Miracle-dz/UniFAR-FTUs huggingface dataset:
Disparities in Elevated Body Mass Index in Youth Receiving Care at Community Health Centers

Childhood obesity has increased significantly in the United States. Racial subgroups are often grouped into categories in research, limiting our understanding of disparities. This study describes the prevalence of obesity among youth of diverse racial and ethnic backgrounds receiving care at community health centers (CHCs). This cross-sectional study describes the prevalence of elevated body mass index (BMI) (≥85th percentile) and obesity (≥95th percentile) in youth aged 9 to 19 years receiving care in CHCs in 2014. Multilevel logistic regression estimated the prevalence of elevated BMI and obesity by age, race/ethnicity, and sex. Among 64 925 youth, 40% had elevated BMI and 22% were obese. By race, obesity was lowest in the combined Asian/Pacific Islander category (13%); however, when subgroups were separated, the highest prevalence was among Native Hawaiians (33%) and Other Pacific Islanders (42%) and the lowest in Asians. By sex, Black females and Hispanic and Asian males were more likely to be obese. By age, the highest prevalence of obesity was among those aged 9 to 10 years (25%). Youth served by CHCs have a high prevalence of obesity, with significant differences observed by race, sex, and age. Combining race categories obscures disparities. The heterogeneity of communities warrants research that describes different populations to address obesity.
Early evidence of the associations between an anti-e-cigarette mass media campaign and e-cigarette knowledge and attitudes: results from a cross-sectional study of youth and young adults

Objective Antismoking mass media campaigns have contributed to significant declines in combustible tobacco use among young people. This study evaluates a national anti-e-cigarette campaign to determine its association with knowledge, attitudes and beliefs in the context of increasing e-cigarette use in the USA. Methods A national sample of respondents aged 15–24 years (n=8421) was drawn from a repeated cross-sectional online panel survey (220 participants/week) (October 2018 to December 2019). Self-reported exposure to the truth anti-e-cigarette campaign was measured according to level of ad awareness. Outcomes were subjective knowledge of campaign-targeted facts about e-cigarettes and attitudinal constructs about perceived e-cigarette harm, social unacceptability and anti-industry sentiments. Covariates included respondent demographics, current e-cigarette use and cigarette use, parental smoking, sensation seeking, mental health and growth in e-cigarette sales. Results Ad awareness was associated with knowledge that e-cigarette users are more likely to start smoking (low OR: 1.28, 95% CI 1.14 to 1.44; high OR: 1.88, 95% CI 1.66 to 2.13) and of the nicotine content of JUUL compared with cigarettes (low OR: 1.63, 95% CI 1.45 to 1.82; high OR: 2.50, 95% CI 2.21 to 2.84). High ad awareness was associated with knowledge that the long-term health effects of JUUL use are unknown (OR: 1.88, 95% CI 1.57 to 2.28). High ad awareness was associated with significantly higher perceived product harm (OR: 1.35, 95% CI 1.18 to 1.54), social unacceptability (OR: 1.32, 95% CI 1.15 to 1.53) and anti-industry attitudes (OR: 1.40, 95% CI 1.21 to 1.62), compared with respondents with no awareness. Conclusions Young people with awareness of anti-e-cigarette ads demonstrate higher levels of campaign-targeted knowledge, attitudes and beliefs. Future campaign evaluation priorities include measuring the campaign effects on e-cigarette use behaviours.
Volumetric and Morphological Analysis of Mandibular Condyles of Angle Class 2 and 3 Malocclusion Patients

Supplemental Digital Content is available in the text Abstract This study was conducted to provide diametric and volumetric data of mandibular condyles from patients with Angle class 2 and 3 malocclusions by semiautomatic segmentation based upon cone-beam computed tomography. Cone-beam computed tomography images of 79 patients were analyzed. By using the open-source software “ITK-SNAP”, diametric and volumetric measurements of 158 mandibular condyles were performed. Descriptive statistics were calculated for all normally distributed variables. Correlations between patients with Angle class 2 and 3 were calculated with the independent Student t test. P values P < 0.05 were considered significant. Irrespective of the side, patients with class 2 malocclusion showed smaller mandibular condyles (right: 1.128 ± 0.504 cm3; left: 1.222 ± 0.596 cm3) than patients with class 3 (right: 1.504 ± 0.361 cm3; left: 1.493 ± 0.335 cm3). These results were reproducible also in accordance with the diametric measurement (class 2 right: 16.75 ± 2.72 mm; left: 17.04 ± 3.01 mm) (class 3 right: 18.24 ± 2.54 mm; left: 18.32 ± 2.13 mm). However, volumetric differences were highly statistically significant (right: P = 0.001; left: P = 0.018) while diametric differences were slightly significant for the right and not significant for the left side (right: P = 0.042; left: P = 0.053). Diametric and volumetric analyses offer important additional information based on 3D images of cone-beam computed tomography technology. Significant differences in diameter and volume of mandibular condyles could be assessed between different classes of malocclusion.
Avapritinib for Systemic Mastocytosis

ABSTRACT Introduction Systemic mastocytosis (SM) is a rare myeloid neoplasm driven in ≈95% of cases by activating KIT mutations, usually D816V. SM can be indolent (ISM), smoldering (SSM) and advanced (AdvSM), the latter characterized by organ damage resulting from infiltrating neoplastic mast cells. The vast majority of cases are indolent, with near-normal life expectancy, although symptoms can be severe. AdvSM, comprising aggressive SM, SM with an associated hematologic neoplasm and mast cell leukemia, however, carries a poor prognosis. Avapritinib is a highly potent and selective inhibitor of mutant KIT. Areas Covered We provide an overview of SM, including the current therapeutic landscape, and discuss avapritinib in detail: its chemistry and discovery, pharmacodynamic and pharmacokinetic data, current approval status and safety and efficacy profiles in both advanced and non-advanced SM. Expert Opinion With a response rate of 75% amongst evaluable patients with AdvSM and marked reductions observed in measures of mast cell and disease burden, avapritinib stands out as a highly effective targeted therapy for this mutant KIT-driven disease. Cognitive impairment may occur, and intracranial hemorrhage has been reported, particularly in association with severe thrombocytopenia. Early results in patients with ISM/SSM are encouraging. Avapritinib is now approved in the US for AdvSM.
Beyond chronic migraine: a systematic review and expert opinion on the off-label use of botulinum neurotoxin type-A in other primary headache disorders

ABSTRACT Introduction: Botulinum neurotoxin type-A (BoNTA) is licensed for the treatment of chronic migraine (CM), but it has been tested off-label as a therapeutic choice in other primary headaches (PHs). We aimed to provide a systematic review and expert opinion on BoNTA use in PHs, beyond CM. Areas covered: After providing an overview on PHs and mechanism of BoNTA action, we report the results of a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of BoNTA therapeutic trials in PHs beyond CM. Studies and results were reviewed and discussed, and levels of evidence were graded. We also collected data on relevant ongoing trials. Expert opinion: Although there are contradictory findings on PHs other than CM, BoNTA may represent a therapeutic option for patients who do not respond to conventional prophylactic treatments. Based on limited available evidence, BoNTA may be considered in refractory tension-type headache, trigeminal autonomic cephalalgias, primary stabbing headache, nummular headache, hypnic headache, and new daily persistent headache, after the primary nature of cephalalgia has been documented and other drugs have failed. Experienced physicians in BoNTA treatment are required to guide the therapeutic protocol for each patient to optimize good and safe outcomes.
Biologics in severe asthma: Which one, When and Where?

Biologics have transformed the treatment of patients with type 2 (T2)-inflammation driven severe asthma (1). In appropriately selected patients, biologic use reduces asthma exacerbations and reliance on maintenance oral steroids (mOCS) and improves lung function and quality of life. The decision to initiate a biologic is usually led by specialist multi-disciplinary teams (MDTs).
Defining the undefinable: the black box problem in healthcare artificial intelligence

The ‘black box problem’ is a long-standing talking point in debates about artificial intelligence (AI). This is a significant point of tension between ethicists, programmers, clinicians and anyone else working on developing AI for healthcare applications. However, the precise definition of these systems are often left undefined, vague, unclear or are assumed to be standardised within AI circles. This leads to situations where individuals working on AI talk over each other and has been invoked in numerous debates between opaque and explainable systems. This paper proposes a coherent and clear definition for the black box problem to assist in future discussions about AI in healthcare. This is accomplished by synthesising various definitions in the literature and examining several criteria that can be extrapolated from these definitions.
Growth of malnourished infants and children: how is inflammation involved?

Malnutrition may be classified as acute or chronic and by severity into mild, moderate, and severe forms. Features of chronic malnutrition include diminished weight gain, stunted growth, mental apathy, and developmental delay. Acute protein-energy malnutrition (PEM) manifests itself most commonly as marasmus (adapted form) but also as kwashiorkor; however, some children may have signs of both (marasmic kwashiorkor). The occurrence of nutritional edema in the two latter forms heralds a state of decompensation (mal-adapted form). One diagnoses marasmus when weightfor-height (WFH) is more than 3 SDs below the mean for age and sex (weight-for-height Z score [WHZ] of less than −3), whereas kwashiorkor is characterized by pitting pedal edema, independent of height or weight. Children may also present with marasmic kwashiorkor, with edema superimposed upon on severe wasting. Similarly, severe stunting is a height (or length) of more than 3 SDs below that expected for age (height-for-age Z-score [HAZ] of <−3). In addition, children with kwashiorkor exhibit behavioral symptoms such as lethargy and apathy when left alone, with increased irritability with physical contact [1]. Moderate malnutrition is defined by anthropometric values between −3 and −2 SDs from the expected. Mild or ‘at-risk’ malnutrition is considered if any of the above-described indexes fall below 1 standard deviation less than the median value for the reference population (Z score <−1 SD). The midupper-arm circumference (MUAC) is considered a measure of lean body mass and correlates strongly with WHZ. It is a strong predictor of mortality [1,2]. Nutritional stunting may occur at several epochs of an individual’s life history: in utero, caused by insufficient maternal nutrition and/or intrauterine undernutrition; during infancy by a lack of breastfeeding until 6 months of age, or during later infancy due to the delayed introduction of complementary feeding, inadequate (quantity and quality) complementary feeding, or impaired absorption of nutrients, especially due to multiple episodes of infectious diseases [3]. The consequences of child stunting may be both immediate and longer term. They include increased morbidity and mortality, poor child development and learning capacity, increased risk of infections and non-communicable diseases, increased susceptibility to accumulate central fat, lower fat oxidation, lower energy expenditure, insulin resistance and a higher risk to develop diabetes, hypertension, dyslipidemia, lowered working capacity, and unfavorable maternal reproductive outcomes in adulthood. Furthermore, stunted children, who experienced rapid weight gain after 2 years, have an increased risk of becoming overweight or obese later in life (components of the metabolic syndrome) [2–4].
Food insecurity during COVID-19 pandemic: A genuine concern for people from disadvantaged community and low-income families in Province 2 of Nepal

Background Food insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal. Methods The semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software. Results The results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection. Conclusion Food insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community.
Warfarin is associated with the risk of vascular calcification in abdominal aorta in hemodialysis patients: a multicenter case-control study

Background/aim Vascular calcifications (VCs), recognized risk factor for increased mortality, are highly prevalent in hemodialysis (HD) patients. We aimed to investigate the relation between VC and warfarin use with plain radiography. Materials and methods VCs were assessed using Adragao (radial and digital) and Kauppila (aortic) scores in 76 HD patients from six centers. Out of a total 711 HD patients, there were 32 (4.5%) who had been treated with warfarin for at least 1 year, and we included 44 control patients. Results Of the patients, 47% were females, the mean age was 66 ± 9 years, 23% were diabetics, the mean dialysis vintage was 68 ± 38 months. In warfarin group, median Kauppila score was higher than in control group [11 vs 6.5, (25%–75% percentile, 5 vs. 15), p = 0.032] and the percentage of the patients with a Kauppila score of >6 was higher, as well (76.6% vs. 50%; p = 0.029). Median Adragao score was not significantly different between the two groups [7 vs. 6, (%25,%75 percentile 6 vs. 8), p = 0.17]. Logistic regression analysis revealed that warfarin treatment was independently associated with Kauppila scores of >6 (OR 3.60, 95% CI 1.18–10.9, p = 0.024). Conclusion In this study, we found that warfarin is associated to vascular calcifications, especially in aorta of HD patients.
XXV. Zur Frage der Geschwindigkeit des Wachsthums und der Auflösung der Krystallflächen

In der krystallographischen Literatur der letzten Zeit erscheinen mehr und mehr Arbeiten, welche dem gegenseitigen Verhältnisse des Krystalles und des Mediums, in welchem er sich bildet, gewidmet sind. Besonders erfolgreich sind in dieser Hinsicht die Arbeiten von B e c k e gewesen. Seine Abhandlung über die Aetzflguren und die Auflösung des Fluorits veranlasste mich, die vorliegende Untersuchung zu beginnen. Das Verhältniss des Krystalles zu seiner Mutterlauge ist dreierlei Art. Der Krystall kann in ihr wachsen oder sich auflösen oder unverändert bleiben, je nach dem Grade der Sättigung der Lösung. Die Fähigkeit des Wachsens unterscheidet wesentlich die Krystalle von den amorphen Körpern. Dabei versteht man unter dem Wachsthume eine solche Vergrösserung des Volums, welche weder von einer Veränderung
Formononetin relieves the facilitating effect of lncRNA AFAP1-AS1-miR-195/miR-545 axis on progression and chemo-resistance of triple-negative breast cancer

This investigation attempted to discern whether formononetin restrained progression of triple-negative breast cancer (TNBC) by blocking lncRNA AFAP1-AS1-miR-195/miR-545 axis. We prepared TNBC cell lines (i.e. MDA-MB-231 and BT-549) and normal human mammary epithelial cell line (i.e. MCF-10A) in advance, and the TNBC cell lines were, respectively, transfected by pcDNA3.1-lncRNA AFAP1-AS1, si-lncRNA AFAP1-AS1, pcDNA6.2/GW/EmGFP-miR-545 or pcDNA6.2/GW/EmGFP-miR-195. Resistance of TNBC cells in response to 5-Fu, adriamycin, paclitaxel and cisplatin was evaluated through MTT assay, while potentials of TNBC cells in proliferation, migration and invasion were assessed via CCK8 assay and Transwell assay. Consequently, silencing of lncRNA AFAP1-AS1 impaired chemo-resistance, proliferation, migration and invasion of TNBC cells (P<0.05), and over-expression of miR-195 and miR-545, which were sponged and down-regulated by lncRNA AFAP1-AS1 (P<0.05), significantly reversed the promoting effect of pcDNA3.1-lncRNA AFAP1-AS1 on proliferation, migration, invasion and chemo-resistance of TNBC cells (P<0.05). Furthermore, CDK4 and Raf-1, essential biomarkers of TNBC progression, were, respectively, subjected to target and down-regulation of miR-545 and miR-195 (P<0.05), and they were promoted by pcDNA3.1-lncRNA AFAP1-AS1 at protein and mRNA levels (P<0.05). Additionally, formononetin significantly decreased expressions of lncRNA AFAP1-AS1, CDK4 and Raf-1, while raised miR-195 and miR-545 expressions in TNBC cells (P<0.05), and exposure to it dramatically contained malignant behaviors of TNBC cells (P<0.05). In conclusion, formononetin alleviated TNBC malignancy by suppressing lncRNA AFAP1-AS1-miR-195/miR-545 axis, suggesting that molecular targets combined with traditional Chinese medicine could yield significant clinical benefits in TNBC.
Targeting cancer with antibody-drug conjugates: Promises and challenges

ABSTRACT Antibody-drug conjugates (ADCs) are a rapidly expanding class of biotherapeutics that utilize antibodies to selectively deliver cytotoxic drugs to the tumor site. As of May 2021, the U.S. Food and Drug Administration (FDA) has approved ten ADCs, namely Adcetris®, Kadcyla®, Besponsa®, Mylotarg®, Polivy®, Padcev®, Enhertu®, Trodelvy®, Blenrep®, and Zynlonta™ as monotherapy or combinational therapy for breast cancer, urothelial cancer, myeloma, acute leukemia, and lymphoma. In addition, over 80 investigational ADCs are currently being evaluated in approximately 150 active clinical trials. Despite the growing interest in ADCs, challenges remain to expand their therapeutic index (with greater efficacy and less toxicity). Recent advances in the manufacturing technology for the antibody, payload, and linker combined with new bioconjugation platforms and state-of-the-art analytical techniques are helping to shape the future development of ADCs. This review highlights the current status of marketed ADCs and those under clinical investigation with a focus on translational strategies to improve product quality, safety, and efficacy.
Genome‐wide analysis of butterfly bush (Buddleja alternifolia) in three uplands provides insights into biogeography, demography and speciation

Summary Understanding processes that generate and maintain large disjunctions within plant species can provide valuable insights into plant diversity and speciation. The butterfly bush Buddleja alternifolia has an unusual disjunct distribution, occurring in the Himalaya, Hengduan Mountains (HDM) and the Loess Plateau (LP) in China. We generated a high‐quality, chromosome‐level genome assembly of B. alternifolia, the first within the family Scrophulariaceae. Whole‐genome re‐sequencing data from 48 populations plus morphological and petal colour reflectance data covering its full distribution range were collected. Three distinct genetic lineages of B. alternifolia were uncovered, corresponding to Himalayan, HDM and LP populations, with the last also differentiated morphologically and phenologically, indicating occurrence of allopatric speciation likely to be facilitated by geographic isolation and divergent adaptation to distinct ecological niches. Moreover, speciation with gene flow between populations from either side of a mountain barrier could be under way within LP. The current disjunctions within B. alternifolia might result from vicariance of a once widespread distribution, followed by several past contraction and expansion events, possibly linked to climate fluctuations promoted by the Kunlun–Yellow river tectonic movement. Several adaptive genes are likely to be either uniformly or diversely selected among regions, providing a footprint of local adaptations. These findings provide new insights into plant biogeography, adaptation and different processes of allopatric speciation.
Feasibility and reliability of evaluate PD‐L1 expression determination using small biopsy specimens in non‐small cell lung cancer

Programmed cell death ligand‐1 (PD‐L1) is a useful biomarker in non‐small cell lung cancer (NSCLC) patients who would probably benefit from immunotherapy. In most patients with advanced stage NSCLC, only small biopsy specimens were available for the evaluation of PD‐L1 expression. In this study, we evaluated the feasibility and reliability of PD‐L1 testing on small biopsy samples.