Critcally Appraised Paper for: “Is modified constraint-induced movement therapy more effective than bimanual training in improving arm motor function in the subacute phase post stroke? A randomized controlled trial.”

Patients poststroke compose one of the largest demographics treated by occupational therapists in the physical disability setting. Approximately two-thirds of individuals who have had a stroke present with arm function impairment (Kwakkel & Kollen, 2007). Therefore, effective arm rehabilitation in occupational therapy settings is critical to help patients regain functional independence and quality of life. Modified constraint-induced movement (MCIM) therapy has been reported as the superior method of arm rehabilitation for individuals in the subacute phase poststroke, although recent research has also supported bimanual training. This 4-week, randomized controlled, quantitative study compared the effect of MCIM therapy and bimanual task-related training for 30 poststroke participants in the subacute phase. The intervention approach for the two groups incorporated activities of daily living, each with a unique rehabilitative focus. Although both groups received task-related training with a therapist 4 hr each week for 4 weeks, the MCIM therapy had a unilateral focus, whereas the bimanual training had a bilateral focus. Participants in the MCIM therapy group were asked to wear a mitt on their unaffected limb 4 hr/day, and participants in the bimanual group were encouraged to use both limbs together in bimanual tasks. All participants were required to complete and record 2–3 hr of self-training daily Results indicated that both the MCIM therapy and the bimanual training participants improved in functional tasks and motor skills of the affected arm within their group, but no statistical difference was identified between the groups. Thus, the researchers concluded that MCIM therapy was no more effective than bimanual training to improve arm function among patients in the subacute phase poststroke. They determined that further comparison was unnecessary, because any difference in effectiveness would not be clinically relevant. Application of these conclusions in occupational therapy settings, however, must be considered carefully in light of the small sample size. The initial power calculation necessitated a sample size of 60 participants, yet only 30 participants were obtained. Furthermore, this study lacked a control group, relied on self-report, and contained a number of biases. Site bias and cointervention bias could not be avoided, because participants resided in various settings and might have received other forms of rehabilitation. Timing bias was likely, because 4 weeks was an insufficient time frame to demonstrate the effect of an intervention on motor function recovery. Contamination might have occurred, given that the MCIM therapy group wore the mitt only 4 hr/day and that bimanual use for tasks at other times of the day could not be prevented. On the basis of the methodological limitations of the study, the conclusion drawn by the authors that the two intervention methods were equally effective in improving motor arm function in the subacute phase poststroke cannot be supported. Further research comparing the two interventions is recommended. With no method demonstrating clear superiority in this study, occupational therapists should consider every client individually when determining whether MCIM or bimanual training would be an appropriate intervention

Global Plastic Pollution Observation System to Aid Policy

Plastic pollution has become one of the most pressing environmental challenges and has received commensurate widespread attention. Although it is a top priority for policymakers and scientists alike, the knowledge required to guide decisions, implement mitigation actions, and assess their outcomes remains inadequate. We argue that an integrated, global monitoring system for plastic pollution is needed to provide comprehensive, harmonized data for environmental, societal, and economic assessments. The initial focus on marine ecosystems has been expanded here to include atmospheric transport and terrestrial and freshwater ecosystems. An earth-system-level plastic observation system is proposed as a hub for collecting and assessing the scale and impacts of plastic pollution across a wide array of particle sizes and ecosystems including air, land, water, and biota and to monitor progress toward ameliorating this problem. The proposed observation system strives to integrate new information and to identify pollution hotspots (i.e., production facilities, cities, roads, ports, etc.) and expands monitoring from marine environments to encompass all ecosystem types. Eventually, such a system will deliver knowledge to support public policy and corporate contributions to the relevant United Nations (UN) Sustainable Development Goals (SDGs)

CD1d-expressing Dendritic Cells but Not Thymic Epithelial Cells Can Mediate Negative Selection of NKT Cells

Natural killer T (NKT) cells are a unique immunoregulatory T cell population that is positively selected by CD1d-expressing thymocytes. Previous studies have shown that NKT cells exhibit autoreactivity, which raises the question of whether they are subject to negative selection. Here, we report that the addition of agonist glycolipid α-galactosylceramide (α-GalCer) to a fetal thymic organ culture (FTOC) induces a dose-dependent disappearance of NKT cells, suggesting that NKT cells are susceptible to negative selection. Overexpression of CD1d in transgenic (Tg) mice results in reduced numbers of NKT cells, and the residual NKT cells in CD1d-Tg mice exhibit both an altered Vβ usage and a reduced sensitivity to antigen. Furthermore, bone marrow (BM) chimeras between Tg and WT mice reveal that CD1d-expressing BM-derived dendritic cells, but not thymic epithelial cells, mediate the efficient negative selection of NKT cells. Thus, our data suggest that NKT cells developmentally undergo negative selection when engaged by high-avidity antigen or abundant self-antigen

Identification of gut dysbiosis in axial spondyloarthritis patients and improvement of experimental ankylosing spondyloarthritis by microbiome-derived butyrate with immune-modulating function

IntroductionDysbiosis is an environmental factor that affects the induction of axial spondyloarthritis (axSpA) pathogenesis. In the present study, we investigated differences in the gut microbiota of patients with axSpA and revealed an association between specific gut microbiota and their metabolites, and SpA pathogenesis.MethodUsing 16S rRNA sequencing data derived from feces samples of 33 axSpA patients and 20 healthy controls (HCs), we examined the compositions of their gut microbiomes.ResultsAs a result, axSpA patients were found to have decreased α-diversity compared to HCs, indicating that axSpA patients have less diverse microbiomes. In particular, at the species level, Bacteroides and Streptococcus were more abundant in axSpA patients than in HCs, whereas Faecalibacterium (F). prausnitzii, a butyrate-producing bacteria, was more abundant in HCs. Thus, we decided to investigate whether F. prausnitzii was associated with health conditions by inoculating F. prausnitzii (0.1, 1, and 10 μg/mL) or by administrating butyrate (0.5 mM) into CD4+ T cells derived from axSpA patients. The levels of IL-17A and IL-10 in the CD4+ T cell culture media were then measured. We also assessed osteoclast formation by administrating butyrate to the axSpA-derived peripheral blood mononuclear cells. The CD4+ IL-17A+ T cell differentiation, IL-17A levels were decreased, whereas IL-10 was increased by F. prausnitzii inoculation. Butyrate reduced CD4+ IL-17A+ T cell differentiation and osteoclastogenesis.DiscussionWe found that CD4+ IL-17A+ T cell polarization was reduced, when F. prausnitzii or butyrate were introduced into curdlan-induced SpA mice or CD4+ T cells of axSpA patient. Consistently, butyrate treatment was associated with the reduction of arthritis scores and inflammation levels in SpA mice. Taken together, we concluded that the reduced abundance of butyrate-producing microbes, particularly F. prausnitzii, may be associated with axSpA pathogenesis

The origin and evolution of the normal Type Ia SN 2018aoz with infant-phase reddening and excess emission

SN~2018aoz is a Type Ia SN with a $B$-band plateau and excess emission in the infant-phase light curves $\lesssim$ 1 day after first light, evidencing an over-density of surface iron-peak elements as shown in our previous study. Here, we advance the constraints on the nature and origin of SN~2018aoz based on its evolution until the nebular phase. Near-peak spectroscopic features show the SN is intermediate between two subtypes of normal Type Ia: Core-Normal and Broad-Line. The excess emission could have contributions from the radioactive decay of surface iron-peak elements as well as ejecta interaction with either the binary companion or a small torus of circumstellar material. Nebular-phase limits on H$\alpha$ and He~I favour a white dwarf companion, consistent with the small companion size constrained by the low early SN luminosity, while the absence of [O~I] and He~I disfavours a violent merger of the progenitor. Of the two main explosion mechanisms proposed to explain the distribution of surface iron-peak elements in SN~2018aoz, the asymmetric Chandrasekhar-mass explosion is less consistent with the progenitor constraints and the observed blueshifts of nebular-phase [Fe~II] and [Ni~II]. The helium-shell double-detonation explosion is compatible with the observed lack of C spectral features, but current 1-D models are incompatible with the infant-phase excess emission, $B_{\rm max}-V_{\rm max}$ color, and absence of nebular-phase [Ca~II]. Although the explosion processes of SN~2018aoz still need to be more precisely understood, the same processes could produce a significant fraction of Type Ia SNe that appear normal after $\sim$ 1 day.Comment: Submitted for publication in ApJ. 35 pages, 16 figures, 7 table

Variation in the ICAM1-ICAM4-ICAM5 locus is associated with systemic lupus erythematosus susceptibility in multiple ancestries

Objective: Systemic lupus erythematosus (SLE; OMIM 152700) is a chronic autoimmune disease for which the aetiology includes genetic and environmental factors. ITGAM, integrin ?M(complement component 3 receptor 3 subunit) encoding a ligand for intracellular adhesion molecule (ICAM) proteins, is an established SLE susceptibility locus. This study aimed to evaluate the independent and joint effects of genetic variations in the genes that encode ITGAM and ICAM. Methods: The authors examined several markers in the ICAM1-ICAM4-ICAM5 locus on chromosome 19p13 and the single ITGAM polymorphism (rs1143679) using a large-scale case-control study of 17 481 unrelated participants from four ancestry populations. The singlemarker association and gene-gene interaction were analysed for each ancestry, and a meta-analysis across the four ancestries was performed. Results: The A-allele of ICAM1-ICAM4-ICAM5 rs3093030, associated with elevated plasma levels of soluble ICAM1, and the A-allele of ITGAM rs1143679 showed the strongest association with increased SLE susceptibility in each of the ancestry populations and the trans-ancestry meta-analysis (ORmeta=1.16, 95% CI 1.11 to 1.22; p=4.88 × 10-10 and ORmeta=1.67, 95% CI 1.55 to 1.79; p=3.32 × 10-46, respectively). The effect of the ICAM single-nucleotide polymorphisms (SNPs) was independent of the effect of the ITGAM SNP rs1143679, and carriers of both ICAM rs3093030-AA and ITGAM rs1143679-AA had an OR of 4.08 compared with those with no risk allele in either SNP (95% CI 2.09 to 7.98; p=3.91 × 10-5). Conclusion: These findings are the first to suggest that an ICAM-integrin-mediated pathway contributes to susceptibility to SLE

Global Norms, Local Activism, and Social Movement Outcomes: Global Human Rights and Resident Koreans in Japan

The authors integrate social movement outcomes research and the world society approach to build a theoretical model to examine the impact of global and local factors on movement outcomes. Challenging the current research on policy change, which rarely examines the effects of global norms and local activism in one analysis, they argue (1) that global regimes empower and embolden local social movements and increase pressure on target governments from below, and (2) that local activists appeal to international forums with help from international activists to pressure the governments from above. When the pressures from the top and the bottom converge, social movements are more likely to succeed. Furthermore, these pressures are stronger in countries integrated into global society and on issues with strong global norms. The empirical analysis of social movements by resident Koreans in Japan advocating for four types of human rights—civil, political, social/economic, and cultural—demonstrates that the movements produced more successes as Japan\u27s involvement in the international human rights regime expanded since the late 1970s, and that activism on issues with strong global norms achieved greater successes. The analysis also shows that lack of cohesive domestic activism can undercut the chances of social movements\u27 success even with strong global norms on the issue

Predisposition to Cancer Caused by Genetic and Functional Defects of Mammalian Atad5

ATAD5, the human ortholog of yeast Elg1, plays a role in PCNA deubiquitination. Since PCNA modification is important to regulate DNA damage bypass, ATAD5 may be important for suppression of genomic instability in mammals in vivo. To test this hypothesis, we generated heterozygous (Atad5+/m) mice that were haploinsuffficient for Atad5. Atad5+/m mice displayed high levels of genomic instability in vivo, and Atad5+/m mouse embryonic fibroblasts (MEFs) exhibited molecular defects in PCNA deubiquitination in response to DNA damage, as well as DNA damage hypersensitivity and high levels of genomic instability, apoptosis, and aneuploidy. Importantly, 90% of haploinsufficient Atad5+/m mice developed tumors, including sarcomas, carcinomas, and adenocarcinomas, between 11 and 20 months of age. High levels of genomic alterations were evident in tumors that arose in the Atad5+/m mice. Consistent with a role for Atad5 in suppressing tumorigenesis, we also identified somatic mutations of ATAD5 in 4.6% of sporadic human endometrial tumors, including two nonsense mutations that resulted in loss of proper ATAD5 function. Taken together, our findings indicate that loss-of-function mutations in mammalian Atad5 are sufficient to cause genomic instability and tumorigenesis

Mutations in KEOPS-Complex Genes Cause Nephrotic Syndrome with Primary Microcephaly

Galloway-Mowat syndrome (GAMOS) is an autosomal-recessive disease characterized by the combination of early-onset nephrotic syndrome (SRNS) and microcephaly with brain anomalies. Here we identified recessive mutations in OSGEP, TP53RK, TPRKB, and LAGE3, genes encoding the four subunits of the KEOPS complex, in 37 individuals from 32 families with GAMOS. CRISPR-Cas9 knockout in zebrafish and mice recapitulated the human phenotype of primary microcephaly and resulted in early lethality. Knockdown of OSGEP, TP53RK, or TPRKB inhibited cell proliferation, which human mutations did not rescue. Furthermore, knockdown of these genes impaired protein translation, caused endoplasmic reticulum stress, activated DNA-damage-response signaling, and ultimately induced apoptosis. Knockdown of OSGEP or TP53RK induced defects in the actin cytoskeleton and decreased the migration rate of human podocytes, an established intermediate phenotype of SRNS. We thus identified four new monogenic causes of GAMOS, describe a link between KEOPS function and human disease, and delineate potential pathogenic mechanisms