Alisa Yamasaki

Syndecan 4 Regulates FGFR1 Signaling in Endothelial Cells by Directing Macropinocytosis

Macropinocytosis controls the kinetics of endothelial signaling initiated by a fibroblast growth factor receptor. Limiting the Signal Through Macropinocytosis Fibroblast growth factor 2 (FGF2) triggers migration and proliferation of endothelial cells by binding to fibroblast growth factor receptor 1 (FGFR1) and the co-receptor syndecan 4 (S4). Activation of FGFR1 initiates signaling through mitogen-activated protein kinases (MAPKs). Elfenbein et al. found that S4 decreased the internalization of FGFR1 through a process called macropinocytosis. Furthermore, S4-mediated macropinocytosis of FGFR1 decreased the amplitude and increased the deactivation kinetics of MAPK signaling. Thus, these results indicate that S4 controls the duration of MAPK activation in response to binding of FGF2 to FGFR1. Fibroblast growth factor 2 (FGF2) induces endothelial cell migration and angiogenesis through two classes of receptors: receptor tyrosine kinases, such as FGF receptor 1 (FGFR1), and heparan sulfate proteoglycans, such as syndecan 4 (S4). We examined the distinct contributions of FGFR1 and S4 in shaping the endothelial response to FGF2. S4 determined the kinetics and magnitude of FGF2-induced mitogen-activated protein kinase (MAPK) signaling by promoting the macropinocytosis of the FGFR1-S4-FGF2 signaling complex. Internalization of the S4 receptor complex was independent of clathrin and dynamin, proceeded from lipid raft–enriched membranes, and required activation of the guanosine triphosphatases RhoG and Rab5. Genetic knockout of S4, disruption of S4 function, or inhibition of Rab5 led to increased endocytosis and MAPK signaling. These data define the mechanism by which FGFR1 and S4 coordinate downstream signaling upon FGF2 stimulation: FGFR1 initiates MAPK signaling, whereas S4-dependent FGFR1 macropinocytosis modulates the kinetics of MAPK activation. Our studies identify S4 as a regulator of MAPK signaling and address the question of how distinct classes of FGFRs individually contribute to signal transduction in endothelial cells.

The impact of music on metabolism

The study of music and medicine is a rapidly growing field that in the past, has been largely focused on the use of music as a complementary therapy. Increasing interest has been centered on understanding the physiologic mechanisms underlying the effects of music and, more recently, the suggested role of music in modulating metabolic responses. Research has established a role for music in the regulation of the hypothalamic-pituitary axis, the sympathetic nervous system, and the immune system, which have key functions in the regulation of metabolism and energy balance. More recent findings have shown a role for music in the metabolic recovery from stress, the regulation of gastric and intestinal motility, the moderation of cancer-related gastrointestinal symptoms, and the increase of lipid metabolism and lactic acid clearance during exercise and postexercise recovery. The purpose of this article is to summarize the most current understanding of the mechanisms by which music affects the metabolic responses in the context of potential applications.

A validated model for the 22-item Sino-Nasal Outcome Test subdomain structure in chronic rhinosinusitis

Previous studies have identified subdomains of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), reflecting distinct and largely independent categories of chronic rhinosinusitis (CRS) symptoms. However, no study has validated the subdomain structure of the SNOT‐22. This study aims to validate the existence of underlying symptom subdomains of the SNOT‐22 using confirmatory factor analysis (CFA) and to develop a subdomain model that practitioners and researchers can use to describe CRS symptomatology.

Association between systemic antibiotic and corticosteroid use for chronic rhinosinusitis and quality of life

We sought to establish the significance of querying chronic rhinosinusitis (CRS) patients about their past CRS‐related oral antibiotic and corticosteroid usage by determining the association between these metrics and patients’ quality of life (QoL).

Musical preference correlates closely to professional roles and specialties in operating room: A multicenter cross-sectional cohort study with 672 participants

BACKGROUND It is unclear whether music preferences and perceptions in the operating room (OR) differ by demographic and professional factors and how an improved understanding of these potential differences can be leveraged to enhance team dynamics and the OR work environment. Currently, there is limited knowledge regarding the impact of music on OR team concentration and communication. METHODS This study was a multicenter, cross-sectional study of 282 preoperative patients and 390 providers-attending physicians, residents, and nurses in anesthesiology and surgery. Patient and provider responses were measured using a newly developed questionnaire. RESULTS Patients who highly enjoyed music felt music alleviated stress and enhanced concentration and communication and favored use of music in the OR. The genres favored most by patients were rock music (32%), classical music (28%), and top 40 hits (26%). All providers reported a high frequency of use of music during the operation. Nurses and residents were more likely than attendings to report high enjoyment of music in the OR (P < .02). Surgeons and anesthesiologists had high median scores for enjoyment of music and low median scores for music as distraction. Anesthesiologists preferred classical and jazz/blues at lower volumes compared with surgeons, who favored top 40 music at higher noise pressure levels. Patients and providers perceived music to improve provider concentration and team communication; nurses held the most positive views. CONCLUSION Musical preferences and perceptions of the effect of music in the OR differ by both professional status and specialty and provide insight into broader team dynamics that could be leveraged potentially to optimize the OR environment.

How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic

Abstract Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student–Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.

A Rare Finding of Schwannoma of the Vidian Canal: A Case Report

Background Schwannomas of the vidian canal are an extremely rare type of intracranial tumor that can have variable clinical presentations including headache, facial pain, facial muscle paralysis, decreased lacrimation, or nasal dryness. We present an atypical case of an incidentally identified asymptomatic vidian canal schwannoma. Case Description A 49-year-old woman with a history of multiple sclerosis presented for routine surveillance magnetic resonance imaging that detected an ovoid mass originating in the vidian canal. Given the unusual location of the lesion, an endoscopic endonasal biopsy was performed and confirmed the diagnosis of a vidian canal schwannoma, for which the patient chose to receive fractionated radiation therapy. Conclusion When a vidian canal tumor is identified, endoscopic endonasal biopsy can be used to confirm the diagnosis before pursuing either surgical or radiotherapy treatment. In particular, fractionated radiation therapy offers a radiobiologically safe means of delivering radiation when there is concern for late radiation-related side effects following treatment completion.

Utilization patterns of systemic corticosteroid use for chronic rhinosinusitis

Abstract Objective: We sought to characterize the utilization pattern and factors associated with use of systemic corticosteroids for CRS. Methods: This was a cross-sectional study of 236 participants with CRS who were prospectively recruited. Participants reported the number of CRS-related oral corticosteroid courses taken in the last year. Baseline CRS symptomatology was measured using the 22-item Sinonasal Outcome Test (SNOT-22) and SNOT-22 sleep, nasal, otologic/facial pain and emotional subdomain scores. Clinical and demographic characteristics were also collected. Association was determined between patient characteristics and oral corticosteroid use in the last year for CRS. Results: Sleep (p = .026), nasal (p < .001) and otologic/facial pain (p = .022) SNOT-22 subdomain scores, and nasal polyps (p = .007) were associated with CRS-related oral corticosteroid use. In study participants without polyps, past CRS-related oral corticosteroid use was associated with sleep (adjusted OR = 1.56, 95%CI: 1.01–2.40, p = .043), otologic/facial pain (adjusted OR = 1.65, 95%CI: 1.09–2.51, p = .019) and nasal subdomain scores (adjusted OR = 1.59, 95%CI: 1.01–2.51, p = .047). In study participants with polyps, past CRS-related oral corticosteroid use was only associated with the nasal subdomain score (adjusted OR = 2.20, 95%CI: 1.40–3.45, p = .001). Conclusions: Past CRS-related oral corticosteroid use was associated with increased baseline severity of specific symptoms, which were different depending on the presence of polyps.

Tympanic Plexus Neurectomy for Intractable Otalgia

The goal of this study was to analyze whether tympanic plexus neurectomy is a successful surgical option in patients with intractable otalgia.