Vashisht A, Trebak M, Motiani RK. STIM and Orai proteins as novel targets for cancer therapy.

Endoplasmic reticulum (ER)-plasma membrane (PM) junctions form functionally active microdomains that connect intracellular and extracellular environments. While the key role of these interfaces in maintenance of intracellular Ca levels has been uncovered in recent years, the functional significance of ER-PM junctions in non-excitable cells has remained unclear. Here, we show that the ER calcium sensor protein STIM1 (stromal interaction molecule 1) interacts with the plasma membrane-localized adenylyl cyclase 6 (ADCY6) to govern melanogenesis. The physiological stimulus α-melanocyte-stimulating hormone (αMSH) depletes ER Ca stores, thus recruiting STIM1 to ER-PM junctions, which in turn activates ADCY6. Using zebrafish as a model system, we further established STIM1's significance in regulating pigmentation STIM1 domain deletion studies reveal the importance of Ser/Pro-rich C-terminal region in this interaction. This mechanism of cAMP generation creates a positive feedback loop, controlling the output of the classical αMSH-cAMP-MITF axis in melanocytes. Our study thus delineates a signaling module that couples two fundamental secondary messengers to drive pigmentation. Given the central role of calcium and cAMP signaling pathways, this module may be operative during various other physiological processes and pathological conditions.

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Patients admitted to an ICU require constant monitoring to assess the need for and effectiveness of interventions. Comprehensive serial assessments are important for timely diagnosis, detection of status changes, treatment planning, monitoring patient response, and optimal patient outcomes. 1 The neurologic examination (neuro exam) is a vital part of such assessments. A comprehensive neuro exam includes assessing seven domains: consciousness, injury severity, speech, cranial nerve function, pain, motor function, and sensory function. 2 The neuro exam is performed to assess for deterioration in a patient's consciousness and to detect new focal neurologic deficits, which can happen quickly and may result in worsened short-or long-term morbidity. 3 Documentation is a critical part of team members' communication across shift handoffs and level-ofcare transitions. Yet the degree to which both the performance and the documentation of the neuro exam correlate is not well established. Moreover, while a comprehensive neuro exam is commonly required for patients admitted to a neuroscience ICU, some form of a neuro exam is recommended for patients in all ICUs. 4 There has been little research examining which components of the neuro exam are assessed in the medical ICU (MICU), surgical An observational study reveals differences in charting by RNs versus providers.ICU (SICU), and cardiovascular ICU (CVICU), where patients with primary neurologic problems are admitted less often. 4Study purpose. This study examined documentation practices to identify the frequency and components of the neuro exam typically documented by RNs and by providers when caring for patients in the MICU, SICU, and CVICU. (For this study, providers included medical fellows and resident or attending physicians, NPs, and physician assistants.) BACKGROUNDNeurologic complications can and do occur in patients with or without a primary neurologic diagnosis. 5,6 This includes transient neurologic conditions as well as severe complications. For example, patients admitted to a MICU, SICU, or CVICU are at increased risk for developing delirium secondary to a host of health care-associated events. 7,8 In more extreme cases, a postsurgical CVICU patient could experience acute ischemic stroke, or a MICU patient's level of consciousness could progress to coma as a result of metabolic derangements. 9, 10 Clearly, neuro exams are critical to patient care in every ICU.In the neuroscience ICU, the neuro exam is typically highly detailed, designed to evaluate the functional status of every component of the ner-

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BACKGROUND: Delirium is associated with worse outcomes, but there is a gap in literature identifying nurse-led interventions to reduce delirium in postoperative (postop) surgical spine patients. Because family presence has been associated with a variety of beneficial effects, we aimed to examine whether family presence in the spine intensive care unit (ICU) during the night after surgery was associated with less confusion or delirium on postop day 1. METHODS: This is a prospective nonrandomized pilot clinical trial with pragmatic sampling. Group designation was assigned by natural history. The family-present group was designated as patients for whom a family member remained present during the first night after surgery. The unaccompanied group was designated as patients who did not have a family member stay the night. Data include the Richmond Agitation Sedation Scale, the Confusion Assessment Method for the ICU, the 4AT (Alertness, Attention, Abbreviated mental test, and Acute change) score, and confusion measured with the orientation item on the Glasgow Coma Scale. Baseline data were collected after admission to the spine ICU and compared with the same data collected in the morning of postop day 1. RESULTS: At baseline, 5 of 16 patients in the family-present group (31.3%) had at least 1 incidence of delirium or confusion. Similarly, 6 of 14 patients in the unaccompanied group (42.9%) had at least 1 incidence of delirium or confusion. There was a clinically relevant, but not statistically significant, reduction in postop day 1 delirium or confusion comparing the family-present (6.3%) and unaccompanied (21.4%) groups ( P = .23). CONCLUSION: Family presence may reduce delirium and confusion for patients after spine surgery. The results support continued research into examining nurse-led interventions to reduce delirium and improve outcomes for this population.