Uncommon Features Research Articles

N-Methyl-D-Aspartate(NMDA) Receptor and Voltage-Gated Potassium Channel (VGKC) Antibody-Associated Encephalitides Presenting as First Episode Acute Psychosis.

Aim: Acute psychosis is not an uncommon presenting feature in immune-mediated encephalitides. Most patients improve if properly diagnosed and treated expediently with immunotherapy. Our study aimed to describe the frequency, clinical spectrum, and long-term outcomes in patients presenting with acute psychosis who have anti-N-methyl-D-aspartate (NMDA) receptor or anti-voltage-gated potassium channel (VGKC) encephalitis. Method: We recruited patients aged 16–50 years presenting with less than 1 month of psychotic and neurological symptoms including cognitive dysfunction, seizures, abnormal movements, and/or autonomic dysfunction. Results: Between September 2011 and October 2013, 60 patients with first episode acute psychosis were screened; 15 were recruited and included for analyses. Four (26.7%) patients were diagnosed with anti-NMDA receptor encephalitis and 1 (6.7%) with anti-VGKC encephalitis. We found that the mean serum white blood cell (WBC) count (12.8 × 109/L ± 4.8 vs. 7.9 × 109/L ± 2.6; p = 0.05) and cerebrospinal fluid WBC count (106 cells/µl ± 101 vs. 8.5 cells/µl ± 18.9; p = 0.05) were higher in positive cases. Certain prodromal features such as fever, headache, confusion, facial dyskinesia, and hypersalivation were also more likely to be present in positive cases. Patients with autoimmune encephalitis also tended to be more unwell, with the majority requiring intensive care, had lower global assessment of functioning scores (30 ± 10 vs. 53.7 ± 21.2, p = 0.09), and were not well enough to complete standard psychiatric and cognitive assessments at presentation. Conclusion: Autoimmune encephalitis is not uncommon in patients with acute psychosis. Elevated WBC counts, certain prodromal features, and a more severe illness at presentation should prompt appropriate evaluation.

Increased Serum Calcitonin in Sporadic Primary Hyperparathyroidism is an Uncommon Occurrence

Objective: To evaluate calcitonin (CT) levels in sporadic primary hyperparathyroidism (PHPT), which has to date rarely been considered. Methods: We evaluated serum CT levels in 290 consecutive patients with sporadic PHPT at diagnosis. Results: Mild elevations in CT levels (hyperCT) were found in 25 patients (8.6%), with no correlation among the demographic, clinical, and biochemical findings. In addition, no differences were found between patients with and without hyperCT. Follow-up data were available for 19/25 patients, but CT values were only available for 10. CT normalized in all surgically cured patients regardless of the extent of the surgery (parathyroidectomy [PTX] only in 8 and associated with partial or total thyroidectomy for benign nodular goiters in 7). Conclusion: hyperCT is an uncommon feature of sporadic PHPT and not related to biochemical or clinical features of the disease. In addition, hyperCT is reversible after PTX, regardless of whether concomitant thyroidectomies have been conducted. Abbreviations: CT = calcitonin; eGFR = estimated glomerular filtration rate; hyperCT = hypercalcitoninemia; MEN = multiple endocrine neoplasm; MTC = medullary thyroid carcinoma; PHPT = primary hyperparathyroidism; PPI = proton pump inhibitor; PTH = parathyroid hormone; PTX = parathyroidectomy.

On the origin of the chemical bimodality of disc stars: a tale of merger and migration

ABSTRACT The Milky Way’s (MW) stellar disc exhibits a bimodality in the [Fe/H] versus [α/Fe] plane, showing a distinct high- and low-α sequences whose origin is still under debate. We examine the [Fe/H]–[α/Fe] abundance plane in cosmological hydrodynamical simulations of MW-like galaxies from the NIHAO-UHD project and show that the bimodal α-sequence is a generic consequence of a gas-rich merger at some time in the Galaxy’s evolution. The high-α sequence evolves first in the early galaxies, extending to high metallicities, while it is the low-α sequence that is formed after the gas-rich merger. The merger brings in fresh metal-poor gas diluting the interstellar medium’s metallicity while keeping the [α/Fe] abundance almost unchanged. The kinematic, structural, and spatial properties of the bimodal α-sequence in our simulations reproduces that of observations. In all simulations, the high-α disc is old, radially concentrated towards the galaxy’s centre and shows large scale heights. In contrast, the low-α disc is younger, more radially extended and concentrated to the disc mid-plane. Our results show that the abundance plane is well described by these two populations that have been distributed radially across the disc by migration: at present day in the solar neighbourhood, low-α stars originate from both the inner and outer discs, while most of the high-α stars have migrated from the inner disc. We show that age dating the stars in the [Fe/H]–[α/Fe] plane can constrain the time of the low-α sequence forming merger and conclude that α-bimodality is likely a not uncommon feature of disc galaxies.

Desmoplastic myxoid tumor, SMARCB1-mutant: clinical, histopathological and molecular characterization of a pineal region tumor encountered in adolescents and adults.

Atypical teratoid/rhabdoid tumor (ATRT) is a highly malignant brain tumor predominantly occurring in infants. Mutations of the SMARCB1 gene are the characteristic genetic lesion. SMARCB1-mutant tumors in adolescents and adults are rare and may show uncommon histopathological and clinical features. Here we report seven SMARCB1-deficient intracranial tumors sharing distinct clinical, histopathological and molecular features. Median age of the four females and three males was 40years (range 15-61years). All tumors were located in the pineal region. Histopathologically, these tumors displayed spindled and epithelioid cells embedded in a desmoplastic stroma alternating with a variable extent of a loose myxoid matrix. All cases showed loss of nuclear SMARCB1/INI1 protein expression, expression of EMA and CD34 was frequent and the Ki67/MIB1 proliferation index was low in the majority of cases (median 3%). Three cases displayed heterozygous SMARCB1 deletions and two cases a homozygous SMARCB1 deletion. On sequencing, one tumor showed a 2bp deletion in exon 4 (c.369_370del) and one a short duplication in exon 3 (c.237_276dup) both resulting in frameshift mutations. Most DNA methylation profiles were not classifiable using the Heidelberg Brain Tumor Classifier (version v11b4). By unsupervised t-SNE analysis and hierarchical clustering analysis, however, all tumors grouped closely together and showed similarities with ATRT-MYC. After a median observation period of 48months, three patients were alive with stable disease, whereas one patient experienced tumor progression and three patients had succumbed to disease. In conclusion, our series represents an entity with distinct clinical, histopathological and molecular features showing epigenetic similarities with ATRT-MYC. We propose the designation desmoplastic myxoid tumor (DMT), SMARCB1-mutant, for these tumors.

Structural and functional investigation of AerF, a NADPH-dependent alkenal double bond reductase participating in the biosynthesis of Choi moiety of aeruginosin

The 2-carboxy-6-hydroxyoctahydroindole (Choi) moiety is an essential residue for the antithrombotic activities of aeruginosins, which are a class of cyanobacterial derived bioactive linear tetrapeptides. Biosynthetic pathway of Choi is still elusive. AerF was suggested to be involved in the biosynthesis of Choi, and can be assigned to the short-chain dehydrogenase/reductase (SDR) superfamily. However, both the exact role and the catalytic mechanism of AerF have not been elucidated. In this study, functional and mechanistic analyses of AerF from Microcystis aeruginosa were performed. Observation of enzymatic assay demonstrates that AerF is a NADPH-dependent alkenal double bond reductase that catalyzes the reduction of dihydro-4-hydroxyphenylpyruvate (H2HPP) to generate tetrahydro-4-hydroxyphenylpyruvate (H4HPP), which is the third step of the biosynthetic pathway from prephenate to Choi. Comparative structural analysis indicates that ligand binding-induced conformational change of AerF is different from that of the other SDR superfamily reductase using H2HPP as a substrate. Analyses of NADPH and substrate analogue binding sites combined with the results of mutagenesis analyses suggest that a particular serine residue mainly involves in the initiation of the proton transfer between the substrate and the residues of AerF, which is an uncommon feature in SDR superfamily reductase. Furthermore, based on the observations of structural and mutagenesis analyses, the catalytic mechanism of AerF is proposed and a proton transfer pathway in AerF is deduced.

Imaging of hepatic hemangioma: from A to Z.

The hemangioma is the most common solid lesion of the liver. Therefore, radiologists must know the typical and atypical imaging findings of this lesion in order to reach a correct diagnosis and avoid diagnostic errors. However, only few papers have comprehensively described the entire spectrum of atypical and uncommon imaging features. In this updated review, we provide the imaging features of hepatic hemangioma, in both typical and atypical forms, as well as its association with abnormalities in the adjacent hepatic parenchyma and other hepatic lesions, and its complications.

The first two Chinese Myhre syndrome patients with the recurrent SMAD4 pathogenic variants: Functional consequences and clinical diversity

Myhre syndrome is a rare autosomal dominant multi-organ disorder characterized by growth retardation, skeletal anomalies, muscular hypertrophy, joint stiffness, facial dysmorphism, deafness, cardiovascular disease, and abnormal sexual development. Here we described the first two Chinese Myhre syndrome patients diagnosed by whole-exome sequencing. They both had de novo c.1498A > G (p.Ile500Val) variant in SMAD4 and presented with key characteristics of Myhre syndrome but also revealed uncommon features (polydactyly in the girl and precocious puberty in the boy). We performed functional analysis on four previously reported SMAD4 pathogenic variants in Myhre syndrome patients using dual-luciferase assay. Our results revealed that the pathogenic variants resulted in a variable degree of increased transcription activity of target genes that contain the minimal SMAD binding elements in their promoter regions. The boy responded to the recombinant human growth hormone treatment with improved height but also led to hyperinsulinemia and advanced bone age. Because of his precocious puberty, we subsequently combined the recombinant human growth hormone and gonadotrophin-releasing hormone agonist treatments, which resulted in overall improved height. We reviewed the sexual features of reported Myhre syndrome cases and discussed the possible mechanism of SMAD4 variants in Myhre syndrome that lead to the abnormal hypothalamic-pituitary-gonadal axis.

Poorly differentiated neuroendocrine rectal carcinoma with uncommon immune-histochemical features and clinical presentation with a subcutaneous metastasis, treated with first line intensive triplet chemotherapy plus bevacizumab FIr-B/FOx regimen: an experience of multidisciplinary management in clinical practice

BackgroundNeuroendocrine tumors (NETs) are heterogeneous, widely distributed tumors arising from neuroendocrine cells. Gastrointestinal (GI)-NETs are the most common and NETs of the rectum represent 15, 2% of gastrointestinal malignancies. Poorly differentiated neuroendocrine carcinomas of the GI tract are uncommon. We report a rare case of poorly differentiated locally advanced rectal neuroendocrine carcinoma with nodal and a subcutaneous metastasis, with a cytoplasmic staining positive for Synaptophysin and Thyroid Transcription Factor-1.Case presentationA 72-year-old male presented to hospital, due to lumbar, abdominal, perineal pain, and severe constipation. A whole-body computed tomography scan showed a mass of the right lateral wall of the rectum, determining significant reduction of lumen caliber. It also showed a subcutaneous metastasis of the posterior abdominal wall. Patient underwent a multidisciplinary evaluation, diagnostic and therapeutic plan was shared and defined. The pathological examination of rectal biopsy and subcutaneous nodule revealed features consistent with small-cell poorly differentiated neuroendocrine carcinoma. First line medical treatment with triplet chemotherapy and bevacizumab, according to FIr-B/FOx intensive regimen, administered for the first time in this young elderly patient affected by metastatic rectal NEC was highly active and tolerable, as previously reported in metastatic colo-rectal carcinoma (MCRC). A consistent rapid improvement in clinical conditions were observed during treatment. After 6 cycles of treatment, CT scan and endoscopic evaluation showed clinical complete response of rectal mass and lymph nodes; patient underwent curative surgery confirming the pathologic complete response at PFS 9 months.Discussion and conclusionsThis case report of a locally advanced rectal NEC with an unusual subcutaneous metastasis deserves further investigation of triplet chemotherapy-based intensive regimens in metastatic GEP NEC.

Pancreatoblastoma: Cytologic and histologic analysis of 12 adultcases reveals helpful criteria in their diagnosis and distinction from common mimics.

Pancreatoblastoma (PBL) is a rare malignant pancreatic tumor seen predominantly in childhood, and its cytologic diagnosis remains challenging. Twelve fine-needle-aspirations from 11 adults were analyzed. In total, 6 men and 5 women (median age, 45years; age range, 32-60years) had tumors measuring a median 5.6cm (range, 2.5-12cm) located in the pancreatic head (n=7) or tail (n=4), including 3 with familial adenomatous polyposis (FAP)/FAP-related syndromes and 4 with metastasis at diagnosis. The median follow-up was 39.8months (range, 0.8-348months), and 5 patients died of disease. The original cytology diagnoses were: PBL (n=2), neuroendocrine neoplasm (n=2), poorly differentiated neuroendocrine carcinoma (n=2), well differentiated neuroendocrine tumor (n=1), poorly differentiated carcinoma (n=2), "positive for malignancy" (n=1), acinar cell carcinoma (n=1), and epithelioid neoplasm with endocrine and acinar differentiation versus PBL (n=1). Universal cytopathologic findings included hypercellularity; 3-dimensional clusters; and single, monotonous, blast-like cells that were from 1.5 to 2.0 times the size of red blood cells with high nuclear-to-cytoplasmic ratio, fine chromatin, small, distinct nucleoli, and a resemblance to well differentiated neuroendocrine tumor and poorly differentiated neuroendocrine carcinoma. Branching pseudopapillae (n=7) and grooved nuclei (n=3) raised the differential diagnosis of solid-pseudopapillary neoplasm, but with more atypia. Uncommon features included pleomorphism (n=4) and numerous mitoses (n=1). Squamoid morules were seen on smears (n=5) or cell blocks (n=6) in 70% of patients and were characterized by epithelioid cells with elongated, streaming nuclei, fine chromatin, absent nucleoli, and positive nuclear β-catenin (n=6 of 8). The median Ki-67 index was 21% (range, 2%-70%), and neuroendocrine marker expression was common (100%), but acinar markers were variable (63%). A combination of cytologic findings in PBL, including a predominant population of primitive blast-like cells, subtle squamoid morules, frequent neuroendocrine and variable acinar phenotype, should facilitate accurate cytologic diagnosis and distinction from common mimics.

RECURRENT AND MASSIVE HEMOPTYSIS: A CONSEQUENCE OF A RARE ETIOLOGY

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Fibrosing mediastinitis is an inflammatory reaction that results in excessive fibrous tissue formation in the mediastinum. It is usually attributed to histoplasmosis. It may affect the airways, great vessels, and other mediastinal structures secondary to robust inflammatory reaction to fungal antigens including granuloma formation and calcifications. The clinical presentation depends on which mediastinal structures being involved and the extent of the damage. Hemoptysis in fibrosing mediastinitis can be the result of bronchial invasion, necrotizing pneumonia, pulmonary or bronchial venous or arterial invasion. CASE PRESENTATION: 68-year-old Caucasian female with past medical history of chronic sinusitis, paroxysmal atrial fibrillation and fibrosing mediastinitis who presented to the emergency room (ER) complaining of three episodes of hemoptysis for 6 hours. The hemoptysis was estimated to be around 100 ml each time, bright red blood and associated with mild shortness of breath. Initial vitals were 104/54 mm Hg, heart rate of 110 bpm, respiratory rate of 22 cpm and Spo2 95% on 4L nasal cannula. The patient received one unit of PRBC for acute drop in hemoglobin from 14 gm/dl to 11 gm/dl. The patient was admitted to the intensive care unit (ICU) due to a concern of airway compromise and potential need for endotracheal intubation. The patient had episodes of massive hemoptysis over the last year and received corticosteroids intermittently without significant improvement. In the ICU, The clinical condition was relatively stable with normal vital signs yet continued to have hemoptysis. CT scan of the chest revealed mediastinal widening with diffuse calcified lymph nodes, broncholith extending into right main stem bronchus, superior vena cava stent and dilated main pulmonary arteries. Conventional angiography demonstrated dilatation of the two right sided intercostal bronchial trunks and multiple dilated intercostal arteries. Successful embolization of the above-mentioned arteries with microspheres was performed until achieving hemostasis. Subsequently, the patient did not experience further episodes of hemoptysis. The patient was discharged home in a stable clinical condition. DISCUSSION: Recurrent and massive hemoptysis is a consequence of numerous etiologies. We are reporting a rare case of fibrosing mediastinitis that presented as recurrent and massive hemoptysis. Diagnostic approach indicated the involvement of the bronchial and intercostal arteries. The involved vessels were treated successfully by embolization CONCLUSIONS: Recurrent massive hemoptysis is an uncommon clinical feature in these patients and associated with poor prognosis along with other local invasive process by the calcified mediastinal masses. Reference #1: Mediastinal fibrosis complicating histoplasmosis, Loyd JE1, Tillman BF, Atkinson JB, Des Prez RM. Reference #2: Chronic fibrous mediastinitis and superior vena caval obstruction due to histoplasmosis, Dis Chest. 1959 Apr;35(4):364-77. DISCLOSURES: No relevant relationships by Mukhtar Al-Saadi, source=Web Response No relevant relationships by Sai Katta, source=Web Response

Uncommon and/or bizarre features of dementia: part IV.

It is well established that the clinical picture of dementias is not clinically homogeneous. For example, non-amnestic presentations of Alzheimer's disease have been referred to as a typical variant. Careful examination of clinical characteristics contributes to understanding the neurobiology of Alzheimer's disease and other dementias and may in turn enhance knowledge of the potential risk factors involved. This study aimed at describing uncommon or bizarre symptoms/syndromes observed in patients suffering from dementia. Medline and Google scholar searches were conducted for relevant articles, chapters, and books published before 2019. Search terms used included dementia, déjà vu, zoophilia, pathological lying, and somatic symptom disorder. Publications found through this indexed search were reviewed for further relevant references. Uncommon/bizarre features of dementia were described as case reports and there were no systematic investigations.

Establishment and characterization of induced pluripotent stem cells (iPSCs) from central nervous system lupus erythematosus

Involvement of the central nervous system (CNS) is an uncommon feature in systemic lupus erythematosus (SLE), making diagnosis rather difficult and challenging due to the poor specificity of neuropathic symptoms and neurological symptoms. In this work, we used human‐induced pluripotent stem cells (hiPSCs) derived from CNS‐SLE patient, with the aim to dissect the molecular insights underlying the disease by gene expression analysis and modulation of implicated pathways. CNS‐SLE‐derived hiPSCs allowed us to provide evidence of Erk and Akt pathways involvement and to identify a novel cohort of potential biomarkers, namely CHCHD2, IDO1, S100A10, EPHA4 and LEFTY1, never reported so far. We further extended the study analysing a panel of oxidative stress‐related miRNAs and demonstrated, under normal or stress conditions, a strong dysregulation of several miRNAs in CNS‐SLE‐derived compared to control hiPSCs. In conclusion, we provide evidence that iPSCs reprogrammed from CNS‐SLE patient are a powerful useful tool to investigate the molecular mechanisms underlying the disease and to eventually develop innovative therapeutic approaches.

Quenching‐Resistant Polymer Carbon Dot Preserving Emission Color Consistency in Solid‐State

AbstractSolid‐state luminescent carbon dot without dispersion matrices is studied to overcome aggregation‐caused quenching, but it usually shows spectral shift between solution‐ and solid‐state accompanying a dramatic decrease of fluorescence intensity, which hinders a real application. Herein, polymer carbon dot (PCD) showing solid‐state luminescence without red‐shift is synthesized by low‐temperature reaction. The PCD solution and solid have the same emission peaks at 434 nm and similar absolute quantum yields of 68.2% and 62.7%, respectively, which is uncommon feature compared to other carbon dots. The mechanism for solid‐state luminescence and emission color consistency is investigated by structural analysis of the PCD compared to carbon dot that shows red‐shift in solid‐state. The PCD is utilized into light‐emitting diode application as a phosphor, and little color change in emission without significant decrease in luminous efficacy is achieved even with high loading fraction (50 wt%), opening the possibility of real application in solid‐state lighting.

Wood anatomy of dominant species with contrasting ecological performance in tropical dry forest succession

Environmental restrictions faced by successional species (those occurring in recovering vegetation) change gradually between early and late succession. In tropical dry forest (TDF), legume species dominate early succession, that is, accumulate more biomass than coexisting species, but later are gradually replaced by late successional species. Stem anatomical traits are involved in water conduction efficiency and safety, and thus biomass accumulation. We hypothesized that anatomical characteristics of dominant species may explain their status in their respective successional community. We analyzed the wood anatomy of TDF dominant successional species: Mimosa eurycarpa and M. tenuiflora (early successional), Lysiloma divaricatum (late successional), and Euphorbia schlechtendalii (successionally ambiguous). Anatomical variables and indices were estimated and compared between species through linear modeling. Unexpectedly, Mimosa species differed in porosity type, which is one characteristic linked to water stress tolerance. M. eurycarpa and L. divaricatum are ring-porous (an uncommon feature in tropical species), whereas M. tenuiflora and E. schlechtendalii displayed diffuse porosity. M. eurycarpa had the lowest vulnerability index (VI) and the highest relative hydraulic conductivity. Within-individual differences in relative water conduction in ring-porous species, driven by high vessel density in earlywood and low VI in latewood, likely represent a highly advantageous strategy in water-stressed successional environments.

Extensive adipose replacement of the parotid glands: an unusual presentation of sialadenosis. A Case Report and Literature Review

AbstractSialadenosis is an asymptomatic, bilateral enlargement of salivary glands which most commonly affects the parotid glands. Dental practitioners must be able to differentiate gland enlargement to inflammatory, autoimmune and neoplastic processes to prevent unnecessary management and allow for correct referrals to specialists. Adipose replacement has been recognised as an uncommon feature of sialadenosis that may be linked to several systemic conditions; however, fatty infiltration of the glands to the degree of this case report has been rarely presented. The authors report on an unusual presentation of sialadenosis with extensive adipose replacement in the parotid glands, and review on the current literature for associated causes, clinicopathological features, various diagnostic tools and the appropriate management of sialadenosis.

An Equivalent Circuit for Perovskite Solar Cell Bridging Sensitized to Thin Film Architectures

Fundamental working mechanisms of perovskite solar cells remain an elusive topic of research. Impedance Spectroscopy (IS) application to perovskite-based devices generates uncommon features and misleading outputs, mainly due to the lack of a stablished model for the interpretation of the results. In this work we control the perovskite precursor concentration to fabricate a series of perovskite-based solar cells with different amounts of perovskite absorber. Low concentration devices present the well-known dye sensitized solar cell (DSSCs) impedance pattern. As the amount of perovskite is increased, the characteristic impedance spectra of thin-film perovskite solar cells (PSCs) arises. This transition is characterized by a change in the working principles, determined by an evolution of the dominant capacitance: from the intermediate frequency chemical capacitance of TiO2 in devices with isolated perovskite domains, to a large low-frequency capacitance signal which divides the spectra in two sections, yet with no direct influence in final device performance. This study allows to link experimentally, in terms of impedance behavior, PSCs with the rest of solar cell devices via DSSCs. We observe that it is not possible to assign a single physical origin to the different resistances determined in the impedance spectra except for the series resistance. In contrast, resistive element present contributions from different physical processes, observing a transport-recombination coupling. Based on this analysis we provide an equivalent circuit model to evaluate the impedance pattern of PSCs in terms of the processes directly affecting the final performance (i.e. considering transport-related and recombination-related losses), a crucial tool for further development of perovskite photovoltaics.

Genomic and spatial variability of a European common vole hepevirus.

Rodents host different orthohepeviruses, namely orthohepevirus C genotype HEV-C1 (rat hepatitis E virus, HEV) and the additional putative genotypes HEV-C3 and HEV-C4. Here, we screened 2,961 rodents from Central Europe by reverse transcription polymerase chain reaction (RT-PCR) and identified HEV RNA in 13 common voles (Microtus arvalis) and one bank vole (Myodes glareolus) with detection rates of 2% (95% confidence interval [CI]: 1-3.4) and 0.08% (95% CI: 0.002-0.46), respectively. Sequencing of a 279-nucleotide RT-PCR amplicon corresponding to a region within open reading frame (ORF) 1 showed a high degree of similarity to recently described common vole-associated HEV (cvHEV) sequences from Hungary. Five novel complete cvHEV genome sequences from Central Europe showed the typical HEV genome organization with ORF1, ORF2 and ORF3 and RNA secondary structure. Uncommon features included a noncanonical start codon in ORF3, multiple insertions and deletions within ORF1 and ORF2/ORF3, and the absence of a putative ORF4. Phylogenetic analysis showed all of the novel cvHEV sequences to be monophyletic, clustering most closely with an unassigned bird-derived sequence and other sequences of the species Orthohepevirus C. The nucleotide and amino acid sequence divergence of the common vole-derived sequences was significantly correlated with the spatial distance between the trapping sites, indicating mostly local evolutionary processes. Detection of closely related HEV sequences in common voles in multiple localities over a distance of 800 kilometers suggested that common voles are infected by cvHEV across broad geographic distances. The common vole-associated HEV strain is clearly divergent from HEV sequences recently found in narrow-headed voles (Microtus gregalis) and other cricetid rodents.

Ultrafast Oxidation of a Tyrosine by Proton-Coupled Electron Transfer Promotes Light Activation of an Animal-like Cryptochrome.

The animal-like cryptochrome of Chlamydomonas reinhardtii (CraCRY) is a recently discovered photoreceptor that controls the transcriptional profile and sexual life cycle of this alga by both blue and red light. CraCRY has the uncommon feature of efficient formation and longevity of the semireduced neutral form of its FAD cofactor upon blue light illumination. Tyrosine Y373 plays a crucial role by elongating , as fourth member, the electron transfer (ET) chain found in most other cryptochromes and DNA photolyases, which comprises a conserved tryptophan triad. Here, we report the full mechanism of light-induced FADH• formation in CraCRY using transient absorption spectroscopy from hundreds of femtoseconds to seconds. Electron transfer starts from ultrafast reduction of excited FAD to FAD•- by the proximal tryptophan (0.4 ps) and is followed by delocalized migration of the produced WH•+ radical along the tryptophan triad (∼4 and ∼50 ps). Oxidation of Y373 by coupled ET to WH•+ and deprotonation then proceeds in ∼800 ps, without any significant kinetic isotope effect, nor a pH effect between pH 6.5 and 9.0. The FAD•-/Y373• pair is formed with high quantum yield (∼60%); its intrinsic decay by recombination is slow (∼50 ms), favoring reduction of Y373• by extrinsic agents and protonation of FAD•- to form the long-lived, red-light absorbing FADH• species. Possible mechanisms of tyrosine oxidation by ultrafast proton-coupled ET in CraCRY, a process about 40 times faster than the archetypal tyrosine-Z oxidation in photosystem II, are discussed in detail.

Directing Cymbeline: Leon activated attributes of God for the 38th Bali Arts Festival 2016

Applying the theory of Bali Creative Art, this paper looks at the theatre directing elements, concept, and method applied by Leon Rubin when he directed Shakespeare’s Cymbeline. Invited by the Head of the Bali Province Cultural Directorate to showcase a cross-cultural theatrical production, Leon selected and integrated twenty-five artists (actors/actresses, costume and lighting designers) from Bali, Indonesia; Malaysia, Mexico, Brazil, China, and England in a new work for the 38th Bali Arts Festival in 2016. Most of the actors were able to stay in Bali for three weeks to rehearse; the piece was also shown in limited seating venues in the villages of Ubud and Abian Semal for three nights in a row from 25 to 27 June 2016. Despite the great challenge for the non-Indonesian actors and director, all were finally able to collaborate under Leon’s direction and perform the Indonesian language translation of the original Shakespearian text. Although the local artists informed Leon that the Cymbeline play would be competing with sounds from loud speakers in several nearby performance venues and the stage crew offered the actors microphones—Leon did not allow sound amplification of the actors, musicians, narrator, or the singer. Surprising yet amusing local audiences with several uncommon features, the Cymbeline show was considered to be the best collaborative production among the nearly 350 performances presented during the month-long festival.

ORAL RADIOGRAPHIC FINDINGS IN SICKLE CELL DISEASE PATIENTS

Sickle cell disease causes vascular microinfarcts that lead to multi-organs alterations including dental involvements. Teeth, oral structures, and maxillofacial bones are affected. Dental alterations of oral and maxillofacial bones are of anatomical, radiographical, and structural significance. Due to compensatory hematopoiesis, hemolysis, and vaso-occlusive events in the maxilla and mandible, bony changes are noticed radiographically in SCD patients. Seven oral radiographic features were reported in the literature among SCD patients: large trabecular spaces, increased medullary spaces, thinning of the inferior mandibular border (osteoporosis), interproximal alveolar bone staircase pattern, thickening of lamina dura, resorption in alveolar bone, and radiopacities/osteosclerosis. Mandibular Hypo-vascularity can induce osteomyelitis and osteonecrosis in SCD patients. Mandibular osteomyelitis can be followed by osteosclerosis (radiopacities) if proper healing is achieved. In this study, we obtained multiple radiographs of 35 SCD patients to 1)determine the common radiographic features seen in SCD patients and 2)assess the seven radiographic features reported in the literature. Results Some SCD patients demonstrated more than one radiographic feature, while other SCD patients manifest no radiographic findings. The most common feature was the staircase pattern and the least common was osteoporosis. A detailed table of the number of SCD patients presented with notable radiographic features is presented in this poster, in addition to a comparison between the common and uncommon features. Conclusion not all SCD patients demonstrate oral radiographic findings, and among the oral radiographic findings reported in the literature, some features are more common than others. Hopefully, 50 or more SCD patients will be included in the study for further evaluation. Furthermore, an equal number of radiographs of competent patients will be examined randomly from Kuwait University's bank of radiographs to serve as a control group. Therefore, we will be able to determine if the reported oral radiographic features are suggestive of SCD or not.