake against metabolic diseases: beyond spirulina-a systematic review of animal studies.

CONTEXT: Microalgae are a diverse source of bioactive molecules, such as polyphenols, carotenoids, and omega-3 fatty acids, with beneficial properties in biomarkers of metabolic diseases. Unlike the rest of the microalgae genera, Arthrospira sp., commonly called spirulina, has been widely studied. OBJECTIVE: This review aims to describe the current knowledge about microalgae, besides spirulina, focusing on their beneficial properties against metabolic diseases. DATA SOURCES: A systematic research of MEDLINE (via PubMed), Cochrane, and Scopus databases was conducted to identify relevant studies published after January 2012. In vivo animal studies including microalgae consumption, except for spirulina, that significantly improved altered biomarkers related to metabolic diseases were included. These biomarkers included body weight/composition, glucose metabolism, lipid metabolism, oxidative damage, inflammation markers, and gut microbiota. DATA EXTRACTION: After the literature search and the implementation of inclusion and exclusion criteria, 37 studies were included in the revision out of the 132 results originally obtained after the application of the equation on the different databases. DATA ANALYSIS: Data containing 15 microalgae genera were included reporting on a wide range of beneficial results at different levels, including a decrease in body weight and changes in plasma levels of glucose and lipoproteins due to molecular alterations such as those related to gene expression regulation. The most reported beneficial effects were related to gut microbiota and inflammation followed by lipid and glucose metabolism and body weight/composition. CONCLUSIONS: Microalgae intake improved different altered biomarkers due to metabolic diseases and seem to have potential in the design of enriched foodstuffs or novel nutraceuticals. Nevertheless, to advance to clinical trials, more thorough/detailed studies should be performed on some of the microalgae genera included in this review to collect more information on their molecular mechanisms of action.

Best Practice Strategies for Retaining Faculty During Times of Rapid Change.

Faculty retention is an issue of concern to schools and colleges of pharmacy. The reasons why faculty leave are multifactorial but often involve a breach of unwritten contract obligations between the faculty member and the organization. This article provides strategies for retaining faculty based on published literature that include perceived breaches of unwritten contracts and our own perspectives as departmental and university administrators and senior faculty members who have been involved in devising and implementing institutional change. Retention begins with recruitment but then needs to be nurtured during onboarding and as part of the overall enculturation process for new faculty members. Particular attention to the factors that influence the retention of underrepresented minorities must be incorporated to help ensure that pharmacy educators reflect the diversity of the US population.

Using Twitter Data Analysis to Understand the Perceptions, Beliefs, and Attitudes about Pharmacotherapy Used in Rheumatology: An Observational Study.

Twitter has become an important platform for disseminating information about rheumatology drugs by patients, health professionals, institutions, and other users. The aim of this study was to analyze tweets related to 16 drugs used in rheumatology, including their volume, content, and type of user (patients, patients' relatives, health professionals, health institutions, pharmaceutical industry, general press, scientific journals and patients' associations), and to detect inappropriate medical content. A total of 8829 original tweets were obtained, with a random sample of 25% of the total number of tweets for each drug (at least 100 tweets) analyzed. Methotrexate (MTX) accounted for a quarter of all tweets, and there were significant differences in the proportion of tweets issued according to the type of user. Patients and their relatives mainly tweeted about MTX, while professionals, institutions, and patient associations posted more about TNF inhibitors. In contrast, the pharmaceutical industry focused on IL-17 inhibitors. Medical content prevailed in all drugs except anti-CD20 and IL-1 inhibitors and the most discussed medical topic was efficacy, followed by posology and adverse effects. Inappropriate or fake content was found to be very low. In conclusion, the majority of the tweets were about MTX, which is a first-line treatment for several diseases. The distribution of medical content varied according to the type of user. In contrast to other studies, the amount of medically inappropriate content was very low.

Airway allergy causes alveolar macrophage death, profound alveolar disorganization and surfactant dysfunction.

Respiratory disorders caused by allergy have been associated to bronchiolar inflammation leading to life-threatening airway narrowing. However, whether airway allergy causes alveolar dysfunction contributing to the pathology of allergic asthma remains unaddressed. To explore whether airway allergy causes alveolar dysfunction that might contribute to the pathology of allergic asthma, alveolar structural and functional alterations were analyzed during house dust mite (HDM)-induced airway allergy in mice, by flow cytometry, light and electron microscopy, monocyte transfer experiments, assessment of intra-alveolarly-located cells, analysis of alveolar macrophage regeneration in Cx3cr1 cre:R26-yfp chimeras, analysis of surfactant-associated proteins, and study of lung surfactant biophysical properties by captive bubble surfactometry. Our results demonstrate that HDM-induced airway allergic reactions caused severe alveolar dysfunction, leading to alveolar macrophage death, pneumocyte hypertrophy and surfactant dysfunction. SP-B/C proteins were reduced in allergic lung surfactant, that displayed a reduced efficiency to form surface-active films, increasing the risk of atelectasis. Original alveolar macrophages were replaced by monocyte-derived alveolar macrophages, that persisted at least two months after the resolution of allergy. Monocyte to alveolar macrophage transition occurred through an intermediate stage of pre-alveolar macrophage and was paralleled with translocation into the alveolar space, Siglec-F upregulation, and downregulation of CX3CR1. These data support that the severe respiratory disorders caused by asthmatic reactions not only result from bronchiolar inflammation, but additionally from alveolar dysfunction compromising an efficient gas exchange.

Description of a Cohort with a New Truncating MYBPC3 Variant for Hypertrophic Cardiomyopathy in Northern Spain.

BACKGROUND: The pathogenicity of the different genetic variants causing hypertrophic cardiomyopathy (HCM) and the genotype/phenotype correlations are difficult to assess in clinical practice, as most mutations are unique or identified in non-informative families. Pathogenic variants in the sarcomeric gene MYBPC3 inherited with an autosomal dominant pattern, whereas incomplete and age-dependent penetrance are the most common causes of HCM. METHODS: We describe the clinical characteristics of a new truncating MYBPC3 variant, p.Val931Glyfs*120, in 75 subjects from 18 different families from northern Spain with the p.Val931Glyfs*120 variant. RESULTS: Our cohort allows us to estimate the penetrance and prognosis of this variant. The penetrance of the disease increases with age, whereas 50% of males in our sample developed HCM by the age of 36 years old, and 50% of women developed the disease by the time they reached 48 years of age (p = 0.104). Men have more documented arrhythmias with potential risk of sudden death (p = 0.018), requiring implantation of cardioverter defibrillators (p = 0.024). Semi-professional/competitive sport among males is related to earlier onset of HCM (p = 0.004). CONCLUSIONS: The p.Val931Glyfs*120 truncating variant in MYBPC3 is associated with a moderate phenotype of HCM, with a high penetrance, onset in middle age, and a worse outcome in males due to higher risk of sudden death due to arrhythmias.

Squalene encapsulation by emulsification and freeze-drying process: Effects on bread fortification.

In the present work, squalene (SQ) was encapsulated by a conventional emulsion method using egg white protein nanoparticles (EWPn) as a high molecular weight surfactant, followed by a freeze-drying process to obtain an SQ powder ingredient. EWPn was produced by heat treatment at 85°C, 10 min, and pH 10.5. EWPn showed higher emulsifying activity regarding native egg white protein (EWP), highlighting their potential to be used for the SQ encapsulation by an emulsification process. First, we explored the encapsulation conditions using pure corn oil as an SQ carrier. Conditions were oil fraction (0.1-0.2), protein amount (2-5 wt.%), homogenization pressure (100 and 200 bar), and maltodextrin amount (10-20 wt.%). At 0.15 oil fraction, 5 wt.%. protein concentration, 200 bar homogenization pressure, and 20% maltodextrin, the highest encapsulation efficiency (EE) was reached. Then, according to these conditions, SQ was encapsulated to obtain a freeze-dried powder ingredient for bread formulation. The total and free oil of SQ freeze-dried powder were 24.4% ± 0.6% and 2.6% ± 0.1%, respectively, resulting in an EE value of 89.5% ± 0.5%. The physical, textural, and sensory properties of functional bread were not affected by the addition of 5.0% SQ freeze-dried powder. Finally, the bread loaves showed higher SQ stability than the one formulated with unencapsulated SQ. Hence, the encapsulation system developed was suitable for obtaining functional bread based on SQ fortification.

Whole-mount immunofluorescence imaging and isolation of mesothelium-bound immune cell aggregates during mouse peritoneal inflammation.

Resident peritoneal macrophages (resMØs) are crucial for repairing peritoneal injuries and controlling infections by forming mesothelium-bound resMØ-aggregates in the peritoneal wall and omentum. Here we present a protocol to analyze these structures in mouse models of peritoneal inflammation. We describe the dissection, fixation, immunofluorescent staining, and mounting of whole peritoneal wall and omentum samples and subsequent confocal microscopy imaging of resMØ-aggregates. We also detail the steps to isolate resMØ-aggregates for additional studies, including flow cytometry and electron-microscopy-based analysis. For complete details on the use and execution of this protocol, please refer to Vega-Pérez et al. (2021).1.

Mouse Tissue-Resident Peritoneal Macrophages in Homeostasis, Repair, Infection, and Tumor Metastasis.

Large peritoneal macrophages (LPMs) are long-lived, tissue-resident macrophages, formed during embryonic life, developmentally and functionally confined to the peritoneal cavity. LPMs provide the first line of defense against life-threatening pathologies of the peritoneal cavity, such as abdominal sepsis, peritoneal metastatic tumor growth, or peritoneal injuries caused by trauma, or abdominal surgery. Apart from their primary phagocytic function, reminiscent of primitive defense mechanisms sustained by coelomocytes in the coelomic cavity of invertebrates, LPMs fulfill an essential homeostatic function by achieving an efficient clearance of apoptotic, that is crucial for the maintenance of self-tolerance. Research performed over the last few years, in mice, has unveiled the mechanisms by which LPMs fulfill a crucial role in repairing peritoneal injuries and controlling microbial and parasitic infections, reflecting that the GATA6-driven LPM transcriptional program can be modulated by extracellular signals associated with pathological conditions. In contrast, recent experimental evidence supports that peritoneal tumors can subvert LPM metabolism and function, leading to the acquisition of a tumor-promoting potential. The remarkable functional plasticity of LPMs can be nevertheless exploited to revert tumor-induced LPM protumor potential, providing the basis for the development of novel immunotherapeutic approaches against peritoneal tumor metastasis based on macrophage reprogramming.

Trendelenburg position for internal jugular vein catheterization: A systematic review and meta-analysis.

To determine the effect of Trendelenburg position on the diameter or cross-section area of the internal jugular vein (IJV) a systematic review and metanalysis was performed. Studies that evaluated the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) with ultrasonography in supine and any degree of head-down tilt (Trendelenburg position) were analyzed. A total of 22 articles (613 study subjects) were included. A >5° Trendelenburg position statistically increases RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended for CVC placement, when patient conditions allow it, and US-guided cannulation is not available.

Bioactive compounds: Application of albumin nanocarriers as delivery systems.

Enriched products with bioactive compounds (BCs) show the capacity to produce a wide range of possible health effects. Most BCs are essentially hydrophobic and sensitive to environmental factors; so, encapsulation becomes a strategy to solve these problems. Many globular proteins have the intrinsic ability to bind, protect, encapsulate, and introduce BCs into nutraceutical or pharmaceutical matrices. Among them, albumins as human serum albumin (HSA), bovine serum albumin (BSA), ovalbumin (OVA) and α-lactalbumin (ALA) are widely abundant, available, and applied in many industrial sectors, becoming promissory materials to encapsulate BCs. Therefore, this review focuses on researches about the main groups of natural origin BCs (namely phenolic compounds, lipids, vitamins, and carotenoids), the different types of nanostructures based on albumins to encapsulate them and the main fields of application for BCs-loaded albumin systems. In this context, phenolic compounds (catechins, quercetin, and chrysin) are the most extensively BCs studied and encapsulated in albumin-based nanocarriers. Other extensively studied subgroups are stilbenes and curcuminoids. Regarding lipids and vitamins; terpenes, carotenoids (ß-carotene), and xanthophylls (astaxanthin) are the most considered. The main application areas of BCs are related to their antitumor, anti-inflammatory, and antioxidant properties. Finally, BSA is the most used albumin to produced BCs-loaded nanocarriers.

PEGylation of genistein-loaded bovine serum albumin nanoparticles and its effect on in vitro cell viability and genotoxicity properties.

Self-assembled bovine serum albumin nanoparticles loaded with the isoflavone genistein have shown apoptosis-mediated cytotoxicity against murine mammary adenocarcinoma F3II cells. Due to their protein nature and small particle size (13-15 nm), their parenteral administration could be affected by possible immunogenic reactions and rapid clearance from the bloodstream. To avoid these problems, PEGylation of the systems was achieved in this work by using a 30 kDa methoxy-polyethylene glycol carbonyl imidazole derivative through the reaction between the carbonyl imidazole group and the amino groups of Lys residues on the protein surface, which was confirmed by a 17% reduction in the available amino groups content measured by the o-phthaldialdehyde method. PEGylated isoforms were obtained, showing an increase of particle size from 13 to 15 nm to around 260 nm, and were purified by SEC-FPLC and characterized by SDS-PAGE, DLS and AFM techniques. The effect of PEGylation on BSAnp-Gen cytotoxicity and genotoxicity against F3II cells was evaluated in vitro by MTT assay, flow cytometry analysis and micronucleus assay. From the results, PEGylation produced an improvement of the biological properties of genistein-loaded nanoparticles in terms of cytotoxicity (lower IC50), not affecting the induction of apoptosis, decreasing the genotoxicity of the systems (less induction of micronucleus formation).

Foaming properties are improved by interactions between brewer's spent grain proteins and carrageenans in aqueous solution.

BACKGROUND: Foaming properties and macromolecular interactions in solution among brewer's spent grain proteins (CP) and iota and lambda carrageenans (i-CG and l-CG, respectively) as a function of aqueous medium pH (2-6) and protein-polysaccharide ratio, RCP:CG (1:1, 2:1 and 4:1), were studied. At these conditions, the CP colloidal stability was favored by the formation of soluble electrostatic complexes with CG. Fluorescence (intrinsic and extrinsic) spectroscopy and dynamic light scattering techniques, including particle size and ζ-potential analysis, were applied to know the phase behavior of the biopolymer systems. The bubbling method was used to produce foams, and the foam expansion (%) and half-life time (t1/2 ) were determined. RESULTS: Both CG promoted an increased Trp fluorescence emission depending on the pH, suggesting conformational changes in CP. The CG in mixed systems produced a significant decrease in the extrinsic fluorescence intensity, mainly at low pH values, highlighting a reduction in CP surface hydrophobicity. At the examined pH range, the ζ-potential values for mixed-systems were negative, and their magnitudes were intermediate between CP and CG, revealing the associative electrostatic nature of biopolymer interactions, which were dependent on the RCP:CG . The particle size analysis confirmed the formation of soluble electrostatic complexes in solution. Finally, using i-CG at pH 2 or 3 and 2:1 RCP:CG , the best foaming properties for mixed systems were observed. CONCLUSION: The formation of electrostatic complexes with a compact assembly among biopolymers, high negative net charge, and colloidal stability convert the CP-CG mixed solutions into promising biopolymer systems for food foams production. © 2022 Society of Chemical Industry.

Resident macrophage-dependent immune cell scaffolds drive anti-bacterial defense in the peritoneal cavity.

Peritoneal immune cells reside unanchored within the peritoneal fluid in homeostasis. Here, we examined the mechanisms that control bacterial infection in the peritoneum using a mouse model of abdominal sepsis following intraperitoneal Escherichia coli infection. Whole-mount immunofluorescence and confocal microscopy of the peritoneal wall and omentum revealed that large peritoneal macrophages (LPMs) rapidly cleared bacteria and adhered to the mesothelium, forming multilayered cellular aggregates composed by sequentially recruited LPMs, B1 cells, neutrophils, and monocyte-derived cells (moCs). The formation of resident macrophage aggregates (resMφ-aggregates) required LPMs and thrombin-dependent fibrin polymerization. E. coli infection triggered LPM pyroptosis and release of inflammatory mediators. Resolution of these potentially inflammatory aggregates required LPM-mediated recruitment of moCs, which were essential for fibrinolysis-mediated resMφ-aggregate disaggregation and the prevention of peritoneal overt inflammation. Thus, resMφ-aggregates provide a physical scaffold that enables the efficient control of peritoneal infection, with implications for antimicrobial immunity in other body cavities, such as the pleural cavity or brain ventricles.

Analysis of Tweets Containing Information Related to Rheumatological Diseases on Twitter.

BACKGROUND: Tweets often indicate the interests of Twitter users. Data from Twitter could be used to better understand the interest in and perceptions of a variety of diseases and medical conditions, including rheumatological diseases which have increased in prevalence over the past several decades. The aim of this study was to perform a content analysis of tweets referring to rheumatological diseases. METHODS: The content of each tweet was rated as medical (including a reference to diagnosis, treatment, or other aspects of the disease) or non-medical (such as requesting help). The type of user and the suitability of the medical content (appropriate content or, on the contrary, fake content if it was medically inappropriate according to the current medical knowledge) were also evaluated. The number of retweets and likes generated were also investigated. RESULTS: We analyzed a total of 1514 tweets: 1093 classified as medical and 421 as non-medical. The diseases with more tweets were the most prevalent. Within the medical tweets, the content of these varied according to the disease (some more focused on diagnosis and others on treatment). The fake content came from unidentified users and mostly referred to the treatment of diseases. CONCLUSIONS: According to our results, the analysis of content posted on Twitter in regard to rheumatological diseases may be useful for investigating the public's prevailing areas of interest, concerns and opinions. Thus, it could facilitate communication between health care professionals and patients, and ultimately improve the doctor-patient relationship. Due to the interest shown in medical issues it seems desirable to have healthcare institutions and healthcare workers involved in Twitter.