Dietary Sodium And Blood Pressure Changes In Hemodialysis Patients Undergoing A Liberalized Renal Diet Intervention

Objective: Investigate the impacts of individual liberalized renal diet counseling in conjunction with a volume reduction hemodialysis (HD) protocol. Design & Methods: Twenty-three maintenance HD patients (age = 55.7 ± 13.3y, 47.8% female), consented and completed this pilot intervention. Across the six-month intervention, participants received thrice weekly dietary counseling about a liberalized renal diet. Liberalized renal dietary guidelines promoted a low sodium diet with greater unprocessed food consumption, decreasing foods eaten outside the home, and increased food label reading. Participant HD sessions were conducted per a volume reduction protocol, gradually decreasing patient post-dialysis weight by removing an additional 200-300 mL/session. Preliminary outcome measures included dietary intake and knowledge, blood pressure (BP), anti-hypertensive medication use, and volume overload (VO). Results: From baseline (BL) to six months (6m), total sodium intake numerically decreased (BL 2886 ± 1570.6 vs 6m 2315 ± 1095 mg, p=0.13), systolic BP (BL 160 ± 25 vs. 6m 156 ± 23 mmHg, p=0.56) and diastolic BP (BL 81 ± 20 vs 6m 79 ± 15 mmHg, p= 0.73) showed no significant changes, but total number of anti-hypertensive medications prescribed to patients (BL 3 ± 1 vs 6m 2 ± 1 medications) were significantly reduced (p=0.003). Additionally, significant improvements were noted in VO (BL 3.6L ± 3.9L vs 6m 2.5L ± 3.5L, p=0.01). Conclusion: Liberalized renal diet education had little effect on sodium intake, likely contributing only minimally to BP control. Volume reduction protocol with gradual reduction of post dialysis weight resulted in significantly decreased VO, and maintenance of BP with coinciding decreases in anti-hypertensive medication usage. Our findings document intervention opportunities to improve BP and decrease medication usage for HD patients

Scholarly Communication and Publishing Lunch and Learn Talks

This series of talks focuses on issues in scholarly communication and publishing presented to University Library System (ULS), University of Pittsburgh colleagues by staff members of the ULS Office of Scholarly Communication and Publishing. Many of these talks feature "toolbox" tips on how to apply knowledge gained from the talks. Links to recordings of the talks are provided when available. For topics and presentations, see the record for each talk

Academic Primer Series: Five Key Papers for Consulting Clinician Educators.

INTRODUCTION: Clinician educators are often asked to perform consultations for colleagues. Invitations to consult and advise others on local problems can help foster great collaborations between centers, and allows for an exchange of ideas between programs. In this article, the authors identify and summarize several key papers to assist emerging clinician educators with the consultation process. METHODS: A consensus-building process was used to generate a list of key papers that describe the importance and significance of educational consulting, informed by social media sources. A three-round voting methodology, akin to a Delphi study, determined the most impactful papers from the larger list. RESULTS: Summaries of the five most highly rated papers on education consultation are presented in this paper. These papers were determined by a mixed group of junior and senior faculty members, who have summarized these papers with respect to their relevance for their peer groups. CONCLUSION: Five key papers on the educational consultation process are presented in this paper. These papers offer background and perspective to help junior faculty gain a grasp of consultation processes

Legacy and social media respectively influence risk perceptions and protective behaviors during emerging health threats: A multi-wave analysis of communications on Zika virus cases.

ObjectiveBoth legacy media, such as television and newspapers, and online social media are potentially important but incompletely understood sources of information in the face of emerging public health risks. This research aimed to understand media effects on risk perceptions and behaviors concerning the Zika virus in the United States.MethodsWe analyzed a multi-wave nationally representative survey (N = 29,062) and the volume of communications in social and legacy media (i.e., legacy media data from news sources and databases, N = 2,660 and social media data from Twitter, N = 1,605,752) in the United States between April and October 2016, dates coinciding with the early cases of local transmission of Zika in the United States (i.e., 25 weeks). The present study conducted econometric analyses (i.e., Granger causality tests) to assess the associations of legacy and social media coverage with risk perceptions and protective behaviors in the total sample and specific groups separated by pregnancy status/intent, geographic region, income, education level, age, and ethnicity.ResultsThe results from the overall sample suggested that changes in the volume of information in legacy and social media (i.e., Twitter) were followed by different changes in community risk perceptions and protective behaviors. Specifically, social media coverage correlated with the level of risk perceptions, whereas the legacy media coverage correlated with the level of protective behaviors. Analyses across different subpopulations, including those of different pregnancy status/intent, geographic Zika risk, income, education level, age, and ethnicity, replicated the social media associations with risk perceptions in most cases. However, legacy media and protective behaviors were linked only in some vulnerable subpopulations (e.g., the less-educated populations).ConclusionUnderstanding how media coverage relates to Zika risk perceptions and protective behaviors will help to facilitate effective risk communications by healthcare professionals and providers, particularly when a health risk emerges

Multi-gene panel testing for hereditary cancer predisposition in unsolved high-risk breast and ovarian cancer patients.

PurposeMany women with an elevated risk of hereditary breast and ovarian cancer have previously tested negative for pathogenic mutations in BRCA1 and BRCA2. Among them, a subset has hereditary susceptibility to cancer and requires further testing. We sought to identify specific groups who remain at high risk and evaluate whether they should be offered multi-gene panel testing.MethodsWe tested 300 women on a multi-gene panel who were previously enrolled in a long-term study at UCSF. As part of their long-term care, all previously tested negative for mutations in BRCA1 and BRCA2 either by limited or comprehensive sequencing. Additionally, they met one of the following criteria: (i) personal history of bilateral breast cancer, (ii) personal history of breast cancer and a first or second degree relative with ovarian cancer, and (iii) personal history of ovarian, fallopian tube, or peritoneal carcinoma.ResultsAcross the three groups, 26 women (9%) had a total of 28 pathogenic mutations associated with hereditary cancer susceptibility, and 23 women (8%) had mutations in genes other than BRCA1 and BRCA2. Ashkenazi Jewish and Hispanic women had elevated pathogenic mutation rates. In addition, two women harbored pathogenic mutations in more than one hereditary predisposition gene.ConclusionsAmong women at high risk of breast and ovarian cancer who have previously tested negative for pathogenic BRCA1 and BRCA2 mutations, we identified three groups of women who should be considered for subsequent multi-gene panel testing. The identification of women with multiple pathogenic mutations has important implications for family testing

Scholarly Communication and Publishing Lunch and Learn Talk #1: ULS Journal Publishing -- Why We Do It

This series of talks focuses on issues in scholarly communication and publishing presented to University Library System (ULS), University of Pittsburgh colleagues by staff members of the ULS Office of Scholarly Communication and Publishing. Many of these talks feature "toolbox" tips on how to apply knowledge gained from the talks. Links to recordings of the talks are provided when available. For topics and presentations, see the record for each talk

Maternal Obesity Drives Functional Alterations in Uterine NK Cells

Over one-fifth of North American women of childbearing age are obese, putting these women at risk for a variety of detrimental chronic diseases. In addition, obesity increases the risk for developing major complications during pregnancy. The mechanisms by which obesity contributes to pregnancy complications and loss remain unknown. Increasing evidence indicates that obesity results in major changes to adipose tissue immune cell composition and function; whether or not obesity also affects immune function in the uterus has not been explored. Here we investigated the effect of obesity on uterine natural killer (uNK) cells, which are essential for uterine artery remodeling and placental development. Using a cohort of obese or lean women, we found that obesity led to a significant reduction in uNK cell numbers accompanied with impaired uterine artery remodeling. uNK cells isolated from obese women had altered expression of genes and pathways associated with extracellular matrix remodeling and growth factor signaling. Specifically, uNK cells were hyper-responsive to PDGF, resulting in overexpression of decorin. Functionally, decorin strongly inhibited placental development by limiting trophoblast survival. Together, these findings establish a potentially new link between obesity and poor pregnancy outcomes, and indicate that obesity-driven changes to uterine-resident immune cells critically impair placental development

Ontogenetic changes in larval swimming and orientation of pre-competent sea urchin Arbacia punctulata in turbulence

© The Author(s), 2016. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Journal of Experimental Biology 219 (2016): 1303-1310, doi:10.1242/jeb.129502.Many marine organisms have complex life histories, having sessile adults and relying on the planktonic larvae for dispersal. Larvae swim and disperse in a complex fluid environment and the effect of ambient flow on larval behavior could in turn impact their survival and transport. However, to date, most studies on larvae–flow interactions have focused on competent larvae near settlement. We examined the importance of flow on early larval stages by studying how local flow and ontogeny influence swimming behavior in pre-competent larval sea urchins, Arbacia punctulata. We exposed larval urchins to grid-stirred turbulence and recorded their behavior at two stages (4- and 6-armed plutei) in three turbulence regimes. Using particle image velocimetry to quantify and subtract local flow, we tested the hypothesis that larvae respond to turbulence by increasing swimming speed, and that the increase varies with ontogeny. Swimming speed increased with turbulence for both 4- and 6-armed larvae, but their responses differed in terms of vertical swimming velocity. 4-Armed larvae swam most strongly upward in the unforced flow regime, while 6-armed larvae swam most strongly upward in weakly forced flow. Increased turbulence intensity also decreased the relative time that larvae spent in their typical upright orientation. 6-Armed larvae were tilted more frequently in turbulence compared with 4-armed larvae. This observation suggests that as larvae increase in size and add pairs of arms, they are more likely to be passively re-oriented by moving water, rather than being stabilized (by mechanisms associated with increased mass), potentially leading to differential transport. The positive relationship between swimming speed and larval orientation angle suggests that there was also an active response to tilting in turbulence. Our results highlight the importance of turbulence to planktonic larvae, not just during settlement but also in earlier stages through morphology–flow interactions.This work was supported by the National Science Foundation [OCE-0850419] and the National Oceanic and Atmospheric Administration Sea Grant [NA14OAR4170074]. K.Y.K.C. was supported by the Postdoctoral Scholar Program at the Woods Hole Oceanographic Institution (WHOI), with funding provided by the Coastal Ocean Institute, the Croucher Foundation and the Royal Swedish Academy of Sciences. K.Y.K.C. is currently funded by the Croucher Foundation. Additional funding was provided to L.S.M. through the WHOI Ocean Life Fellowship and discretionary WHOI funds, and to E.J.A. through the faculty sabbatical program at Grove City College

Cofactor Requirement of HpyAV Restriction Endonuclease

BACKGROUND: Helicobacter pylori is the etiologic agent of common gastritis and a risk factor for gastric cancer. It is also one of the richest sources of Type II restriction-modification (R-M) systems in microorganisms. PRINCIPAL FINDINGS: We have cloned, expressed and purified a new restriction endonuclease HpyAV from H. pylori strain 26695. We determined the HpyAV DNA recognition sequence and cleavage site as CCTTC 6/5. In addition, we found that HpyAV has a unique metal ion requirement: its cleavage activity is higher with transition metal ions than in Mg(++). The special metal ion requirement of HpyAV can be attributed to the presence of a HNH catalytic site similar to ColE9 nuclease instead of the canonical PD-X-D/EXK catalytic site found in many other REases. Site-directed mutagenesis was carried out to verify the catalytic residues of HpyAV. Mutation of the conserved metal-binding Asn311 and His320 to alanine eliminated cleavage activity. HpyAV variant H295A displayed approximately 1% of wt activity. CONCLUSIONS/SIGNIFICANCE: Some HNH-type endonucleases have unique metal ion cofactor requirement for optimal activities. Homology modeling and site-directed mutagenesis confirmed that HpyAV is a member of the HNH nuclease family. The identification of catalytic residues in HpyAV paved the way for further engineering of the metal binding site. A survey of sequenced microbial genomes uncovered 10 putative R-M systems that show high sequence similarity to the HpyAV system, suggesting lateral transfer of a prototypic HpyAV-like R-M system among these microorganisms