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ObjectiveThe narrow therapeutic window of lithium medications necessitates frequent serum monitoring, which can be expensive and inconvenient for the patient. Compared to blood, saliva collection is easier, non-invasive, requires less processing, and can be done without the need for trained personnel. This study investigated the utility of longitudinal salivary lithium level monitoring.MethodsWe measured salivary lithium levels using ICP-OES in n = 169 passive drool samples, collected both as single observations and longitudinally for up to 18 months, from a multi-center cohort of n = 75 patients with bipolar disorder or other psychiatric conditions.ResultsSaliva and serum lithium levels were highly correlated. Adjustment for daily lithium dose, diabetes, and smoking improved this relationship (r = 0.77). Using the adjusted intersubject equation and a patient's salivary lithium value, we observed a strong correlation between the predicted vs. observed serum lithium levels (r = 0.70). Most patients had highly stable saliva/serum ratios across multiple visits, with longitudinal variability significantly greater with age. Use of the intrasubject saliva/serum ratio from a single prior observation had similar predictive power to the use of the adjusted intersubject equation. However, the use of the mean intrasubject ratio from three prior observations could robustly predict serum lithium levels (predicted vs. observed r = 0.90).ConclusionsThese findings strongly suggest that saliva could be used for lithium monitoring, and open the door for the development and implementation of a point-of-care salivary lithium device for use at home or the clinic. We propose that the use of saliva will dramatically improve treatment opportunities for patients with mood disorders.

Neuroinflammation is an important contributor to neuronal pathology and death in neurodegenerative diseases and neuronal injury. Therapeutic interventions blocking the activity of the inflammatory kinase IKKβ, a key regulator of neuroinflammatory pathways, is protective in several animal models of neurodegenerative disease and neuronal injury. In Huntington's disease (HD), however, significant questions exist as to the impact of blocking or diminishing the activity of IKKβ on HD pathology given its potential role in Huntingtin (HTT) degradation. In cell culture, IKKβ phosphorylates HTT serine (S) 13 and activates HTT degradation, a process that becomes impaired with polyQ expansion. To investigate the in vivo relationship of IKKβ to HTT S13 phosphorylation and HD progression, we crossed conditional tamoxifen-inducible IKKβ knockout mice with R6/1 HD mice. Behavioral assays in these mice showed a significant worsening of HD pathological phenotypes. The increased behavioral pathology correlated with reduced levels of endogenous mouse full-length phospho-S13 HTT, supporting the importance of IKKβ in the phosphorylation of HTT S13 in vivo. Notably, many striatal autophagy genes were up-regulated in HD vs. control mice; however, IKKβ knockout partially reduced this up-regulation in HD, increased striatal neurodegeneration, and enhanced an activated microglial response. We propose that IKKβ is protective in striatal neurons early in HD progression via phosphorylation of HTT S13. As IKKβ is also required for up-regulation of some autophagy genes and HTT is a scaffold for selective autophagy, IKKβ may influence autophagy through multiple mechanisms to maintain healthy striatal function, thereby reducing neuronal degeneration to slow HD onset.

BackgroundHuntington's disease (HD) is a progressive neurodegenerative disorder associated with aging, caused by an expanded polyglutamine (polyQ) repeat within the Huntingtin (HTT) protein. In HD, degeneration of the striatum and atrophy of the cortex are observed while cerebellum is less affected.ObjectiveTo test the hypothesis that HTT protein levels decline with age, which together with HTT mutation could influence disease progression.MethodsUsing whole brain cell lysates, a unique method of SDS-PAGE and western analysis was used to quantitate HTT protein, which resolves as a monomer and as a high molecular weight species that is modulated by the presence of transglutaminase 2. HTT levels were measured in striatum, cortex and cerebellum in congenic homozygous Q140 and HdhQ150 knock-in mice and WT littermate controls.ResultsMutant HTT in both homozygous knock-in HD mouse models and WT HTT in control striatal and cortical tissues significantly declined in a progressive manner over time. Levels of mutant HTT in HD cerebellum remained high during aging.ConclusionsA general decline in mutant HTT levels in striatum and cortex is observed that may contribute to disease progression in homozygous knock-in HD mouse models through reduction of HTT function. In cerebellum, sustained levels of mutant HTT with aging may be protective to this tissue which is less overtly affected in HD.

PLEXUS is a student-organized publication that showcases artwork by the UCI School of Medicine students, physicians, faculty, staff, and patients.True to its name, PLEXUS aspires to connect those who seek to heal and to be healed through the unifying language of art. This year we continued to expand our presence in the UCI medical community and beyond.For our 18th edition of PLEXUS, we chose the theme of “Beneath the Surface, Between the Lines.” Throughout our lives and in medicine, there is more than meets the eye – a story untold. There is so much left unseen if we simply look at the surface. Every year we are amazed by the emotions, reflections, stories, richness, and creativity of the submissions. We thank all of our submitters for their time and thought. Additionally, please find our performing arts pieces on our website, www.uciplexus.org. Previous publications and submissions are also available online.Winners of the PLEXUS medical student competitions were made possible by the Program in Medical Humanities & Arts. Congratulations to this year’s winners:Writing competition: 1st: Nazin Sedehi, MS1 “When Your Dad Gets the C-Word”; 2nd: Adam Kalawi, MS3 “A Reflection on Anatomy Lab”; 3rd: Lauren DeDecker, MS1 “The Longest Trip”Visual competition: 1st: Andy Trang, MS3 “Human Hands”; 2nd: Richelle Homo, MS1 “Vitality”; 3rd: Jamie Miller, MS3 “Restoration”Performing arts competition: 1st: Jeremy Martin & Nathan Calixto, MS2s “Stars”; 2nd: Tiffany Pham, MS3 “Bleach and Scrub”; 3rd: Faith Njoku, MS1 “Integrate”Thank you to our superb editors, staff, and faculty for their support in making this 18th edition possible. We would like to give special thanks to our faculty advisor, Dr. Johanna Shapiro and Dr. Ellena Peterson, Associate Dean of Admissions & Outreach - this book would not have been possible without your continuous support and guidance.We hope you enjoy PLEXUS 2017 – Beneath the Surface, Between the Lines Plexus Editor-In-Chief: Sunober SiddiqiProject HX Editor-In-Chief: Soe TheinCreative Writing & Visual Arts Editors: Celia Cheung, Kaavya Raman, Joanna Turkiewicz Will NoveyDesign Editors: Ben Nguyen, Sunober SiddiqiDesign Team: Christina Kong, Stephanie Noh, Nahzaneen SedehiPerforming Arts Team: Nathan Calixto. Jeremy Martin. Melinda SchneiderCommunity Outreach & Selection Committee: Shreya Condamoor, Richelle Homo, Olivia Kaminsky, Carlin Lee, Olivia Marik-Reis, Faith Njoku, Violeta Osegueda, Patrick Penalosa, Tiffany Pham, Hyder Said, Rachel Sunico, Jamie Yabuno1st place winner: Nazin Sedehi2nd place winner: Adam Kalawi3rd place winner:  Lauren DeDecker To contribute to PLEXUS or to request a PLEXUS exhibit at your event, please visit www.uciplexus.org Follow us at www.facebook.com/uciplexus

PLEXUS is a student-organized publication that showcases artwork by the UCI School of Medicine students, physicians, faculty, staff and patients.True to its name, PLEXUS aspires to connect those who seek to heal and to be healed through the unifying language of art.In 2016, PLEXUS invited submissions to complement our theme of “Cultivating perspectives.” The PLEXUS team was astounded by the depth and richness of the pieces submitted, and we thank each and every one of our submitters for their time and thought. Additionally, please find our performing arts pieces on our website, www.uciplexus.org. Previous publications and pieces are available online as well.Winners of PLEXUS Student Competitions made possible by the Program in Medical Humanities & Arts. We would like to congratulate the following winners for this year’s medical student competitions:Writing competition: 1st: Leigh Goodrich, MS2 “Looking Up”; 2nd: Adam Kalawi MS2 “Death of A Star”; and 3rd: Carolyn Fall, MS2 “Passing.”Visual competition: 1st: Andy Trang, MS2, “Fibers of Life”; 2nd: Mia Shan, MS2 “Nagare”; and 3rd: Vira Fomenko, MS2 “Ballooning Through Fairy Chimneys.” Performing arts competition: 1st: Sandra Gattas & Luke Yu, MS1, “When It’s Time”; 2nd: Stefan Brooks, Graduate student, “Best Days Ahead”; and 3rd: Nathan Calixto & Jeremy Martin, MS1, “Two Selections from ‘A Shropshire Lad’.”Thank you to our wonderful editors, staff and faculty for their support in making this year’s edition possible. We would like to give special thanks to our faculty advisor, Dr. Johanna Shapiro and Dr. Ellena Peterson, Associate Dean of Admissions & Outreach - this book would not have been possible without your guiding hands. We hope you enjoy PLEXUS 2016 – Cultivating Perspectives  Editors-In-Chief: Austin Momii, Tiffany PhamCreative Writing Editors: Carolyn Fall, Kaavya RamanDesign & Visual Editors: Heechul Jun, Faith Njoku, Kaavya Raman, Sunober Siddiqi, Beatrice Sun, Christopher VoMarketing & Outreach: Michael Bernaba, Carolyn Fall, Heechul Jun, Olivia Kaminsky, Helene Nepomuceno, Violeta Osegueda, Soe Thein, Jamie YabunoWebsite Design/ Digital Journal: Heechul Jun, Austin Momii, Sunober Siddiqi, Beatrice Sun To contribute to PLEXUS or to request a PLEXUS exhibit at your event, please visit www.uciplexus.org

PLEXUS is a student-organized publication that showcases artwork by UCI School of Medicine students, physicians, faculty, staff and patients. True to its name, PLEXUS aspires to connect those who seek to heal and to be healed through the unifying language of art.In 2015, PLEXUS invited submissions to complement our theme of ‘At the Intersection of Loss and Restoration”. The PLEXUS team was astounded by the depth and richness of the pieces submitted, and we thank each and every one of our submitters for their time and thought. Additionally, please find our multimedia submissions on our website, www.uciplexus.com. Previous publications and submissions are available online as well.We would like to congratulate this year’s winners of the medical student writing competition. 1st: Kyle Barbour, MS1 “Two Months,” 2nd: Leigh Goodrich, MS1 “That Good Night,” and 3rd: Kimberly Vu, MS1 “The First of Many Patient Progress Notes”.Thank you to our wonderful editors, staff and faculty for their support in making this year’s edition possible. We would like to give special thanks to our faculty advisor, Dr. Johanna Shapiro and Dr. Ellena Peterson, Associate Dean of Admissions and Outreach - this book would not have been possible without your guiding hands.We hope you enjoy PLEXUS 2015 – At the Intersection of Loss and Restoration.Editors-In-Chief: Kevin Gustafson, Jiwon ShinDigital Editor-In-Chief: Neil SaezCreative Arts: Evelyn Hoover, Katherine Stern, Katie McDaniel, Carolyn Fall, Kyle Barbour, Wilfred ManzanoLayout, Design & Visuals: Ben Nguyen, Austin Momii, Christopher Vo, Michael BernabaMarketing And Outreach: Helene Nepomuceno, Tiffany PhamWebsite Design: Austin Momii, Christopher VoWinners of PLEXUS Student Writing Competition made possible by UCISOM Humanities Department1st Place Winner: Kyle Barbour2nd Place Winner:  Leigh Goodrich3rd Place Winner: Kimberly VuTo contribute to PLEXUS or to request a PLEXUS exhibit at your event, please visit www.uciplexus.com.

OBJECTIVE: Rubella vaccine is not included in the immunization schedule in Myanmar. Although surveillance for outbreaks of measles and rubella is conducted nationwide, there is no routine surveillance for congenital rubella syndrome (CRS). Therefore, we organized a study to assess the burden of CRS. METHODS: From 1 December 2000 to 31 December 2002 active surveillance for CRS was conducted among children aged 0-17 months at 13 hospitals and 2 private clinics in Yangon, the capital city. Children with suspected CRS had a standard examination and a blood sample was obtained. All serum samples were tested for rubella-specific IgM; selected samples were tested for rubella-specific IgG and for rubella RNA by reverse transcriptase-polymerase chain reaction (RT-PCR). FINDINGS: A total of 81 children aged 0-17 months were suspected of having CRS. Of these, 18 children had laboratory-confirmed CRS (7 were IgM positive; 7 were RT-PCR positive; and 10 were IgG positive at > 6 months of age). One additional child who tested positive by RT-PCR and whose mother had had rubella during pregnancy but who had a normal clinical examination was classified as having congenital rubella infection. During 2001-02 no rubella outbreaks were detected in Yangon Division. In the 31 urban townships of Yangon Division, the annual incidence was 0.1 laboratory-confirmed cases of CRS per 1000 live births. CONCLUSION: This is the first population-based study of CRS incidence from a developing country during a rubella-endemic period; the incidence of CRS is similar to endemic rates found in industrialized countries during the pre-vaccine era. Rubella-specific IgG tests proved practical for diagnosing CRS in children aged > 6 months. This is one of the first studies to report on the use of rubella-specific RT-PCR directly on serum samples; further studies are warranted to confirm the utility of this method as an additional means of diagnosing CRS.

In 2001, Myanmar (Burma) had its largest outbreak of dengue--15,361 reported cases of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), including 192 deaths. That year, 95% of dengue viruses isolated from [...]