Lack of MSH2 involvement differentiates V(D)J recombination from other non-homologous end joining events

V(D)J recombination and class switch recombination are the two DNA rearrangement events used to diversify the mouse and human antibody repertoires. While their double strand breaks (DSBs) are initiated by different mechanisms, both processes use non-homologous end joining (NHEJ) in the repair phase. DNA mismatch repair elements (MSH2/MSH6) have been implicated in the repair of class switch junctions as well as other DNA DSBs that proceed through NHEJ. MSH2 has also been implicated in the regulation of factors such as ATM and the MRN (Mre11, Rad50, Nbs1) complex, which are involved in V(D)J recombination. These findings led us to examine the role of MSH2 in V(D)J repair. Using MSH2(−/−) and MSH2(+/+) mice and cell lines, we show here that all pathways involving MSH2 are dispensable for the generation of an intact pre-immune repertoire by V(D)J recombination. In contrast to switch junctions and other DSBs, the usage of terminal homology in V(D)J junctions is not influenced by MSH2. Thus, whether the repair complex for V(D)J recombination is of a canonical NHEJ type or a separate microhomology-mediated-end joining (MMEJ) type, it does not involve MSH2. This highlights a distinction between the repair of V(D)J recombination and other NHEJ reactions

Beliefs and attitudes of paramedical college staff towards complementary and alternate medicine

Background: Complementary and alternate medicine (CAM) has been defined as a group of diverse medical and healthcare systems, practices, and products not presently considered part of conventional medicine (CM). Studies in different countries have revealed a geographical difference in the knowledge about CAM therapies, especially among medical school staff and students. This study aimed to assess the extent of CAM use among staff working in paramedical colleges in the Riyadh region of Saudi Arabia and to examine their perception and attitudes towards such medicines.Materials and methods: Eighty paramedical staff members of different age groups and specializations were invited to participate in the study. A self-administered questionnaire adapted from similar studies was used in this study.Results: The response rate was 99%. The majority of respondents (56%) reported believing that CAM therapies play an important complementary role to the action of CM.Conclusion: To the best of the authors’ knowledge, this is the first study of its kind to assess peoples’ attitudes towards CAM use in the region. As the use of healing practices outside of CM rise among patients, ignorance of CAM by future medical practitioners can cause a communication gap between people and the profession that serves them. It is encouraging that the majority of medical staff in this study recognizes and is enthusiastic to rectify this lack of knowledge.Keywords: Complementary and alternate medicine, paramedical staffs, attitude, perception, belief

Effect of posture on swallowing.

Background: Swallowing is a systematic process. Any structural, physiological or neurological disturbance in this process may cause dysphagia. Although there are studies that report head/neck movements during mastication, there are fewer studies that show the effect of different head/neck postures on difficulty while swallowing. Objectives: To observe the effect of different body postures on the self-perceived difficulty while swallowing in normal healthy subjects. Methods: Participants were asked to swallow 25 ml of water in one go while sitting upright, sitting with head/neck flexed, head/ neck extended and lying supine. Following this, they had to rate their self-perceived difficulty while swallowing on a scale of 0-10, 0 being most easy and 10 being most difficult. Results: 186 subjects with mean age 32.7 SD 9.04 participated in this study. It was found to be least difficult to swallow when subjects were asked to swallow in upright sitting position. Statistically significant differences were found between sitting upright, sitting with head/neck flexed, head/neck extended and lying supine. Conclusion: Postural modification may help in rehabilitation of patients with dysphagia by affecting bolus flow to improve speed and safety of swallowing by closure of airways to prevent aspiration

BELIEFS AND ATTITUDES OF PARAMEDICAL COLLEGE STAFF TOWARDS COMPLEMENTARY AND ALTERNATE MEDICINE

Background: Complementary and alternate medicine (CAM) has been defined as a group of diverse medical and healthcare systems, practices, and products not presently considered part of conventional medicine (CM). Studies in different countries have revealed a geographical difference in the knowledge about CAM therapies, especially among medical school staff and students. This study aimed to assess the extent of CAM use among staff working in paramedical colleges in the Riyadh region of Saudi Arabia and to examine their perception and attitudes towards such medicines. Materials and methods: Eighty paramedical staff members of different age groups and specializations were invited to participate in the study. A self-administered questionnaire adapted from similar studies was used in this study. Results: The response rate was 99%. The majority of respondents (56%) reported believing that CAM therapies play an important complementary role to the action of CM. Conclusion: To the best of the authors’ knowledge, this is the first study of its kind to assess peoples’ attitudes towards CAM use in the region. As the use of healing practices outside of CM rise among patients, ignorance of CAM by future medical practitioners can cause a communication gap between people and the profession that serves them. It is encouraging that the majority of medical staff in this study recognizes and is enthusiastic to rectify this lack of knowledg

Negative Supercoiling Creates Single-Stranded Patches of DNA That Are Substrates for AID–Mediated Mutagenesis

Antibody diversification necessitates targeted mutation of regions within the immunoglobulin locus by activation-induced cytidine deaminase (AID). While AID is known to act on single-stranded DNA (ssDNA), the source, structure, and distribution of these substrates in vivo remain unclear. Using the technique of in situ bisulfite treatment, we characterized these substrates—which we found to be unique to actively transcribed genes—as short ssDNA regions, that are equally distributed on both DNA strands. We found that the frequencies of these ssDNA patches act as accurate predictors of AID activity at reporter genes in hypermutating and class switching B cells as well as in Escherichia coli. Importantly, these ssDNA patches rely on transcription, and we report that transcription-induced negative supercoiling enhances both ssDNA tract formation and AID mutagenesis. In addition, RNaseH1 expression does not impact the formation of these ssDNA tracts indicating that these structures are distinct from R-loops. These data emphasize the notion that these transcription-generated ssDNA tracts are one of many in vivo substrates for AID

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence of work-related musculoskeletal disorders among physical therapists

Background: Health professions like dentistry, nursing and physical therapy have been reported at high risk for developing workrelated musculoskeletal disorders. Results of studies conducted in these occupational groups may help formulate prevention strategies. However, no such data among physical therapists has been reported in India. Material and Methods: We conducted an online survey among 100 physiotherapists in Delhi. Results: The response rate was 75%. The prevalence of work-related musculoskeletal disorders is found to be high since 92% of them reported to feel some pain after joining physical therapy which affects daily activities and even sometimes forces them to change their work. Physical therapists specialty, gender, furniture used in clinic and duration of patient contact are found to be related to the pain development (p < 0.05). Conclusions: We need to emphasize the role of ergonomics and techniques of patient handling in development of work-related pain symptoms. Med Pr 2015;66(4):459–46

Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study

Background. Teaching is one of the professions where incidence and prevalence of neck pain is high. Prolonged use of computers, which has further increased due to online teaching amid pandemic, is known to cause neck pain and alter posture, while people with forward head posture (FHP) are prone to develop neck pain and related disability. Research has shown that impairment of deep cervical flexor (DCF) muscles leads to insufficiency in coordination, activation, overload, and poor support on cervical structures that further lead to development of neck pain and altered neck posture. The objective of this study was to see the effect of DCF muscle training using pressure biofeedback on pain and FHP in school teachers with neck pain. Methods. This observational study was conducted at medical center in school premises. Fifty-five school teachers aged between 25 and 40 years with experience of more than 5 years were invited to participate in this study. Subjects were divided in two groups. Both the groups received conventional exercises while in experimental group DCF muscle training using pressure biofeedback was given additionally. Pain and FHP were assessed using NPRS and cranio-vertebral angle using digital photograph technique, respectively, at baseline and end of four weeks of treatment. Results. Although pain and FHP improved in both the groups, mean improvement in both the measures was more in the group that also received DCF training using pressure biofeedback. Conclusions. This study shows that although pain and FHP improved following conventional exercises in school teachers with neck pain, mean improvement was more significant among those who received additional DCF muscle training using pressure biofeedback