Miracle-dz/UniFAR-FTUs huggingface dataset:
Influence of the Retrocolic Versus Antecolic Route for Alimentary Tract Reconstruction on Delayed Gastric Emptying After Pancreatoduodenectomy

Objective: This study aimed to determine whether retrocolic alimentary tract reconstruction is noninferior to antecolic reconstruction in terms of DGE incidence after pancreatoduodenectomy (PD) and investigated patients’ postoperative nutritional status. Summary of Background Data: The influence of the route of alimentary tract reconstruction on DGE after PD is controversial. Methods: Patients from 9 participating institutions scheduled for PD were randomly allocated to the retrocolic or antecolic reconstruction groups. The primary outcome was incidence of DGE, defined according to the 2007 version of the International Study Group for Pancreatic Surgery definition. Noninferiority would be indicated if the incidence of DGE in the retrocolic group did not exceed that in the antecolic group by a margin of 10%. Patients’ postoperative nutrition data were compared as secondary outcomes. Results: Total, 109 and 103 patients were allocated to the retrocolic and antecolic reconstruction group, respectively (n = 212). Baseline characteristics were similar between both groups. DGE occurred in 17 (15.6%) and 13 (12.6%) patients in the retrocolic and antecolic group, respectively (risk difference; 2.97%, 95% confidence interval; −6.3% to 12.6%, which exceeded the specified margin of 10%). There were no differences in the incidence of other postoperative complications and in the duration of hospitalization. Postoperative nutritional indices were similar between both groups. Conclusions: This trial could not demonstrate the noninferiority of retrocolic to antecolic alimentary tract reconstruction in terms of DGE incidence. The alimentary tract should not be reconstructed via the retrocolic route after PD, to prevent DGE.
Ultrasonic Monitoring of Dentin Demineralization

Demineralization is a process of loss of minerals in the dental hard tissue that affects seriously the health of the patients, as it diminishes the tooth resistance, generating chewing problems by altering the occlusal structure, hypersensitivity, and pulpal problems. Demineralization can be produced by pathological processes as erosion or caries, or by surgical processes as etching. Due to the complexity of natural demineralization processes, it is mandatory to provide quantitative and standardized tests to allow their study in controlled laboratory conditions. Ultrasonic techniques are suitable for this purpose as they are nondestructive, quick, and provide localized mechanical information about the tissue, which is related with its degree of demineralization. In the present work, we evaluate the complete process of demineralization of the human dentin under controlled laboratory conditions using a pulse-echo ultrasonic technique. Up to 15 human dentin teeth have been demineralized with phosphoric acid at 10%. The time-of-flight measurements using the pulse-echo system allows to obtain the speed of sound in healthy (3415 m/s) and demineralized dentin tissue (1710 m/s), as well as to characterize the dynamical process of the acid penetration, which generates well-defined boundaries between two media (demineralized and mineralized dentin), showing very different mechanical properties. These boundaries advance in depth at an initial rate of $2.9~\mu \text{m}$ /min, decelerating at −9.3 nm/min2 until the whole demineralization of the sample is achieved. In addition, the technique allows to measure the relevance of the demineralization produced by the acid residues inside the tooth once it has been removed from the acidic solution. Beyond the assessment of artificial demineralization lesions under laboratory conditions, as demonstrated in this article, the proposed technique opens new approaches to the assessment of demineralization caused by natural caries in vivo.
Hydrogen sulfide induces Ca2+ signal in guard cells by regulating reactive oxygen species accumulation

ABSTRACT Hydrogen sulfide (H2S) is an important gas signal molecule, but little is known about its signal mechanism. Ca2+ is an important second messenger in plant cells, and its fluctuation in the cytoplasm causes downstream physiological responses. Our previous study found that H2S can induce the accumulation of hydrogen peroxide (H2O2). We also found that reactive oxygen species (ROS) can further induce the Ca2+ influx in guard cells by noninvasive micro-teat technology (NMT). This study confirmed that the accumulation of reactive oxygen species to induce Ca2+ signal in guard cells, resulting in stomatal closure. Thus, revealing a novel mechanism of H2S promoting stomatal closure.
Acne as an altered dermato‐endocrine response problem

Acne is the most common skin disease in adolescent Westernized populations. Several data support the involvement of the mammalian target of rapamycin complex 1 (mTORC1) signalling in the interplay between androgens, insulin, insulin‐like growth factor (IGF1) and high‐glycaemic index diet in acne. The peroxisome proliferator–activated receptor γ (PPARγ) is involved in both differentiation and anti‐inflammatory response. Low differentiated sebocytes showed decreased expression of PPARγ and increased level of insulin and IGF‐1 receptors, resulting in the production of acne‐like sebum and inflammatory mediators. In this viewpoint, we discuss how in acne the dysregulation of proliferation and differentiation processes in sebocytes and keratinocytes may be associated with altered response to androgens and other hormones, such as insulin or IGF‐1. Moreover, we propose PPARγ modulation as an innovative therapeutic approach to normalize sebocyte differentiation process, interfering with the different mechanisms involved in altered pilosebaceous unit.
Improving the Environmental Risk Assessment of Substances of Unknown or Variable Composition, Complex Reaction Products, or Biological Materials

Substances of unknown or variable composition, complex reaction products, or biological materials (UVCBs) pose unique risk assessment challenges to regulators and to product registrants. These substances can contain many constituents, sometimes partially unknown and/or variable, depending on fluctuations in their source material and/or manufacturing process. International regulatory agencies have highlighted the difficulties in characterizing UVCBs and assessing their toxicity and environmental fate. Several industrial sectors have attempted to address these issues by developing frameworks and characterization methods. Based on the output of a 2016 workshop, this critical review examines current practices for UVCB risk assessment and reveals a need for a multipronged and transparent approach integrating whole‐substance and constituent‐based information. In silico tools or empirical measurements can provide information on discrete and/or blocks of UVCB constituents with similar hazard properties. Read‐across and/or whole‐substance toxicity and fate testing using adapted emerging methods can provide whole‐substance information. Continued collaboration of stakeholders representing government, industry, and academia will facilitate the development of practical testing strategies and guidelines for addressing regulatory requirements for UVCBs. Environ Toxicol Chem 2020;39:2097–2108. © 2020 Health and Environmental Sciences Institute. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
Genetic Grouping of Bradyrhizobium Strains Compatible with Soybean (Glycine max L. Merr.) Harboring Rj?gene by AFLP?fingerprinting Analysis

Soybean (Glycine max L. Merr.) cultivars form nodules on roots by infection with Bradyrhizobium strains. However, soybean cultivars harbor nodulation conditioning genes, Rj2, Rj3 and Rj4 form ineffective nodules with some strains of Bradyrhizobium. These strains were classified into nodulation–types A, B and C through their compatibility with Rj–gene. The type B was incompatible with Rj2Rj3–cultivars while the type C was incompatible with Rj4–ones. The type A was compatible with both Rj2Rj3– and Rj4–cultivars. In this study, in order to examine the relationship between phenotype (nodulation type) and genotype of Bradyrhizobium strains for nodulation, genotyping of Bradyrhizobium strains of each nodulation type was performed and classified by AFLP (Amplified Fragment Length Polymorphism) fingerprinting. On this dendrogram, two clusters could be distinguished at a similarity level of 77%, and the cluster I was divided into 4 sub–clusters. The sub–cluster Ia had types A and B, and the sub–cluster Ib had types A, B and C. The cluster II had types A and C. These results were similar to that of a RFLP analysis performed in our laboratory. Thus, Bradyrhizobium strains of each nodulation type unformed a specific cluster. However, types A and B formed one sub–cluster, and types A and C did another cluster. These findings indicated that type B was distantly related to type C in regard to the structure of genomic DNA, while type A located in an intermediate position between type B and type C.
Exploring Readiness for Teleprecepting in Psychiatric Mental Health Nurse Practitioner Training

OBJECTIVE: Telehealth offers a solution to many challenges in health care, including the shortage of psychiatric providers. Recently the need to limit patient and provider exposure to coronavirus disease 2019 (COVID-19) has escalated implementation of telehealth across the globe. As telehealth utilization expands, its role in nursing education and training requires systematic evaluation. Since publication of the National Organization of Nurse Practitioner Faculty white paper supporting telehealth in health care delivery and nurse practitioner education, several studies have demonstrated successful didactic instruction and training in telehealth. However, a recent literature review found no studies evaluating the use of telehealth technology as a means of precepting in clinical training. METHODS: This small-scale qualitative study investigates the readiness of one behavioral health clinic to provide teleprecepting to psychiatric mental health nurse practitioner students. Two preceptors and one student were interviewed using a peer-reviewed semistructured interview guide using video chat. Responses were reviewed, coded, and categorized into themes. RESULTS: Thematic analysis of the interviews revealed three categories for consideration in establishing teleprecepting. Clinical factors, logistics, and comparison with traditional precepting are discussed. Interviewees viewed teleprecepting as a viable method of increasing access to clinical training. CONCLUSIONS: This project supports teleprecepting as a feasible strategy for improving access to clinical training and as a technological resource that merits systematic evaluation. Practice guidelines are needed for teleprecepting of advanced practice registered nurse students, and both preceptors and students may benefit from training to support best practices prior to implementation.
Putative founder effect in the Polish, Iranian and United States populations for the L144S SOD1 mutation associated with slowly uniform phenotype of amyotrophic lateral sclerosis

Abstract Mutations in SOD1 cause approximately 12–25% of familial ALS and ≈2% of apparently sporadic ALS cases. Clinical phenotypes linked to SOD1 mutations are heterogeneous and intra-familial variability of the clinical phenotype is frequently observed. SOD1 L144S mutation, identified also in Brazil, Iran and United States, is the second most frequent mutation among ALS patients in Poland. So far, 10 FALS pedigrees with SOD1 L144S mutation have been reported worldwide. The aim of the study was to establish the origin of SOD1 L144S mutation in geographically distinct populations. The clinical presentation of the Polish patients was compared with those from the previously reported populations (26 ever-reported patients). Clinically, L144S mutation is associated with both sporadic and familial ALS of relatively slow uniform course, a prevalent onset in the lower limbs, either classic or PMA presentation and a long survival time. Like in the case of other previously described SOD1 mutations, there was an intra-familial heterogeneity and reduced penetrance for ALS was observed. We propose that the L144S SOD1 mutation in the three studied populations has a common founder most likely of Polish origin.
Identification of Players Controlling Meristem Arrest Downstream of the FRUITFULL-APETALA2 Pathway1[OPEN]

At the end of the plant reproductive phase, the FRUITFULL-APETALA2 pathway modulates responses to both endogenous and exogenous factors to coordinate inflorescence meristem arrest. The end of the reproductive phase in monocarpic plants is determined by a coordinated arrest of all active meristems, a process known as global proliferative arrest (GPA). GPA is linked to the correlative control exerted by developing seeds and, possibly, the establishment of strong source-sink relationships. It has been proposed that the meristems that undergo arrest at the end of the reproductive phase behave at the transcriptomic level as dormant meristems, with low mitotic activity and high expression of abscisic acid response genes. Meristem arrest is also controlled genetically. In Arabidopsis (Arabidopsis thaliana), the MADS-box transcription factor FRUITFULL induces GPA by directly repressing genes of the APETALA2 (AP2) clade. The AP2 genes maintain shoot apical meristem (SAM) activity in part by keeping WUSCHEL expression active, but the mechanisms downstream of this pathway remain elusive. To identify target genes, we performed a transcriptomic analysis, inducing AP2 activity in meristems close to arrest. Our results suggest that AP2 controls meristem arrest by repressing genes related to axillary bud dormancy in the SAM and negative regulators of cytokinin signaling. In addition, our analysis indicates that genes involved in the response to environmental signals also respond to AP2, suggesting that it could modulate the end of flowering by controlling responses to both endogenous and exogenous signals. Our results support the previous observation that at the end of the reproductive phase the arrested SAM behaves as a dormant meristem, and they strongly support AP2 as a master regulator of this process.
Predictive Value of Pulmonary Arterial Compliance in Systemic Lupus Erythematosus Patients With Pulmonary Arterial Hypertension

Supplemental Digital Content is available in the text. Pulmonary arterial hypertension is a serious complication of systemic lupus erythematosus. It is characterized by increased right ventricular afterload which mainly comprises pulmonary arterial compliance (PAC) and pulmonary vascular resistance. The role of PAC in predicting the outcome of systemic lupus erythematosus-associated pulmonary arterial hypertension has not been investigated yet. Between February 2012 to December 2016, 120 consecutive patients diagnosed with systemic lupus erythematosus-associated pulmonary arterial hypertension based on right heart catheterization were enrolled, prospectively. Baseline clinical characteristics and hemodynamic assessment were analyzed. Baseline right ventricular afterload was stratified according to the PAC and pulmonary vascular resistance. The end point was a composite of all-cause mortality and clinical worsening. Among them, end points occurred in 49 (41%) patients after 15 months (interquartile range, 8.5–24.0). Patients with a PAC <1.39 mL/mm Hg had a 3.09-fold higher risk (95% CI, 1.54–6.20, P=0.001) of the end point events than the patients with a PAC ≥1.39 mL/mm Hg. Multivariable Cox regression analysis showed that stratified right ventricular afterload was the only independent predictor for the end point (hazard ratio, 2.009 [95% CI, 1.390–2.904], P<0.001). A 3-group prediction risk was created. The patients with the highest right ventricular afterload (PAC <1.39 mL/mm Hg and pulmonary vascular resistance ≥10.3Wood Unit) had the highest risk (χ2, 6.10; P<0.014) of experiencing the end point. Our results suggest that PAC is a good predictor of mortality and clinical worsening in systemic lupus erythematosus-associated pulmonary arterial hypertension. PAC, in addition to pulmonary vascular resistance, may be an attractive tool for screening high-risk populations in these patients.
Response to Alfonso Santamaría-Gadea and Colleagues

with COVID-19 with smell loss via a ‘‘face-validated’’ anosmia reporting tool for clinicians. Face validity is merely a subjective superficial assessment of whether the measurement procedure that you use appears to be valid. The authors reported 73% of anosmia occurring before the diagnosis of COVID-19. This percentage was inadequately used as OD prevalence in the Tong et al forest plot. The second study, by Moein et al, reported an alarming 98% prevalence of OD in confirmed COVID-19 cases among Iranian patients. They used the University of Pennsylvania Smell Identification Test (UPSIT), a well-validated psychophysical smell test in an American population. However, the UPSIT has been demonstrated not to be valid for an Iranian population due to a large number of unfamiliar odors. Indeed, a modified UPSIT exists with different normative values for Persian population that includes only 24 of the 40 original odorants. The third study, by Lechien et al, showed an 85% prevalence of OD based on a short version of the Questionnaire of Olfactory Disorders–Negative Statements. To our knowledge, this questionnaire is validated only in German and English languages; however, the authors included nativespeaking patients from France, Belgium, Spain, and Italy. Tong et al placed special emphasis on these 3 articles in their meta-analysis. However, on the basis of the evidence mentioned here, we think that the authors may yield false results by overestimating OD prevalence in patients with COVID-19. Meta-analyses are powerful scientific tools used to condense findings from individual studies, and their popularity is hence increasing. However, their validity depends on the quality of studies involved; thus, publication of prevalence numbers is nice but ultimately pointless if the quality of primary data is low and heterogeneous.
Assessing the current and future potential geographic distribution of the American dog tick, Dermacentor variabilis (Say) (Acari: Ixodidae) in North America

The American dog tick, Dermacentor variabilis, is a veterinary- and medically- significant tick species that is known to transmit several diseases to animal and human hosts. The spatial distribution of this species in North America is not well understood, however; and knowledge of likely changes to its future geographic distribution owing to ongoing climate change is needed for proper public health planning and messaging. Two recent studies have evaluated these topics for D. variabilis; however, less-rigorous modeling approaches in those studies may have led to erroneous predictions. We evaluated the present and future distribution of this species using a correlative maximum entropy approach, using publicly available occurrence information. Future potential distributions were predicted under two representative concentration pathway (RCP) scenarios; RCP 4.5 for low-emissions and RCP 8.5 for high-emissions. Our results indicated a broader current distribution of this species in all directions relative to its currently known extent, and dramatic potential for westward and northward expansion of suitable areas under both climate change scenarios. Implications for disease ecology and public health are discussed.
Microbiological profile and antimicrobial resistance among diabetic foot infections in Lebanon

Diabetic Foot Infection (DFI) is a challenging complication of diabetes mellitus with a high burden in the Middle East where there is a marked increase in diabetes prevalence and complications. Early detection of DFI and the infectious organisms could result in the early initiation of appropriate antibiotic therapy and improved outcomes. DFI microbiological profiles differ between countries. In our region, Western guidelines are used when initiating treatment for DFI in the absence of local guidance. The purpose of our study was to determine the microbiologic profile and antimicrobial susceptibility of the DFI admissions at a large tertiary referral centre in Beirut and review other reported series in Lebanon and our region. This is a retrospective observational study of patients with DFI admitted to the American University of Beirut Medical Centre from January 2008 to June 2017. The bacteriologic isolation and antimicrobial susceptibility tests were performed according to standard microbiological methods. Between 2008 and 2017, 319 diabetic patients with DFU were admitted to AUBMC, and deep‐tissue cultures were taken for 179 patients. From 179 deep tissue cultures, 314 bacterial isolates were obtained. Fifty‐four percent of patients had the polymicrobial infection. Aerobic gram‐negative rods (GNR) were more prevalent than gram‐positive cocci (GPC) (55%, 39%, respectively). The most common isolate was Escherichia coli (15%) followed by Enterococcus (14%) and Pseudomonas aeruginosa (11%). Staphylococcus aureus isolates accounted for 9% with 50% of them being methicillin‐resistant (MRSA). Among Enterobacteriaceae, 37% of isolates were fluoroquinolone‐resistant, 25% were ESBL producers, and 2% were carbapenem‐resistant. Antibiotic resistance was significantly associated with prior usage of antibiotics. Anaerobes were isolated in 1% and Candida species in 5% of isolates. The sensitivity, specificity, PPV, and NPV of swab culture recovery of pathogens compared with deep tissue culture were (76%, 72%, 76%, 72%) and (94%, 81%, 91%, 86%) for gram‐positive and gram‐negative organisms, respectively. The microbiological profile of DFI in Lebanon is comparable to other countries in the MENA region with big differences compared with the West. Therefore, it is imperative to develop local guidelines for antimicrobial treatment. The high prevalence of GNR in DFI and the high fluoroquinolone resistance should be taken into consideration when choosing empiric antibiotics. Empiric treatment for MRSA or Pseudomonas does not appear necessary except for patients with specific risk factors.
Targeted‐dose of busulfan: Higher risk of sinusoidal obstructive syndrome observed with systemic exposure dose above 5000 µMol⸱min. A historically controlled clinical trial

Busulfan is given in the conditioning regimens preceding hematopoietic stem cell transplantation (HSCT), and plasma levels can be monitored. A targeted, individualized systemic exposure (SE) dose can be achieved by calculating the area under the plasma concentration versus time curve (AUC). The objective of this study was to determine a cutoff value for safety for the AUC for busulfan plasma levels in patients undergoing HSCT. A total of 149 consecutive HSCT patients were studied. After an oral test dose of busulfan, we set target doses of 4000, 5000, or 6000 µMol⸱min/day, and analyzed the AUC of oral or intravenous Bu. These patients were compared with 53 historical control subjects who had received myeloablative conditioning regimen without busulfan pharmacokinetic monitoring. Using a test dose and the administration route had no impact on the sinusoidal obstructive syndrome (SOS) incidence, transplant‐related mortality or 1‐year overall survival. However, patients receiving busulfan at doses set up at AUC > 5000 had an increased risk to develop SOS after HSCT (hazard ratio 3.39, p = 0.034, 95% CI 1.09–10.52). Adjusting the busulfan dose according to SE levels target dose during conditioning is associated with lower rates of oral severe mucositis and SOS. A cutoff of 5000 µMol⸱min is safe and does not impair survival.