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  1. Article ; Online: The C-terminal D/E-rich domain of MBD3 is a putative Z-DNA mimic that competes for Zα DNA-binding activity.

    Lee, Chi-Hua / Shih, Yan-Ping / Ho, Meng-Ru / Wang, Andrew H-J

    Nucleic acids research

    2018  Volume 46, Issue 22, Page(s) 11806–11821

    Abstract: ... and revealed that Zα interacted with its C-terminal acidic region, an aspartate (D)/glutamate (E)-rich ... domain, with high affinity. The D/E-rich domain of MBD3 may act as a DNA mimic to compete with Z-DNA ... for binding to Zα. Dimerization of MBD3 via intermolecular interaction of the D/E-rich domain and its N ...

    Abstract The Z-DNA binding domain (Zα), derived from the human RNA editing enzyme ADAR1, can induce and stabilize the Z-DNA conformation. However, the biological function of Zα/Z-DNA remains elusive. Herein, we sought to identify proteins associated with Zα to gain insight into the functional network of Zα/Z-DNA. By pull-down, biophysical and biochemical analyses, we identified a novel Zα-interacting protein, MBD3, and revealed that Zα interacted with its C-terminal acidic region, an aspartate (D)/glutamate (E)-rich domain, with high affinity. The D/E-rich domain of MBD3 may act as a DNA mimic to compete with Z-DNA for binding to Zα. Dimerization of MBD3 via intermolecular interaction of the D/E-rich domain and its N-terminal DNA binding domain, a methyl-CpG-binding domain (MBD), attenuated the high affinity interaction of Zα and the D/E-rich domain. By monitoring the conformation transition of DNA, we found that Zα could compete with the MBD domain for binding to the Z-DNA forming sequence, but not vice versa. Furthermore, co-immunoprecipitation experiments confirmed the interaction of MBD3 and ADAR1 in vivo. Our findings suggest that the interplay of Zα and MBD3 may regulate the transition of the DNA conformation between B- and Z-DNA and thereby modulate chromatin accessibility, resulting in alterations in gene expression.
    MeSH term(s) Adenosine Deaminase/chemistry ; Binding Sites ; Biochemistry ; CpG Islands ; Cross-Linking Reagents/chemistry ; DNA/chemistry ; DNA, Z-Form/chemistry ; DNA-Binding Proteins/chemistry ; Gene Expression Profiling ; HEK293 Cells ; Humans ; Nucleic Acid Conformation ; Protein Binding ; Protein Domains ; Protein Multimerization ; RNA-Binding Proteins/chemistry
    Chemical Substances Cross-Linking Reagents ; DNA, Z-Form ; DNA-Binding Proteins ; MBD3 protein, human ; RNA-Binding Proteins ; DNA (9007-49-2) ; ADAR protein, human (EC 3.5.4.37) ; Adenosine Deaminase (EC 3.5.4.4)
    Language English
    Publishing date 2018-10-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 186809-3
    ISSN 1362-4962 ; 1362-4954 ; 0301-5610 ; 0305-1048
    ISSN (online) 1362-4962 ; 1362-4954
    ISSN 0301-5610 ; 0305-1048
    DOI 10.1093/nar/gky933
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Intracranial Hemorrhage in Older Adults: Implications for Fall Risk Assessment and Prevention.

    Shih, Richard D / Ouslander, Joseph G

    Journal of the American Geriatrics Society

    2020  Volume 68, Issue 5, Page(s) 953–955

    MeSH term(s) Accidental Falls/prevention & control ; Aged ; Cohort Studies ; Geriatric Assessment ; Humans ; Intracranial Hemorrhages/prevention & control ; Risk Assessment
    Language English
    Publishing date 2020-03-06
    Publishing country United States
    Document type Editorial ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.16399
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Exogenous Peptide Injection Causing Medical Thigh Compartment Syndrome.

    Lamour, Daniella / Bruno, Tony W / Shih, Richard D / Solano, Joshua J / Alter, Scott M

    The Journal of emergency medicine

    2023  Volume 66, Issue 4, Page(s) e526–e529

    Abstract: Background: Acute compartment syndrome can be caused by any condition that increases the pressure of an intracompartmental muscular space, resulting in ischemia, which is a limb-threatening emergency. This case report is the first known documented ... ...

    Abstract Background: Acute compartment syndrome can be caused by any condition that increases the pressure of an intracompartmental muscular space, resulting in ischemia, which is a limb-threatening emergency. This case report is the first known documented example of an exogenously injected peptide causing compartment syndrome. The use of natural supplements and holistic therapies is on the rise, specifically, peptide injections. It is important to obtain the history of use and routes of administration of these substances.
    Case report: We present a case of a 43-year-old man who presented to the Emergency Department with worsening thigh pain. The patient had injected a "peptide cocktail" into his thigh 3 days prior. Physical examination revealed trace pitting edema of the left leg with moderate muscle spasm and tenderness of the medial aspect of the distal thigh with associated numbness along the medial aspect of the knee. Point-of-care ultrasound detected intramuscular edema and free fluid in the leg. He was found to have acute compartment syndrome of the thigh secondary to the peptide cocktail injection, causing a large hematoma posterior to the adductor magnus. The patient required fasciotomy and hematoma evacuation. He ultimately left against medical advice during his hospitalization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In an age when many patients look for supplements to aid with weight loss and muscle growth, it is essential to be aware of peptide injection therapies and the potential complication of compartment syndrome.
    MeSH term(s) Male ; Humans ; Adult ; Thigh ; Compartment Syndromes/diagnosis ; Compartment Syndromes/etiology ; Leg ; Fasciotomy ; Edema/complications ; Hematoma/complications
    Language English
    Publishing date 2023-12-03
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2023.11.025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: The accuracy of total body weight estimation in adults - A systematic review and meta-analysis.

    Wells, Mike / Goldstein, Lara N / Alter, Scott M / Solano, Joshua J / Engstrom, Gabriella / Shih, Richard D

    The American journal of emergency medicine

    2023  Volume 76, Page(s) 123–135

    Abstract: ... of estimates within 10% of true weight, with 95% confidence intervals) were 3-D camera estimates (88.8% (85.8 ...

    Abstract Background: Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often impossible. Inaccurate estimations may lead to inaccurate drug doses, which may cause patient harm. Little is known about the relative accuracy of different methods of weight estimation that could be used during resuscitative care. The aim of this study was to evaluate the performance and suitability of existing weight estimation methods for use in adult emergency care.
    Methods: A systematic literature search was performed for suitable articles that studied the accuracy of weight estimation systems in adults. The study characteristics, the quality of the studies, the weight estimation methods evaluated, the accuracy data, and any information on the ease-of-use of the method were extracted and evaluated.
    Results: A total of 95 studies were included, in which 27 different methods of total body weight estimation were described, with 42 studies included in the meta-analysis. The most accurate methods, determined from the pooled estimates of accuracy (the percentage of estimates within 10% of true weight, with 95% confidence intervals) were 3-D camera estimates (88.8% (85.8 to 91.8%)), patient self-estimates (88.7% (87.7 to 89.7%)), the Lorenz method (77.5% (76.4 to 78.6%)) and family estimates (75.0% (71.5 to 78.6%)). However, no method was without significant potential limitations to use during emergency care.
    Conclusion: Patient self-estimations of weight were generally very accurate and should be the method of choice during emergency care, when possible. However, since alternative estimation methods must be available when confused, or otherwise incapacitated, patients are unable to provide an estimate, alternative strategies of weight estimation should also be available.
    MeSH term(s) Adult ; Humans ; Body Weight ; Emergency Service, Hospital ; Emergency Medical Services ; Resuscitation ; Patients
    Language English
    Publishing date 2023-11-29
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2023.11.037
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Remdesivir for coronavirus 2019 (COVID-19): More promising but still unproven.

    Shih, Richard D / Maki, Dennis G / Hennekens, Charles H

    Contemporary clinical trials communications

    2020  Volume 20, Page(s) 100663

    Abstract: From December 2019 to May 22, 2020 the emerging and ever-increasing pandemic of coronavirus 19 (COVID-19) had no effective and safe treatment. Not surprisingly, remdesivir attracted worldwide attention. In a trial published online ahead of print, of 1063 ...

    Abstract From December 2019 to May 22, 2020 the emerging and ever-increasing pandemic of coronavirus 19 (COVID-19) had no effective and safe treatment. Not surprisingly, remdesivir attracted worldwide attention. In a trial published online ahead of print, of 1063 patients, 541 were assigned at random to remdesivir and 522 to placebo. The primary prespecified endpoint was mean recovery time and patients assigned to remdesivir had a mean recovery time of 11 days versus 15 days for those assigned a random to placebo. (p < 0.001). With respect to mortality, the prespecfied secondary endpoint, 34/538 patients in remdesivir and 54/521 in placebo died after 28 days, yielding a possible 31% reduction that approached but did not achieve statistical significance (p = 0.059). The only other published trial of remdesivir randomized 237 patients in China. In that trial, 178 patients were assigned at random to remdesivir compared to 79 assigned to placebo. Those assigned at random to remdesivir experienced a possible but nonsignificant 23% faster time to clinical improvement of 21 days compared with 23 for those assigned to placebo [hazard ratio 1.23 [95% CI, 0·87-1.75)]. With respect to mortality there was no suggestion of any benefit. In fact, the mortality rate in those receiving remdesivir was 15% (22/150) compared with 13% (10/77) for those assigned to placebo. Ongoing randomized trials should be designed, conducted and analyzed to provide the necessary reliable data on mortality to resolve the remaining clinical uncertainties.
    Keywords covid19
    Language English
    Publishing date 2020-10-07
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2451-8654
    ISSN (online) 2451-8654
    DOI 10.1016/j.conctc.2020.100663
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Book: Handbook of poisonous and injurious plants

    Nelson, Lewis S. / Shih, Richard D. / Balick, Michael J.

    2007  

    Author's details Lewis S. Nelson ; Richard D. Shih ; Michael J. Balick
    Language English
    Size XVIII, 340 S. : zahlr. Ill.
    Edition 2. ed.
    Publisher Springer
    Publishing place New York
    Publishing country United States
    Document type Book
    HBZ-ID HT015230277
    ISBN 0-387-31268-4 ; 978-0-387-31268-2
    Database Catalogue ZB MED Nutrition, Environment, Agriculture

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  7. Article ; Online: Balancing vision with pragmatism: The geriatric emergency department guidelines-realistic expectations from emergency medicine and geriatric medicine.

    Shih, Richard D / Carpenter, Christopher R / Tolia, Vaishal / Binder, Ellen F / Ouslander, Joseph G

    Journal of the American Geriatrics Society

    2022  Volume 70, Issue 5, Page(s) 1368–1373

    Abstract: In 2014 the Geriatric Emergency Department (GED) Guidelines were published and endorsed by four major medical organizations. The multidisciplinary GED Guidelines characterize the complex needs of the older emergency department (ED) patient and current ... ...

    Abstract In 2014 the Geriatric Emergency Department (GED) Guidelines were published and endorsed by four major medical organizations. The multidisciplinary GED Guidelines characterize the complex needs of the older emergency department (ED) patient and current best practices with the goal of promoting more cost-effective and patient-centered care. The recommendations are extensive and the vast majority of EDs then and now do not have either the resources nor hospital administrative support to provide this additional service. At the 2021 American Academy of Emergency Medicine's Scientific Assembly, a panel of emergency medicine physicians and geriatricians discussed the GED Guidelines and the current realities of EDs' capacity to provide best practice and guideline recommended care of GED patients. This article is a synthesis of the panel's presentation and discussion. With the substantial challenges in providing guideline recommended care in EDs, this article will explore three high impact GED clinical conditions to highlight guideline recommendations, challenges and opportunities, and discuss realistically achievable expectations for non-Geriatric ED accredited institutions. In 2014 the Geriatric Emergency Department Guidelines were published describing the current best practices for geriatric ED patients. Unfortunately, the vast majority of EDs worldwide do not provide the level of service recommended by the GED guidelines. The GED Guidelines can best be termed aspirational for U.S. EDs at the present time.
    MeSH term(s) Aged ; Emergency Medicine ; Emergency Service, Hospital ; Geriatrics ; Hospitals ; Humans ; Motivation
    Language English
    Publishing date 2022-03-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.17745
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Balancing Vision With Pragmatism: The Geriatric Emergency Department Guidelines-Realistic Expectations From Emergency Medicine and Geriatric Medicine.

    Shih, Richard D / Carpenter, Christopher R / Tolia, Vaishal / Binder, Ellen F / Ouslander, Joseph G

    The Journal of emergency medicine

    2022  Volume 62, Issue 5, Page(s) 585–589

    Abstract: Background: In 2014, the Geriatric Emergency Department (GED) Guidelines were published and endorsed by four major medical organizations. The multidisciplinary GED Guidelines characterized the complex needs of the older emergency department (ED) patient ...

    Abstract Background: In 2014, the Geriatric Emergency Department (GED) Guidelines were published and endorsed by four major medical organizations. The multidisciplinary GED Guidelines characterized the complex needs of the older emergency department (ED) patient and current best practices, with the goal of promoting more cost-effective and patient-centered care. The recommendations are extensive and most EDs then and now have neither the resources nor the hospital administrative support to provide this additional service.
    Discussion: At the 2021 American Academy of Emergency Medicine's Scientific Assembly, a panel of emergency physicians and geriatricians discussed the GED Guidelines and the current realities of EDs' capacity to provide best practice and guideline-recommended care of GED patients. This article is a synthesis of the panel's presentation and discussion. With the substantial challenges in providing guideline-recommended care in EDs, this article will explore three high-impact GED clinical conditions to highlight guideline recommendations, challenges, and opportunities, and discuss realistically achievable expectations for non-GED-accredited institutions.
    Conclusions: In 2014, the GED Guidelines were published, describing the current best practices for GED patients. Unfortunately, most of the EDs worldwide do not provide the level of service recommended by the GED Guidelines. The GED Guidelines can best be termed aspirational for U.S. EDs at the present time.
    MeSH term(s) Aged ; Emergency Medicine ; Emergency Service, Hospital ; Geriatrics ; Hospitals ; Humans ; Motivation ; United States
    Language English
    Publishing date 2022-02-15
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2021.12.017
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: The Role of Thromboelastography in Identifying Coagulopathy Among Geriatric Traumatic Brain Injury Patients.

    Busko, Alexander M / Solano, Joshua J / Clayton, Lisa M / Hughes, Patrick G / Paley, Richard J / Shih, Richard D / Alter, Scott M

    Cureus

    2022  Volume 14, Issue 12, Page(s) e32818

    Abstract: Background The geriatric population has the highest incidence of head injury, and those who are anticoagulated have an increased risk of traumatic intracranial hemorrhage (ICH). The availability of viscoelastic coagulation studies has coincided with the ... ...

    Abstract Background The geriatric population has the highest incidence of head injury, and those who are anticoagulated have an increased risk of traumatic intracranial hemorrhage (ICH). The availability of viscoelastic coagulation studies has coincided with the development of many anticoagulation reversal agents. In this study, our objective was to assess whether the thromboelastography (TEG) assay affected clinical decision-making regarding reversal agent administration among geriatric patients with ICH caused by blunt head trauma. Methodology We prospectively screened adults aged 65 and older with head trauma presenting to the emergency departments of two level-one trauma centers. International Classification of Diseases, Tenth Revision codes S00-09 were used to identify the diagnosis of head injury. Patients with CT head imaging positive for acute ICH were included. Each patient was assessed for home use of antiplatelet or anticoagulant medications, as well as in-hospital use of any reversal agents. Reversal agent administration and mortality were compared between patients who received TEG and those who did not. Results A total of 680 patients had acute ICH on head CT, and 324 (48%) patients received TEG. More patients screened with TEG were transfused platelets (30.2% vs. 10.7%, p < 0.001). This remained significant for patients taking anticoagulants, antiplatelets, or neither. There were no differences in the administration of other reversal agents (prothrombin complex concentrate or fresh frozen plasma) or mortality whether or not TEG was performed. Conclusions Patients who had TEG performed were more likely to receive platelet reversal agents, regardless of antiplatelet medication usage. Among elderly adults with ICH, TEG is a rapid screening test that may help identify patients with platelet function abnormalities requiring reversal.
    Language English
    Publishing date 2022-12-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.32818
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Comparing rates of skull fractures in female versus male geriatric patients who sustain head injuries.

    Alter, Scott M / Gonzalez, Michelly R / Solano, Joshua J / Clayton, Lisa M / Hughes, Patrick G / Shih, Richard D

    The American journal of emergency medicine

    2023  Volume 65, Page(s) 168–171

    Abstract: Background: Head trauma is the leading cause of serious injury in the older adult population with skull fractures as a serious reported outcome. This study aims to evaluate the role of sex in the risk of skull fracture in patients over the age of 65.: ...

    Abstract Background: Head trauma is the leading cause of serious injury in the older adult population with skull fractures as a serious reported outcome. This study aims to evaluate the role of sex in the risk of skull fracture in patients over the age of 65.
    Methods: A prospective cohort study was conducted at two level-one trauma centers, serving a population of 360,000 geriatric residents. Over a year-long period, consecutive patients aged 65 years and older who presented with blunt head injury were included. Patients who did not receive head CT imaging were excluded. The primary outcome was rate of skull fracture due to the acute trauma, compared by sex. Additional factors examined included patient race/ethnicity and mechanism of injury.
    Results: Among 5402 patients enrolled, 3010 (56%) were female and 2392 (44%) were male. 4612 (85%) of the head injuries sustained were due to falls, and 4536 (90%) of all subjects were Caucasian. Overall, 199 patients (3.7%) sustained skull fractures. Males had a significantly greater rate of skull fracture when compared to females (4.6% vs 3.0%, OR 1.5, 95% CI: 1.2-2.1, p = 0.002). This trend was also seen across race/ethnicity and mechanism of injury.
    Conclusions: Older males were found to have a higher rate of skull fractures compared to females after sustaining blunt head trauma, mostly due to falls.
    MeSH term(s) Humans ; Male ; Female ; Aged ; Prospective Studies ; Retrospective Studies ; Skull Fractures ; Head Injuries, Closed/complications ; Tomography, X-Ray Computed/adverse effects
    Language English
    Publishing date 2023-01-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2022.12.044
    Database MEDical Literature Analysis and Retrieval System OnLINE

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