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  1. Article ; Online: Polysomnographic airflow shapes and site of collapse during drug-induced sleep endoscopy.

    Op de Beeck, Sara / Vena, Daniel / Mann, Dwayne / Azarbarzin, Ali / Huyett, Phillip / Van de Perck, Eli / Gell, Laura K / Alex, Raichel M / Dieltjens, Marijke / Willemen, Marc / Verbraecken, Johan / Wellman, Andrew / Vanderveken, Olivier M / Sands, Scott A

    The European respiratory journal

    2024  

    Abstract: Rationale: Differences in the pharyngeal site-of-collapse influences efficacy of non-CPAP therapies for obstructive sleep apnoea (OSA). Notably, complete concentric collapse at the palate (CCCp) during drug-induced sleep endoscopy (DISE) is associated ... ...

    Abstract Rationale: Differences in the pharyngeal site-of-collapse influences efficacy of non-CPAP therapies for obstructive sleep apnoea (OSA). Notably, complete concentric collapse at the palate (CCCp) during drug-induced sleep endoscopy (DISE) is associated with reduced efficacy of hypoglossal nerve stimulation, but CCCp is currently not recognisable using polysomnography. Here we develop a means to estimate DISE-based site-of-collapse using overnight polysomnography.
    Methods: 182 OSA patients provided DISE and polysomnography data. Six polysomnographic flow-shape characteristics (mean during hypopnoeas) were identified as candidate predictors of CCCp (primary outcome variable, N=44/182), including inspiratory skewness and inspiratory scoopiness. Multivariable logistic regression combined the six characteristics to predict clear presence (N=22)
    Results: CCCp was characterised by greater scoopiness (β=1.5±0.6 per 2SD, multivariable estimate±se) and skewness (β=11.4±2.4) compared to non-CCCp. Odds ratio [95%CI] for CCCp in predicted positive
    Conclusions: The current study provides a means to recognise patients with likely CCCp or other DISE-based site-of-collapse categories using routine polysomnography. Since site-of-collapse influences therapeutic responses, polysomnographic airflow shape analysis could facilitate precision site-specific OSA interventions.
    Language English
    Publishing date 2024-03-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 639359-7
    ISSN 1399-3003 ; 0903-1936
    ISSN (online) 1399-3003
    ISSN 0903-1936
    DOI 10.1183/13993003.00261-2024
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: How threat perceptions relate to learning and conspiracy beliefs about COVID-19: Evidence from a panel study.

    Heiss, Raffael / Gell, Sascha / Röthlingshöfer, Esther / Zoller, Claudia

    Personality and individual differences

    2021  Volume 175, Page(s) 110672

    Abstract: ... complex information environments marked by high levels of uncertainty. In such contexts, individuals ...

    Abstract According to appraisal theory, individuals cope with perceived threats in different ways. If engaging in problem-focused coping, for example, they may seek information useful for eliminating the root cause of the threat. However, during crises such as the COVID-19 pandemic, people tend to navigate complex information environments marked by high levels of uncertainty. In such contexts, individuals may adopt maladaptive behaviours-for instance, avoiding information or switching to pseudo-epistemic coping-in which they engage with non-scientific explanations. As a consequence, they may learn less from their information environment and become susceptible to conspiracy theories. Against that background, we investigated how threat perceptions relate to learning, believing in conspiracy claims and conspiracy thinking in context of the COVID-19 pandemic. Drawing from two-wave panel data, we found that threat perceptions were associated with a decrease in knowledge and an increase in believing conspiracy claims. Taken together, our findings indicate that high levels of threat perceptions in uncertain information environments may impede societal learning and encourage conspiracy beliefs. Thus, although provoking general anxiety may support short-term political goals, including adherence to policy during crises, accumulated threat perceptions may adversely affect citizens' motivation to cooperate in the long term.
    Language English
    Publishing date 2021-01-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 625323-4
    ISSN 0191-8869
    ISSN 0191-8869
    DOI 10.1016/j.paid.2021.110672
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Clinical polysomnographic methods for estimating pharyngeal collapsibility in obstructive sleep apnea.

    Vena, Daniel / Taranto-Montemurro, Luigi / Azarbarzin, Ali / Op de Beeck, Sara / Marques, Melania / Vanderveken, Olivier M / Edwards, Bradley A / Gell, Laura / Calianese, Nicole / Hess, Lauren B / Radmand, Reza / Hamilton, Garun S / Joosten, Simon A / Verbraecken, Johan / Braem, Marc / White, David P / Redline, Susan / Sands, Scott A / Wellman, Andrew

    Sleep

    2022  Volume 45, Issue 6

    Abstract: Study objectives: Obstructive sleep apnea has major health consequences but is challenging to treat. For many therapies, efficacy is determined by the severity of underlying pharyngeal collapsibility, yet there is no accepted clinical means to measure ... ...

    Abstract Study objectives: Obstructive sleep apnea has major health consequences but is challenging to treat. For many therapies, efficacy is determined by the severity of underlying pharyngeal collapsibility, yet there is no accepted clinical means to measure it. Here, we provide insight into which polysomnographic surrogate measures of collapsibility are valid, applicable across the population, and predictive of therapeutic outcomes.
    Methods: Seven promising polysomnography-derived surrogate collapsibility candidates were evaluated: Vpassive (flow at eupneic ventilatory drive), Vmin (ventilation at nadir drive), event depth (depth of the average respiratory event), oxygen desaturation slope and mean oxygen desaturation (events-related averages), Fhypopneas (fraction of events scored as hypopneas), and apnea index. Evaluation included (1) validation by comparison to physiological gold-standard collapsibility values (critical closing pressure, Pcrit), (2) capacity to detect increased collapsibility with older age, male sex, and obesity in a large community-based cohort (Multi-Ethnic Study of Atherosclerosis, MESA), and (3) prediction of treatment efficacy (oral appliances and pharmacological pharyngeal muscle stimulation using atomoxetine-plus-oxybutynin).
    Results: Pcrit was significantly correlated with Vmin (r = -0.54), event depth (r = 0.49), Vpassive (r = -0.38), Fhypopneas (r = -0.46), and apnea index (r = -0.46; all p < .01) but not others. All measures detected greater collapsibility with male sex, age, and obesity, except Fhypopneas and apnea index which were not associated with obesity. Fhypopneas and apnea index were associated with oral appliance and atomoxetine-plus-oxybutynin efficacy (both p < .05).
    Conclusions: Among several candidates, event depth, Fhypopneas, and apnea index were identified as preferred pharyngeal collapsibility surrogates for use in the clinical arena.
    MeSH term(s) Atomoxetine Hydrochloride ; Humans ; Male ; Obesity ; Oxygen ; Pharynx ; Sleep Apnea, Obstructive/therapy
    Chemical Substances Atomoxetine Hydrochloride (57WVB6I2W0) ; Oxygen (S88TT14065)
    Language English
    Publishing date 2022-03-02
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 424441-2
    ISSN 1550-9109 ; 0161-8105
    ISSN (online) 1550-9109
    ISSN 0161-8105
    DOI 10.1093/sleep/zsac050
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Depression and activity-limiting fall worry among older adults: longitudinal reciprocal relationships.

    Choi, Namkee G / Gell, Nancy M / DiNitto, Diana M / Marti, C Nathan / Kunik, Mark E

    International psychogeriatrics

    2019  Volume 32, Issue 4, Page(s) 495–504

    Abstract: Objectives: Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry ...

    Abstract Objectives: Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry are associated with changes in depressive illness and vice versa. This study examined longitudinal relationships between probable major depression (PMD) and activity-limiting fall worry (ALW).
    Design, setting, participants, measurements: This longitudinal panel observational study used data from the National Health and Aging Trends Study (NHATS) waves 5 (referred to as T1 in this study) and 6 (T2), conducted in 2015 and 2016, respectively (N = 6,299, aged 65 and older). We examined associations of new and continued ALW between T1 and T2 with T2 PMD, controlling for T1 PMD; and associations of new and continued PMD between T1 and T2 with T2 ALW, controlling for T1 ALW. We used χ2 and t tests for descriptive statistics and logistic regression for multivariable analysis.
    Results: Those with new ALW at T2 had significantly greater odds of T2 PMD compared to those without ALW at both time points (AOR = 2.64, 95% CI = 1.98-3.51), and those with new PMD at T2 had significantly greater odds of T2 ALW (AOR = 2.42, 95% CI = 1.66-3.52). Those with continued PMD also had greater odds of T2 ALW compared to those without PMD at either time point (AOR = 2.31, 95% CI = 1.62-3.29).
    Conclusions: The findings add to knowledge about bidirectional (mutually reinforcing) relationships between depression and activity-limiting fall worry. Innovative interventions are needed to reduce both late-life depression and activity-limiting fall worry.
    MeSH term(s) Accidental Falls/prevention & control ; Accidental Falls/statistics & numerical data ; Age Factors ; Aged ; Aged, 80 and over ; Aging/psychology ; Anxiety/psychology ; Cross-Sectional Studies ; Depression/epidemiology ; Depression/psychology ; Female ; Humans ; Longitudinal Studies ; Male
    Language English
    Publishing date 2019-07-18
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 1038825-4
    ISSN 1741-203X ; 1041-6102
    ISSN (online) 1741-203X
    ISSN 1041-6102
    DOI 10.1017/S1041610219000838
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Early experience with targeted therapy as a first-line adjuvant treatment for pediatric low-grade glioma.

    Leclair, Nathan K / Lambert, William / Roche, Kimberley / Gillan, Eileen / Gell, Joanna J / Lau, Ching C / Wrubel, Gregory / Knopf, Joshua / Amin, Shirali / Anderson, Megan / Martin, Jonathan E / Bookland, Markus J / Hersh, David S

    Neurosurgical focus

    2022  Volume 53, Issue 6, Page(s) E15

    Abstract: Objective: Pediatric low-grade gliomas (pLGGs) frequently exhibit dysregulation of the mitogen-activated protein kinase (MAPK) pathway. Targeted therapies, including mutant BRAF inhibitors (dabrafenib) and MEK inhibitors (trametinib), have shown promise ...

    Abstract Objective: Pediatric low-grade gliomas (pLGGs) frequently exhibit dysregulation of the mitogen-activated protein kinase (MAPK) pathway. Targeted therapies, including mutant BRAF inhibitors (dabrafenib) and MEK inhibitors (trametinib), have shown promise in patients in whom conventional chemotherapy has failed. However, few studies have investigated the use of targeted therapy as a first-line treatment for pLGG. Here, the authors reviewed their institutional experience with using a personalized medicine approach to patients with newly diagnosed pLGGs.
    Methods: All pediatric patients at the authors' institution who had been treated with dabrafenib or trametinib for pLGG without first receiving conventional chemotherapy or radiation were retrospectively reviewed. Demographic, clinical, and radiological data were collected.
    Results: Eight patients underwent targeted therapy as a first-line treatment for pLGG. Five patients had a BRAF alteration (1 with a BRAFV600E mutation, 4 with a KIAA1549:BRAF fusion), and 3 patients had an NF1 mutation. One of the 8 patients was initially treated with dabrafenib, and trametinib was added later. Seven patients were initially treated with trametinib; of these, 2 later transitioned to dual therapy, whereas 5 continued with trametinib monotherapy. Six patients (75%) demonstrated a partial response to therapy during their treatment course, whereas stable disease was identified in the remaining 2 patients (25%). One patient experienced mild disease progression after completing a course of trametinib monotherapy, but ultimately stabilized after a period of close observation. Another patient experienced tumor progression while on dabrafenib, but subsequently responded to dual therapy with dabrafenib and trametinib. The most common adverse reactions to targeted therapy were cutaneous toxicity (100%) and diarrhea (50%).
    Conclusions: Targeted therapies have the potential to become a standard treatment option for pLGG due to their favorable toxicity profile and oral route of administration. This case series provides preliminary evidence that targeted therapies can induce an early disease response as a first-line adjuvant treatment; however, large-scale studies are required to assess long-term durability and safety.
    MeSH term(s) Child ; Humans ; Proto-Oncogene Proteins B-raf/genetics ; Retrospective Studies ; Oximes/therapeutic use ; Adjuvants, Immunologic ; Glioma/drug therapy ; Glioma/genetics ; Protein Kinase Inhibitors/therapeutic use
    Chemical Substances dabrafenib (QGP4HA4G1B) ; Proto-Oncogene Proteins B-raf (EC 2.7.11.1) ; Oximes ; Adjuvants, Immunologic ; Protein Kinase Inhibitors
    Language English
    Publishing date 2022-12-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2026589-X
    ISSN 1092-0684 ; 1092-0684
    ISSN (online) 1092-0684
    ISSN 1092-0684
    DOI 10.3171/2022.9.FOCUS22410
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Randomized Trial of BCG Vaccine to Protect against Covid-19 in Health Care Workers.

    Pittet, Laure F / Messina, Nicole L / Orsini, Francesca / Moore, Cecilia L / Abruzzo, Veronica / Barry, Simone / Bonnici, Rhian / Bonten, Marc / Campbell, John / Croda, Julio / Dalcolmo, Margareth / Gardiner, Kaya / Gell, Grace / Germano, Susie / Gomes-Silva, Adriano / Goodall, Casey / Gwee, Amanda / Jamieson, Tenaya / Jardim, Bruno /
    Kollmann, Tobias R / Lacerda, Marcus V G / Lee, Katherine J / Lucas, Michaela / Lynn, David J / Manning, Laurens / Marshall, Helen S / McDonald, Ellie / Munns, Craig F / Nicholson, Suellen / O'Connell, Abby / de Oliveira, Roberto D / Perlen, Susan / Perrett, Kirsten P / Prat-Aymerich, Cristina / Richmond, Peter C / Rodriguez-Baño, Jesus / Dos Santos, Glauce / da Silva, Patricia V / Teo, Jia Wei / Villanueva, Paola / Warris, Adilia / Wood, Nicholas J / Davidson, Andrew / Curtis, Nigel

    The New England journal of medicine

    2023  Volume 388, Issue 17, Page(s) 1582–1596

    Abstract: Background: The bacille Calmette-Guérin (BCG) vaccine has immunomodulatory "off-target" effects that have been hypothesized to protect against coronavirus disease 2019 (Covid-19).: Methods: In this international, double-blind, placebo-controlled ... ...

    Abstract Background: The bacille Calmette-Guérin (BCG) vaccine has immunomodulatory "off-target" effects that have been hypothesized to protect against coronavirus disease 2019 (Covid-19).
    Methods: In this international, double-blind, placebo-controlled trial, we randomly assigned health care workers to receive the BCG-Denmark vaccine or saline placebo and followed them for 12 months. Symptomatic Covid-19 and severe Covid-19, the primary outcomes, were assessed at 6 months; the primary analyses involved the modified intention-to-treat population, which was restricted to participants with a negative test for severe acute respiratory syndrome coronavirus 2 at baseline.
    Results: A total of 3988 participants underwent randomization; recruitment ceased before the planned sample size was reached owing to the availability of Covid-19 vaccines. The modified intention-to-treat population included 84.9% of the participants who underwent randomization: 1703 in the BCG group and 1683 in the placebo group. The estimated risk of symptomatic Covid-19 by 6 months was 14.7% in the BCG group and 12.3% in the placebo group (risk difference, 2.4 percentage points; 95% confidence interval [CI], -0.7 to 5.5; P = 0.13). The risk of severe Covid-19 by 6 months was 7.6% in the BCG group and 6.5% in the placebo group (risk difference, 1.1 percentage points; 95% CI, -1.2 to 3.5; P = 0.34); the majority of participants who met the trial definition of severe Covid-19 were not hospitalized but were unable to work for at least 3 consecutive days. In supplementary and sensitivity analyses that used less conservative censoring rules, the risk differences were similar but the confidence intervals were narrower. There were five hospitalizations due to Covid-19 in each group (including one death in the placebo group). The hazard ratio for any Covid-19 episode in the BCG group as compared with the placebo group was 1.23 (95% CI, 0.96 to 1.59). No safety concerns were identified.
    Conclusions: Vaccination with BCG-Denmark did not result in a lower risk of Covid-19 among health care workers than placebo. (Funded by the Bill and Melinda Gates Foundation and others; BRACE ClinicalTrials.gov number, NCT04327206.).
    MeSH term(s) Humans ; BCG Vaccine/therapeutic use ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; COVID-19 Vaccines/therapeutic use ; Double-Blind Method ; Health Personnel ; SARS-CoV-2 ; Adjuvants, Immunologic/therapeutic use
    Chemical Substances BCG Vaccine ; COVID-19 Vaccines ; Adjuvants, Immunologic
    Language English
    Publishing date 2023-04-27
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMoa2212616
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Expanding homogeneous culture of human primordial germ cell-like cells maintaining germline features without serum or feeder layers.

    Kobayashi, Mutsumi / Kobayashi, Misato / Odajima, Junko / Shioda, Keiko / Hwang, Young Sun / Sasaki, Kotaro / Chatterjee, Pranam / Kramme, Christian / Kohman, Richie E / Church, George M / Loehr, Amanda R / Weiss, Robert S / Jüppner, Harald / Gell, Joanna J / Lau, Ching C / Shioda, Toshi

    Stem cell reports

    2022  Volume 17, Issue 3, Page(s) 507–521

    Abstract: ... proteomics confirmed reduced H3K9me2 and increased H3K27me3 marks in LTC-hPGCLCs compared ...

    Abstract In vitro expansion of human primordial germ cell-like cells (hPGCLCs), a pluripotent stem cell-derived PGC model, has proved challenging due to rapid loss of primordial germ cell (PGC)-like identity and limited cell survival/proliferation. Here, we describe long-term culture hPGCLCs (LTC-hPGCLCs), which actively proliferate in a serum-free, feeder-free condition without apparent limit as highly homogeneous diploid cell populations maintaining transcriptomic and epigenomic characteristics of hPGCLCs. Histone proteomics confirmed reduced H3K9me2 and increased H3K27me3 marks in LTC-hPGCLCs compared with induced pluripotent stem cells (iPSCs). LTC-hPGCLCs established from multiple human iPSC clones of both sexes were telomerase positive, senescence-free cells readily passaged with minimal cell death or deviation from the PGC-like identity. LTC-hPGCLCs are capable of differentiating to DAZL-positive M-spermatogonia-like cells in the xenogeneic reconstituted testis (xrTestis) organ culture milieu as well as efficiently producing fully pluripotent embryonic germ cell-like cells in the presence of stem cell factor and fibroblast growth factor 2. Thus, LTC-hPGCLCs provide convenient access to unlimited amounts of high-quality and homogeneous hPGCLCs.
    MeSH term(s) Cell Differentiation ; Cells, Cultured ; Feeder Cells ; Female ; Germ Cells ; Humans ; Induced Pluripotent Stem Cells ; Male
    Language English
    Publishing date 2022-02-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2720528-9
    ISSN 2213-6711 ; 2213-6711
    ISSN (online) 2213-6711
    ISSN 2213-6711
    DOI 10.1016/j.stemcr.2022.01.012
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  8. Article: Application of portable gas chromatography–mass spectrometer for rapid field based determination of TCE in soil vapour and groundwater

    Wang, Liang / Cheng, Ying / Naidu, Ravi / Chadalavada, Sreenivasulu / Bekele, Dawit / Gell, Peter / Donaghey, Mark / Bowman, Mark

    Environmental technology & innovation. 2021 Feb., v. 21

    2021  

    Abstract: The application of portable chromatography–mass spectrometer (GC–MS) is restrained by its detection limits without the development of proper sample pre-concentration methods. The primary focus of this paper is to introduce a practical field measurement ... ...

    Abstract The application of portable chromatography–mass spectrometer (GC–MS) is restrained by its detection limits without the development of proper sample pre-concentration methods. The primary focus of this paper is to introduce a practical field measurement methodology for the analysis of volatile organic compounds (VOCs) in soil vapour and groundwater using a portable gas (GC–MS)system for application to in situ assessment of vapour intrusion from VOC contamination. A solid-phase micro-extraction (SPME) technique was applied for sample pre-concentration before the GC–MS​ measurement. Practical in-field soil gas SPME sampling methods have been developed to optimise the SPME extraction efficiency to then ultimately improve the detection limits of portable GC–MS. An Australian site impacted by a chlorinated VOC, trichloroethylene (TCE), was the subject of the case study. To rapidly assess soil vapour samples in subsurface soil, in-house-developed retractable soil vapour sampling probes (SVSPs) were installed at the site in clusters at depths of 1 m, 2 m and 3 m below ground level at each sampling location. Use of the SVSPs for sampling enabled the generation of a three-dimensional map and distribution contours for TCE concentrations using the in situ measurement results of a portable GC–MS analysis for vapour intrusion investigation. The results of the portable GC–MS​ analysis were compared with the results from conventional USEPA methods, such as TO-15 and Method 8265 for soil vapour and groundwater samples, respectively. This work demonstrates that the developed methodology of using a portable GC–MS system has the capability for in-field quantitative analysis of VOCs for rapid contaminated site vapour intrusion assessment.
    Keywords United States Environmental Protection Agency ; case studies ; environmental technology ; groundwater ; quantitative analysis ; soil air ; spectrometers ; subsurface soil layers ; trichloroethylene ; vapors ; volatile organic compounds
    Language English
    Dates of publication 2021-02
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2352-1864
    DOI 10.1016/j.eti.2020.101274
    Database NAL-Catalogue (AGRICOLA)

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  9. Article ; Online: The structure of α-haemoglobin in complex with a haemoglobin-binding domain from Staphylococcus aureus reveals the elusive α-haemoglobin dimerization interface.

    Kumar, Kaavya Krishna / Jacques, David A / Guss, J Mitchell / Gell, David A

    Acta crystallographica. Section F, Structural biology communications

    2014  Volume 70, Issue Pt 8, Page(s) 1032–1037

    Abstract: ... preserved in the α2 dimer. However, a marked asymmetry is observed in the α2 interface, suggesting ...

    Abstract Adult haemoglobin (Hb) is made up of two α and two β subunits. Mutations that reduce expression of the α- or β-globin genes lead to the conditions α- or β-thalassaemia, respectively. Whilst both conditions are characterized by anaemia of variable severity, other details of their pathophysiology are different, in part owing to the greater stability of the β chains that is conferred through β self-association. In contrast, α subunits interact weakly, and in the absence of stabilizing quaternary interactions the α chain (α) is prone to haem loss and denaturation. The molecular contacts that confer weak self-association of α have not been determined previously. Here, the first structure of an α2 homodimer is reported in complex with one domain of the Hb receptor from Staphylococcus aureus. The α2 dimer interface has a highly unusual, approximately linear, arrangement of four His side chains within hydrogen-bonding distance of each other. Some interactions present in the α1β1 dimer interface of native Hb are preserved in the α2 dimer. However, a marked asymmetry is observed in the α2 interface, suggesting that steric factors limit the number of stabilizing interactions that can form simultaneously across the interface.
    MeSH term(s) Crystallization ; Crystallography, X-Ray ; Dimerization ; Hemoglobins/chemistry ; Hemoglobins/metabolism ; Protein Binding ; Protein Conformation ; Staphylococcus aureus/metabolism
    Chemical Substances Hemoglobins
    Language English
    Publishing date 2014-07-23
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2053-230X
    ISSN (online) 2053-230X
    DOI 10.1107/S2053230X14012175
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Symptom Burden Among Community-Dwelling Older Adults in the United States.

    Patel, Kushang V / Guralnik, Jack M / Phelan, Elizabeth A / Gell, Nancy M / Wallace, Robert B / Sullivan, Mark D / Turk, Dennis C

    Journal of the American Geriatrics Society

    2018  Volume 67, Issue 2, Page(s) 223–231

    Abstract: Objectives: To determine the prevalence and impact of common co-occurring symptoms among community-dwelling older adults in the United States.: Design: The National Health and Aging Trends Study is a nationally representative, prospective study with ... ...

    Abstract Objectives: To determine the prevalence and impact of common co-occurring symptoms among community-dwelling older adults in the United States.
    Design: The National Health and Aging Trends Study is a nationally representative, prospective study with annual data collection between 2011 and 2017.
    Setting: Community-based, in-person interviews (survey response rates, 71%-96%).
    Participants: A total of 7,609 community-dwelling Medicare beneficiaries, 65 years or older.
    Measurements: Symptoms assessed at baseline include pain, fatigue, breathing difficulty, sleeping difficulty, depressed mood, and anxiety. Total symptom count ranged from zero to six. Several outcomes were examined, including grip strength, gait speed, and overall lower-extremity function as well as incidence of recurrent falls (two or more per year), hospitalization, disability, nursing home admission, and mortality.
    Results: Prevalence of zero, one, two, three, and four or more symptoms was 25.0%, 26.6%, 20.7%, 14.0%, and 13.6%, respectively. Symptom count increased with advancing age and was higher in women than in men. Pain and fatigue were the most common co-occurring symptoms. Higher symptom count was associated with decreased physical capacity. For example, participants with one, two, three, and four or more symptoms had gait speeds that were 0.04, 0.06, 0.09, and 0.13 m/s slower, respectively, than those with no symptoms, adjusting for specific diseases, total number of diseases, and other potential confounders (P < .001). The risk of several adverse outcomes also increased with greater symptom count. For example, compared with those with no symptoms, the adjusted risk ratios for recurrent falls were 1.48 (95% confidence interval [CI] = 1.30-1.70), 1.54 (95% CI = 1.32-1.80), 1.90 (95% CI = 1.55-2.32), and 2.38 (95% CI = 2.00-2.83) for older adults with one, two, three, and four or more symptoms, respectively.
    Conclusions: Symptoms frequently co-occur among community-dwelling older adults and are strongly associated with increased risk of a range of adverse outcomes. Symptoms represent a potential treatment target for improving outcomes and should be systematically captured in health records. J Am Geriatr Soc 67:223-231, 2019.
    MeSH term(s) Accidental Falls/statistics & numerical data ; Age Factors ; Aged ; Aged, 80 and over ; Comorbidity ; Female ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Independent Living/statistics & numerical data ; Male ; Medicare ; Prevalence ; Prospective Studies ; Symptom Assessment/statistics & numerical data ; United States/epidemiology
    Language English
    Publishing date 2018-12-12
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.15673
    Database MEDical Literature Analysis and Retrieval System OnLINE

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