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The extracellular matrix comprises a network of macromolecules such as collagens, proteoglycans and glycoproteins. VWA1 (von Willebrand factor A domain containing 1) encodes a component of the extracellular matrix that interacts with perlecan/collagen VI, appears to be involved in stabilizing extracellular matrix structures, and demonstrates high expression levels in tibial nerve. Vwa1-deficient mice manifest with abnormal peripheral nerve structure/function; however, VWA1 variants have not previously been associated with human disease. By interrogating the genome sequences of 74 180 individuals from the 100K Genomes Project in combination with international gene-matching efforts and targeted sequencing, we identified 17 individuals from 15 families with an autosomal-recessive, non-length dependent, hereditary motor neuropathy and rare biallelic variants in VWA1. A single disease-associated allele p.(G25Rfs*74), a 10-bp repeat expansion, was observed in 14/15 families and was homozygous in 10/15. Given an allnervation rather than indicating an additional myopathic disease process. Duplex reverse transcription polymerase chain reaction and immunoblotting using patient fibroblasts revealed that the founder allele results in partial nonsense mediated decay and an absence of detectable protein. CRISPR and morpholino vwa1 modelling in zebrafish demonstrated reductions in motor neuron axonal growth, synaptic formation in the skeletal muscles and locomotive behaviour. In summary, we estimate that biallelic variants in VWA1 may be responsible for up to 1% of unexplained hereditary motor neuropathy cases in Europeans. The detailed clinical characterization provided here will facilitate targeted testing on suitable patient cohorts. This novel disease gene may have previously evaded detection because of high GC content, consequential low coverage and computational difficulties associated with robustly detecting repeat-expansions. Reviewing previously unsolved exomes using lower QC filters may generate further diagnoses.Veratrum poisonings are known to the toxicology literature as multiple Veratrum species grow in different parts of the Northern Hemisphere and are occasionally ingested by mistake. Veratrum toxicity is attributed to the steroidal alkaloids contained in all parts of the plant. In Russia Veratrum poisonings are more common since there is an over-the-counter Veratrum Lobelianum-based tincture, Veratrum Aqua (VA), that is topically used for treatment of lice infestation. Despite its toxicity, VA is misused in traditional medicine as a remedy for alcohol use disorder. We describe four cases of VA poisoning that occurred in Moscow, Russia. this website Three main Veratrum Lobelianum alkaloids (jervine, protoveratrine A and protoveratrine B), were determined in patient plasma and urine samples using liquid chromatography tandem mass-spectrometry (LC-MS/MS). Here we describe a novel validated LC-MS/MS method for jervine and protoveratrine A quantification. Simple and rapid liquid-liquid extraction with methyl tert-butyl ether was utilized for analyte extraction. Chromatographic separation was achieved using Poroshell 120 EC-C18 column, and the total run time was 14 min. The lower limit of quantification was 0.1 ng/mL for jervine and proA in both plasma and urine. Biological samples were obtained upon hospital admission and during treatment, thus enabling to get a better understanding of the alkaloid elimination profile. Upon admission plasma concentrations of jervine (concentration range 0.10-5.01 ng/mL) prevailed over protoveratrine A (concentration range 0-0.67 ng/mL). At this time, protoveratrine A already reached maximum concentrations in urine (concentration range 0.15-37.70 ng/mL). Maximum concentrations of jervine in urine were observed 24 hours after admission (concentration range 0.10-9.55 ng/mL). In all cases plasma concentrations of Veratrum alkaloids correlated with condition severity. Since none of the patients confirmed VA intake, instrumental analysis was the basis for the definitive diagnosis of VA poisoning.

Training and education may be effective strategies for the prevention of work-related contact dermatitis. While there is some information in the literature related to skin-specific training experiences, there is very little information available on workers' preferences related to content and format and to barriers and facilitators to training.

To understand workers' experiences and preferences for workplace training and barriers and facilitators to training.

Following ethics approval, 24 patients with work-related contact dermatitis participated in semi-structured interviews obtaining information on training experiences, perceived training effectiveness, desired training characteristics, and barriers and facilitators to training. An inductive thematic analysis was used to identify themes.

Though many workers had received general workplace health and safety training, none reported training about skin exposure and disease prevention. Examples of what the workers perceived as good training included first aid training, while Workplace Hazardous Materials Information System training was felt to be ineffective. Desired content of training for preventing skin exposures included information on the hazards, short- and long-term health impacts, and potential symptoms and personal protective equipment. They desired multi-modal presentation (e.g. in-person and online supplement), hands-on training with visual content and suggested the use of personal stories and negative messaging. Training that could be applied outside the workplace was also valued. Barriers and facilitators to implementation included factors related to the training program itself, the organization, and the regulatory landscape.

These findings can help to shape more effective workplace training programs for skin protection.

These findings can help to shape more effective workplace training programs for skin protection.

In 2020, the Guidelines Task Force conducted another systematic review of the relevant literature on deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) to update the original 2014 guidelines to ensure timeliness and accuracy for clinical practice.

To conduct a systematic review of the literature and update the evidence-based guidelines on DBS for OCD.

The Guidelines Task Force conducted another systematic review of the relevant literature, using the same search terms and strategies as used to search PubMed and Embase for relevant literature. The updated search included studies published between 1966 and December 2019. The same inclusion/exclusion criteria as the original guideline were also applied. Abstracts were reviewed and relevant full-text articles were retrieved and graded. Of 864 articles, 10 were retrieved for full-text review and analysis. Recommendations were updated according to new evidence yielded by this update.

Seven studies were included in the original guideline, reporting the use of bilateral DBS as more effective in improving OCD symptoms than sham treatment.

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