bluuebunny/crossref_metadata_2025 huggingface dataset:
Immune checkpoint inhibitors in advanced upper and lower tract urothelial carcinoma: a comparison of outcomes
Authors: Esagian Stepan M. , Khaki Ali Raza , Diamantopoulos Leonidas N. , Carril‐Ajuria Lucia , Castellano Daniel , De Kouchkovsky Ivan , Park Joseph J. , Alva Ajjai , Bilen Mehmet A. , Stewart Tyler F. , McKay Rana R. , Santos Victor S. , Agarwal Neeraj , Jain Jayanshu , Zakharia Yousef , Morales‐Barrera Rafael , Devitt Michael E. , Nelson Ariel , Hoimes Christopher J. , Shreck Evan , Gartrell Benjamin A. , Sankin Alex , Tripathi Abhishek , Zakopoulou Roubini , Bamias Aristotelis , Rodriguez‐Vida Alejo , Drakaki Alexandra , Liu Sandy , Kumar Vivek , Lythgoe Mark P. , Pinato David J. , Murgic Jure , Fröbe Ana , Joshi Monika , Isaacsson Velho Pedro , Hahn Noah , Alonso Buznego Lucia , Duran Ignacio , Moses Marcus , Barata Pedro , Galsky Matthew D. , Sonpavde Guru , Yu Evan Y. , Msaouel Pavlos , Koshkin Vadim S. , Grivas Petros
Published: February 2021

Objectives

To compare clinical outcomes between patients with locally advanced (unresectable) or metastatic urothelial carcinoma (aUC) in the upper and lower urinary tract receiving immune checkpoint inhibitors (ICIs).

Patients and Methods

We performed a retrospective cohort study collecting clinicopathological, treatment, and outcome data for patients with aUC receiving ICIs from 2013 to 2020 across 24 institutions. We compared the objective response rate (ORR), overall survival (OS), and progression‐free survival (PFS) between patients with upper and lower tract UC (UTUC, LTUC). Uni‐ and multivariable logistic and Cox regression were used to assess the effect of UTUC on ORR, OS, and PFS. Subgroup analyses were performed stratified based on histology (pure, mixed) and line of treatment (first line, subsequent line).

Results

Out of a total of 746 eligible patients, 707, 717, and 738 were included in the ORR, OS, and PFS analyses, respectively. Our results did not contradict the hypothesis that patients with UTUC and LTUC had similar ORRs (24% vs 28%; adjusted odds ratio [aOR] 0.73, 95% confidence interval [CI] 0.43–1.24), OS (median 9.8 vs 9.6 months; adjusted hazard ratio [aHR] 0.93, 95% CI 0.73–1.19), and PFS (median 4.3 vs 4.1 months; aHR 1.01, 95% CI 0.81–1.27). Patients with mixed‐histology UTUC had a significantly lower ORR and shorter PFS vs mixed‐histology LTUC (aOR 0.20, 95% CI 0.05–0.91 and aHR 1.66, 95% CI 1.06–2.59), respectively).

Conclusion

Overall, patients with UTUC and LTUC receiving ICIs have comparable treatment response and outcomes. Subgroup analyses based on histology showed that those with mixed‐histology UTUC had a lower ORR and shorter PFS compared to mixed‐histology LTUC. Further studies and evaluation of molecular biomarkers can help refine patient selection for immunotherapy.
Fish as a model in social neuroscience: conservation and diversity in the social brain network
Authors: Ogawa Satoshi , Pfaff Donald W. , Parhar Ishwar S.
Published: February 2021

Mechanisms for fish social behaviours involve a social brain network (SBN) which is evolutionarily conserved among vertebrates. However, considerable diversity is observed in the actual behaviour patterns amongst nearly 30000 fish species. The huge variation found in socio‐sexual behaviours and strategies is likely generated by a morphologically and genetically well‐conserved small forebrain system. Hence, teleost fish provide a useful model to study the fundamental mechanisms underlying social brain functions. Herein we review the foundations underlying fish social behaviours including sensory, hormonal, molecular and neuroanatomical features. Gonadotropin‐releasing hormone neurons clearly play important roles, but the participation of vasotocin and isotocin is also highlighted. Genetic investigations of developing fish brain have revealed the molecular complexity of neural development of the SBN. In addition to straightforward social behaviours such as sex and aggression, new experiments have revealed higher order and unique phenomena such as social eavesdropping and social buffering in fish. Finally, observations interpreted as ‘collective cognition’ in fish can likely be explained by careful observation of sensory determinants and analyses using the dynamics of quantitative scaling. Understanding of the functions of the SBN in fish provide clues for understanding the origin and evolution of higher social functions in vertebrates.
Identification of circular RNAs as novel biomarkers and potentially functional competing endogenous RNA network for myelodysplastic syndrome patients
Authors: Wu Wan‐ling , Li Shuang , Zhao Guang‐jie , Li Nian‐yi , Wang Xiao‐Qin
Published: February 2021

Circular RNAs (circRNAs) have been identified to exert vital biological functions and can be used as new biomarkers in a number of tumors. However, little is known about the functions of circRNAs in myelodysplastic syndrome (MDS). Here, we aimed to investigate circRNA expression profiles and to investigate the functional and clinical value of circRNAs in MDS. Differential expression of circRNAs between MDS and control subjects was analyzed using circRNA arrays, in which we identified 145 upregulated circRNAs and 224 downregulated circRNAs. Validated by real‐time quantitative PCR between 100 MDS patients and 20 controls, three upregulated (hsa_circRNA_100352, hsa_circRNA_104056, and hsa_circRNA_104634) and three downregulated (hsa_circRNA_103846, hsa_circRNA_102817, and hsa_circRNA_102526) circRNAs matched the arrays. The receiver operating characteristic curve analysis of these circRNAs showed that the area under the curve was 0.7266, 0.8676, 0.7349, 0.7091, 0.8806, and 0.7472, respectively. Kaplan‐Meier survival analysis showed that only hsa_circRNA_100352, hsa_circRNA_104056, and hsa_circRNA_102817 were significantly associated with overall survival. Furthermore, we generated a competing endogenous RNA network focused on hsa_circRNA_100352, hsa_circRNA_104056, and hsa_circRNA_102817. Analyses using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes showed that the three circRNAs were linked with some important cancer‐related functions and pathways.
Gingival transcriptomics of follicular T cell footprints in progressing periodontitis
Authors: Ebersole J L , Kirakodu S S , Orraca L , Gonzalez Martinez J , Gonzalez O A
Published: February 2021

Follicular helper T cells (Tfh) cells have been identified in the circulation and in tertiary lymphoid structures in chronic inflammation. Gingival tissues with periodontitis reflect chronic inflammation, so genomic footprints of Tfh cells should occur in these tissues and may differ related to aging effects. Macaca mulatta were used in a ligature-induced periodontitis model [adult group (aged 12–23 years); young group (aged 3–7 years)]. Gingival tissue and subgingival microbiome samples were obtained at matched healthy ligature-induced disease and clinical resolution sites. Microarray analysis examined Tfh genes (n = 54) related to microbiome characteristics documented using 16S MiSeq. An increase in the major transcription factor of Tfh cells, BCL6, was found with disease in both adult and young animals, while master transcription markers of other T cell subsets were either decreased or showed minimal change. Multiple Tfh-related genes, including surface receptors and transcription factors, were also significantly increased during disease. Specific microbiome patterns were significantly associated with profiles indicative of an increased presence/function of Tfh cells. Importantly, unique microbial complexes showed distinctive patterns of interaction with Tfh genes differing in health and disease and with the age of the animals. An increase in Tfh cell responsiveness occurred in the progression of periodontitis, affected by age and related to specific microbial complexes in the oral microbiome. The capacity of gingival Tfh cells to contribute to localized B cell activation and active antibody responses, including affinity maturation, may be critical for controlling periodontal lesions and contributing to limiting and/or resolving the lesions.
Alveolar ridge preservation using autogenous whole‐tooth versus demineralized dentin grafts: A randomized controlled clinical trial
Authors: Elfana Ahmed , El‐Kholy Samar , Saleh Heba Ahmed , Fawzy El‐Sayed Karim
Published: February 2021

Objective

The objective of this randomized controlled trial was to evaluate the radiographic changes and histologic healing following alveolar ridge preservation (ARP) using autogenous whole tooth (AWTG), test group, versus autogenous demineralized dentin graft (ADDG), control group.

Material and methods

Twenty non‐molar teeth indicated for extraction were randomized into two groups (n = 10/group). Extracted teeth were prepared into AWTG or ADDG (0.6N HCl; 30 min), inserted into extraction sockets and covered by collagen membranes. Cone‐beam computed tomography (CBCT) scans at baseline and six months were compared to assess ridge‐dimensional changes. At six months, bone biopsies of engrafted sites were harvested and analyzed histomorphometrically.

Results

All sites healed uneventfully. Reduction was 0.85 ± 0.38 mm and 1.02 ± 0.45 mm in ridge width, 0.61 ± 0.20 mm and 0.72 ± 0.27 mm in buccal and 0.66 ± 0.31 mm and 0.56 ± 0.24 mm in lingual ridge height for the AWTG and ADDG group, respectively (p > .05). Histologically, no inflammatory reactions were noticeable and all samples showed new bone formation. Qualitatively, graft‐bone amalgamations were more pronounced in ADDG samples. Histomorphometrically, new bone, graft remnants and soft tissue occupied 37.55% ± 8.94%, 17.05% ± 5.58% and 45.4% ± 4.06% of the areas in the AWTG group and 48.4% ± 11.56%, 11.45% ± 4.13% and 40.15% ± 7.73% in the ADDG group of the examined areas, respectively (p > .05).

Conclusions

AWTG and ADDG are similarly effective in ARP. Yet, histologically ADDG seems to demonstrate better graft remodeling, integration and osteoinductive properties.
Small marine reserves do not provide a safeguard against overfishing
Authors: LaScala‐Gruenewald Diana E. , Grace Roger V. , Haggitt Tim R. , Hanns Benjamin J. , Kelly Shane , MacDiarmid Alison , Shears Nick T.
Published: February 2021

Marine reserves aim to protect harvested species within their boundaries and can therefore provide insurance against the effects of overfishing. To evaluate whether marine reserves are meeting this expectation, we compiled over 40 years of rock lobster (Jasus edwardsii) monitoring data and examined long‐term trends in three relatively small marine reserves (c.4–8 km2) in northern New Zealand, a region that has experienced large‐scale declines in the fishery over the last decade. In all three reserves, lobster density initially increased by at least a factor of three following protection. However, over the last 10 years, lobster populations have experienced large declines in all three reserves with densities now 59–80%, and spawning stock biomass (SSB) now 51–86%, below historic levels. Using peak lobster density in each reserve as an unfished reference point, current densities on fished reefs are <15% of unfished levels and SSB is currently only 3–12% of peak population biomass in reserves. These results highlight the poor state of the wider stock and declines in the reserves follow regional declines in catch‐per‐unit‐effort in the fishery, suggesting that lobster populations within these reserves are not fully protected from fishing. Adult J. edwardsii are known to undertake seasonal foraging excursions that carry them beyond the offshore boundaries of these reserves where they are susceptible to fishing‐related mortality. We propose that the observed declines are likely a result of direct harvest of individuals beyond reserve boundaries and that larger reserves which encompass both a species' longshore and offshore movements are needed.
Perceptions and realities of elephant crop raiding and mitigation methods
Authors: Kiffner Christian , Schaal Isabel , Cass Leah , Peirce Kiri , Sussman Olivia , Grueser Ashley , Wachtel Ellie , Adams Hayley , Clark Krissie , König Hannes J. , Kioko John
Published: February 2021

Crop raiding by African elephants (Loxodonta africana) jeopardizes human livelihoods and undermines conservation efforts. Addressing this issue is particularly important in subsistence farms adjacent to protected areas and requires assessing the perceived and actual scale of the problem and the benefits, limitations and adoption potential of mitigation techniques. To achieve these objectives, we assessed the effectiveness of chili and beehive fences relative to control plots, using a daily farm monitoring protocol implemented on 20 farms bordering the Ngorongoro Conservation Area (Tanzania). Prior to the field study, we interviewed 65 farmers about human–elephant interactions and contrasted interview findings with those of daily farm monitoring. Farmer perception of crop raiding frequency declined with increasing distance from the protected area and was, on average, eight times greater than daily farm monitoring data indicated. The majority of interviewees expressed a willingness to try chili or beehive fences, though chili fences were preferred. Generalized‐linear‐mixed models indicated that neither elephant farm intrusions nor damages were significantly reduced by either chili or beehive fences relative to the control sites. Losses per month and hectare did not differ significantly by fence type. However, farm plots with chili fences did not experience massive damages which occasionally occurred in beehive or control plots. This partial effectiveness of chili fences was further confirmed by contrasting crop losses from a subset of farms that were subject to a cross‐over experimental design. Our multidimensional case study suggests that chili fences have greater adoption potential than beehive fences. Nevertheless, additional efforts are required to increase effectiveness and to realize adoption potential. By providing insights into the context and circumstances that presented challenges to the effectiveness, sustainability and scalability of beehive and chili fences, this study can serve as reference for areas where crop raiding by elephants is a key conservation conflict.
Increased blood transfusion after outpatient autologous transplantation with reduced intensity conditioning for hematological malignancies predicts worse outcomes
Authors: Jaime‐Pérez José Carlos , Hernández‐Coronado Marcela , Ancer‐Rodríguez Jesús , Gómez‐Almaguer David
Published: February 2021

Transfusion has a recognized immunomodulatory effect, and its role on the outcomes after an ambulatory autologous hematopoietic stem cell transplantation (auto‐HSCT) following reduced intensity conditioning (RIC) has not been documented. A study to assess factors associated with the number of packed red blood cells (PRBCs) and platelet units transfused and their impact on survival rates of auto‐HSCT recipients after RIC was conducted between 2013 and 2019. Transfusions were recorded from days 0 to 100. Of the 130 patients studied, seventy (53.9%) required transfusion support. The median number of PRBC transfused was 2 (range 1‐20), and for platelets, it was also 2 units (range 1‐19). Infused CD34 + cells/kg, pre‐transplant CMV status, and relapse/progression were significantly associated with the number of PRBC units transfused and sex, infused CD34 + cells/kg, and pre‐transplant CMV status with the number of platelet units transfused. In multivariate analysis, a high/very high Disease Risk Index (P = .001) (P = .001) and transfusion of ≥ 5 total blood products (P = .001) (P = .010) were associated with decreased disease‐free and overall survival. Two‐year cumulative incidence of relapse was 50% for transfused patients vs. 34% for those not transfused (P = .009). These data suggest that the transfusion burden and its interplay with other patient and transplant‐related factors could be associated with inferior auto‐HSCT outcomes.
Race and the gift of lament
Authors: Rector Denise
Published: February 2021

A close look at historical narratives can help us understand how intractable racial injustice is, both in society and in the church. Progress toward racial equity requires us to recognize ourselves as actors in history, and also as those influenced by and acted upon by the forces of history. In addition, lament can help us move toward the theological work of repentance. This article is adapted from The Gift of Lament: Moving from Diversity to Racial Equity in the ELCA, 2018 MDiv Thesis, Wartburg Theological Seminary. Portions of this article were also presented at the June 2019 Convocation of Teaching Theologians.
Real‐world evidence of bariatric surgery and cardiovascular benefits using electronic health records data: A lesson in bias
Authors: Rassen Jeremy A. , Murk William , Schneeweiss Sebastian
Published: February 2021

Aim

To reproduce and correct studies on bariatric surgery and the reduction in major adverse cardiovascular events (MACE) among patients with obesity and type 2 diabetes (T2D).

Methods

We used electronic healthcare records (EHR) from in and outpatient facilities around the United States to identify a cohort of patients with T2D, aged 18 to 80 years and with a body mass index (BMI) of 30 kg/m2 or higher undergoing bariatric surgery. We compared against hip/knee arthroplasty to establish an active comparison group that reduced bias from differential information and confounding. The main outcome was six‐point MACE. Pre‐exposure characteristics were adjusted in propensity score (PS) models with 1:2 matching plus high‐dimensional PS matching.

Results

After a range of exclusions, the final cohort included 344 bariatric surgery patients (65% female; mean age 58 years) and 551 PS‐matched patients undergoing arthroplasty (65% female; 59 years). Median follow‐up was 2.5 years in both groups. Bariatric surgery patients showed a sustained 20% weight reduction and an HbA1c reduction by 1% point. We found no benefits of bariatric surgery for six‐point MACE (HR = 0.99; 95% CI 0.76‐1.30). We observed known increases in risks for vitamin B12 deficiency anaemia (HR = 3.06; 1.10‐8.49) and cholelithiasis (HR = 1.72; 0.94‐3.13).

Conclusions

This real‐world evidence study found reductions in HbA1c and BMI following bariatric surgery similar to trials, and no meaningful cardiovascular benefit compatible with the underpowered trials but in contrast to earlier EHR studies. We showed how information bias typical in EHR analyses and confounding may cause substantial bias.
Circulating serum and plasma levels of micro‐RNA in type‐1 diabetes in children and adolescents: A systematic review and meta‐analysis
Authors: Margaritis Kosmas , Margioula‐Siarkou Georgia , Margioula‐Siarkou Chrysoula , Petousis Stamatios , Kotanidou Eleni P. , Christoforidis Athanasios , Pavlou Evangelos , Galli‐Tsinopoulou Assimina
Published: February 2021

Background

Type 1 diabetes mellitus (T1DM) is a complex metabolic disorder characterized by hyperglycaemia, with constantly increasing incidence in paediatric population. The discovery of new molecules, such as microRNAs, and their possible interactions with T1DM create novel aspects in the diagnosis of the disease.

Methods

This systematic review and meta‐analysis adhered to PRISMA guidelines. MEDLINE, SCOPUS, Cochrane CENTRAL and Clinicaltrials.gov. were searched up to 20 April 2020. Inclusion criteria for individual studies were quantification of microRNAs in serum/plasma samples and study groups consisting of children and adolescents with T1DM and healthy controls. Primary outcome of the study was the qualitative expression of microRNAs between the two groups. Statistical analysis was performed with Comprehensive Meta‐Analysis Software v3.0. Methodological quality of included studies was assessed using Newcastle‐Ottawa scale.

Results

A total of 484 studies were retrieved from the initial search of the databases. These were subsequently limited to seven included studies. Seven microRNAs demonstrated contrasting expression between the two groups, with two of them showing significant overexpression in T1DM group (miR‐181:95% CI: 0.429 to 1.341 P < .001, miR‐210:95% CI: 0.381 to 0.852, P < .001) and one micro‐RNA being significantly overexpressed in control group (miR‐375:95% CI: 0.293 to 1.459, P = .003).

Conclusion

A total of three micro‐RNA molecules appeared to have a significantly different expression in T1DM patients, serving as a possible diagnostic panel of biomarkers. These findings may contribute as reference for future research to further support the use of microRNAs as a novel diagnostic tool in T1DM.
Categorical versus dimensional models of early psychosis
Authors: Phalen Peter , Millman Zachary , Rouhakhtar Pamela Rakhshan , Andorko Nicole , Reeves Gloria , Schiffman Jason
Published: February 2021

Aim

Early psychosis is typically operationalized as a categorical construct by dividing people into one of three diagnostic statuses: low‐risk, clinical high‐risk, and first episode psychosis. We empirically assess whether an alternative dimensional approach focused on observed symptom severity may be more desirable for clinical and research purposes.

Methods

Participants were 152 help‐seeking youths ages 12–22 years old. Structured interview for psychosis risk syndromes interviews were used to obtain dimensional psychosis symptom severity ratings, and to classify participants by categorical psychosis risk status. Twenty‐five participants were classified as having a diagnosable psychotic disorder, 52 participants as clinical high‐risk, and 75 participants as help‐seeking controls. We assessed the relation between categorical and dimensional measurements of psychosis severity, and then compared categorical versus dimensional psychosis severity in their ability to predict social and role functioning.

Results

On average, dimensional psychosis symptom severity increased along with categorical risk status (help‐seeking control < clinical high‐risk < diagnosable psychotic disorder). There was, however, considerable overlap between categories, with people at clinical high‐risk being particularly hard to distinguish from people with diagnosable psychotic disorders on the basis of symptom severity. Dimensional symptom severity was more predictive of functioning than categorical risk status.

Conclusions

Categorical risk status and psychosis symptom severity are related but not interchangeable, and dimensional models of psychosis may be more predictive of functional outcomes. Adopting a dimensional rather than categorical approach to the psychosis risk spectrum may facilitate better predictive models and a richer theoretical understanding of early psychosis.
Development of an innovative educational escape game to promote teamwork in dentistry
Authors: Zaug Pernilla , Gros Catherine‐Isabelle , Wagner Delphine , Pilavyan Elise , Meyer Florent , Offner Damien , Strub Marion
Published: February 2021

Background

Escape games have proven to be an innovative pedagogical tool that allows students to use the professional skills they acquired. The appeal of the game lies in the stimulation of the players’ minds and in the diversity of the puzzles.

Purpose/objectives

To evaluate the effectiveness of an educational tool aimed at cultivating team spirit and group cohesion in dentistry students through a fun collaborative activity that mobilises their knowledge and skills.

Materials and method

Twenty‐four students participated to the escape game over a one‐day period. In order to win, they had to solve dentistry‐related puzzles.

Results

Feedback was strongly positive. The balance between manipulations and theoretical questions stimulated them. Students did favour this type of activity which allows to increase interactions between students as well as with the teaching team.

Conclusion

Escape games in dental schools foster a supportive learning environment and stimulated students’ motivation and group cohesion.
Anger and Aggression: A New Beginning?
Authors: Lindenfeld George L. , Hummer John T. , Billiot Katherine
Published: February 2021

Within our civilian population, Intimate Partner Violence (IPV) has become a major health problem. Consequences of anger and aggression have resulted in incarceration rates which place the United States as the world's leader with 2.2 million people in prisons and jails. The current treatment of anger and aggression is based primarily on theories that were developed in the early 1980s. Advances in neuroscientific knowledge have exponentially added to our understanding of the underlying biological basis and neuroanatomy of violence and aggression. Through a binaural sound‐based non‐verbal intervention, we have found a key to unlock long‐term memory (Reconsolidation) that facilitates rapid remediation of anger and violence issues. Within our Pilot Study findings, a number of our combat‐veterans with Post‐Traumatic Stress Disorder (PTSD) experienced a positive transformation in their capacity to evidence empathy, intimacy and social engagement as contrasted with their prior isolative tendencies. We extrapolate how this intervention might positively impact those engaged in Anger Management (AM) and IPV programs.
Establishing Identity: How Direct‐to‐Consumer Genetic Testing Challenges the Assumption of Donor Anonymity
Authors: Darroch Fiona , Smith Ian
Published: February 2021

The rise of direct‐to‐consumer genetic testing is challenging the rules and expectations of the fertility industry concerning donor anonymity. While ethicists debate whose rights should prevail, many donor conceived people, recipient parents and donors are currently sharing their genetic information, along with methods to identify genetic links, in vast online communities, invalidating donor anonymity and providing a platform for those who advocate globally for legislative change to support donor‐linking practices. This article looks at why it is important to access this information in relation to identity and kinship formation and how the Family Court Community can apply this knowledge in order to achieve better outcomes for children and families.
Microsatellite DNA analysis of overwintering bull trout (Salvelinus confluentus) and its implications for harvest regulation and habitat management
Authors: Taylor Eric B. , Chudnow Rachel , Pillipow Ray , Spendlow Ian , van Poorten Brett
Published: February 2021

A mixed‐stock fishery occurs when multiple populations of a fish species are exploited together in a common area where they aggregate outside the breeding season (e.g. for feeding or overwintering), and the aggregation is known as a mixture. Recreational fishing often exploits such mixtures, and estimating the proportional contributions of populations to fisheries promotes more sustainable resource use. Ten DNA microsatellites were assayed in a mixture of bull trout Salvelinus confluentus Suckley overwintering in the Nechako River, upper Fraser River, British Columbia, and in baseline population samples from 14 tributaries putatively contributing to the overwintering mixture. A DNA microsatellite‐based mixed‐stock fishery analysis suggested that five populations together contributed 0.80 to the mixture. Most of the errors associated with the mixture estimates were attributable to uncertainty in baseline allele frequencies. Radiotracking data confirmed that tributary populations contributing to the mixture estimated by genetic analysis also contained individuals that moved between spawning tributaries and overwintering sites. The results better resolve habitat use by potadromous bull trout in the upper Fraser River and, in combination with assessments of baseline population‐specific spawning abundances and productivity, will better inform a decision of whether or not allowing some harvest within the current catch‐and‐release fishery is biologically sustainable.
Association between polymorphisms in catechol‐O‐methyl transferase, opioid receptor Mu 1 and serotonin receptor genes with postoperative pain following root canal treatment
Authors: Karataş E. , Kahraman Ç. Y. , Akbıyık N.
Published: February 2021

Aim

To evaluate the effect of single nucleotide polymorphisms in the COMT, OPRM1, 5HT1A, 5HT2A and 5HTR3B genes on the intensity of postoperative pain following root canal treatment.

Methodology

Ninety‐five patients with mandibular and maxillary molar teeth diagnosed with symptomatic apical periodontitis and a level of preoperative pain greater than 50 on a 100 mm visual analogue scale (VAS) were included. Salivary DNA was collected from the participants and stored in Eppendorf tubes at −80 °C. Preoperative percussion pain values were recorded before the root canal treatment procedures. After completion of root canal treatment, the participants were given instructions to record their postoperative pain intensity levels at 24, 48 and 72 h, 5 days and 1 week after treatment, using the VAS. A second visit for the patients after seven days was planned to record their intensity levels of percussion pain on VAS. The percussion test was performed by tapping on the occlusal surface of the tooth with a blunt instrument. A QIAamp DNA Mini Kit was used to isolate DNA from saliva, and SNP Genotyping Analysis software version 1 was used to analyse the genotypes by calculating FAM and HEX signals. The Kruskal–Wallis and Mann–Whitney U‐tests were used to evaluate pain intensity values amongst the genotypes, alleles, haplotypes and allele combinations. Nominal data (gender, intake and tooth number) were analysed using a Chi‐square test. Bonferroni correction was performed. Thus, the significance level was set at 1.6% (P = 0.016), 2.5% (P = 0.025) and 1.25% (P = 0.0125) for genotype, allele and haplotype comparisons, respectively.

Results

There was no significant difference amongst the genotypes and alleles in terms of pre‐ and postoperative pain intensity. There was no significant difference amongst the haplotypes formed for the COMT gene in terms of pain intensity. Additionally, there was no significant association between the allelic combination formed for 5HT1A + 5HT2A genes and the intensity of postoperative pain.

Conclusion

The findings indicate that none of the evaluated SNPs for COMT, OPRM1, 5HT1A, 5HT2A and 5HTR3B genes were associated with the intensity of postoperative pain.
Effect of XP‐endo Shaper versus conventional rotary files on postoperative pain and bacterial reduction in oval canals with necrotic pulps: a randomized clinical study
Authors: Emara R. S. , Gawdat S. I. , El‐Far H. M. M.
Published: February 2021

Aim

To assess postoperative pain and bacterial reduction following the use of XP‐endo Shaper versus conventional rotary files in preparation of oval canals with necrotic pulps.

Methodology

This superiority, parallel, randomized, double blinded clinical trial was conducted in the clinic of the Endodontic Department, Faculty of Dentistry, Cairo University, Egypt. Sixty single‐canalled mandibular premolars with necrotic pulps were randomly assigned into two equal groups. Canals were instrumented using XP‐endo Shaper files in the intervention group and iRaCe rotary files in the control group. Bacterial samples were taken before and after canal instrumentation. Incidence and severity of postoperative pain was assessed using a modified VAS after 6, 12, 24 h and daily for 5 days. A culture method was used to assess the number of bacterial colony forming units. Incidence of analgesic intake as well as flare‐ups was recorded. Data were analysed using chi‐square, Fisher Exact, Mann–Whitney, Independent t‐test, and Spearman’s correlation for pain and bacterial counts.

Results

The XP‐endo Shaper compared with the iRaCe group was associated with a significantly lower incidence of postoperative pain at 6, 12, and 24 h (P = 0.039, 0.047, and 0.026, respectively), and severity of postoperative pain at 6 h (mean difference: 1.33, 95% CI: 0.307–2.352, P = 0.02), 12 h (mean difference: 1.1, 95% CI: 0.26–1.936, P = 0.007), 24 h (mean difference: 0.94, 95% CI: 0.178–1.701, P = 0.008) and 48 h (mean difference: 0.97, 95% CI: 0.192–1.747, P = 0.038). There was a significant decrease in bacterial count following canal instrumentation in both groups (P < 0.001) with no significant difference between them (mean difference: 0.83 × 105, 95% CI: 0.336 × 105–1.996 × 105, P = 0.56). A weak correlation existed between postoperative pain severity and bacterial counts (P = 0.54). There was no significant difference in analgesic intake between the two groups (P = 0.085). Flare‐ups occurred in 3.3% of teeth in the iRaCe group, while no flare‐ups occurred in the XP‐endo Shaper group.

Conclusions

XP‐endo Shaper was associated with a significantly lower frequency of postoperative pain for up to 24 h, and lower severity of postoperative pain for up to 48 h compared with iRaCe files. Both systems were equally effective in bacterial reduction from oval root canals with necrotic pulps.
Determinants of incorrect inhaler technique in chronic obstructive pulmonary disease patients
Authors: Harb Hadeer S. , Ibrahim Laz Nabila , Rabea Hoda , Abdelrahim Mohamed E. A.
Published: February 2021

Aims

There is a lack of an overview of determinants of incorrect inhaler technique among chronic obstructive pulmonary diseases (COPD) subjects. The aim of this study was to determine the prevalence and possible determinants of incorrect inhaler technique in COPD subjects with common inhalers.

Methods

A cross over study was conducted in 180 COPD subjects. Baseline assessment of inhaler technique was evaluated in 10 placebo inhalers including: [pressurised metered dose inhaler (pMDI), Aerolizer, Handihaler, Turbohaler, Discus, Breezhaler, Ellipta, Easyhaler, Diskhaler and Respimat] without receiving any instructions. Subjects were then crossed over to other inhalers in random order. Inhaler technique was assessed. The proper technique of inhalers was demonstrated and the number of counselling attempts needed to achieve a correct technique was recorded. Patient past‐experience, demographics/clinical variables were recorded.

Results

Incorrect inhaler techniques were highly prevalent among COPD subjects, ranging from 80% of participants demonstrated incorrect use, a minimum of 1 error, with Ellipta, to 100% with Respimat/Diskhaler (P < .001). Past‐experience (OR = 14.639 at P < .001) and inhaler‐type (OR = 10.397 at P < .001, 4.267 at P =. 007, 2.664 at P =. 057, 8.666 at P =. 001, 10.250 at P < .001, 0.613 at P =. 212 and 0.265 at P< .001 for pMDI, Aerolizer, Handihaler, Turbohaler, Discus, Breezhaler and Ellipta, respectively) were the strongest determinants of incorrect technique followed by gender (OR = 0.310 at P < .001), age category (OR = 0.307 at P < .001) and GOLD group (OR = 2.289 at P =. 005).

Conclusion

Incorrect inhaler techniques are highly prevalent among COPD subjects. Lack of past‐experience, certain inhaler types, female gender, older age and lower GOLD group are the most significant determinants of incorrect technique.
Regulation of Chlamydia spreading from the small intestine to the large intestine via an immunological barrier
Authors: He Conghui , Xu Ying , Huo Zhi , Wang Jie , Jia Tianjun , Li Xiao‐Dong , Zhong Guangming
Published: February 2021

The obligate intracellular bacterium Chlamydia is a genital tract pathogen that can also colonize the gastrointestinal tract for long periods. The long‐lasting colonization is dependent on chlamydial spreading from the small intestine to the large intestine. We previously reported that a mutant Chlamydia was able to activate an intestinal barrier for blocking its own spreading to the large intestine. In the current study, we used the mutant Chlamydia colonization model to confirm the intestinal barrier function and further to determine the immunological basis of the barrier with gene‐deficient mice. Recombination activating gene 1−/− mice failed to block the mutant Chlamydia spreading, while mice deficient in toll‐like receptors, myeloid differentiation primary response 88 or stimulator of interferon genes still blocked the spreading, suggesting that the intestinal barrier function is dependent on lymphocytes that express antigen receptors. Mice deficient in CD4, but not CD8 nor μ chain failed to prevent the chlamydial spreading, indicating a protective role of CD4+ cells in the intestinal barrier. Consistently, adoptive transfer of CD4+ T cells reconstituted the intestinal barrier in CD4‐/‐ mice. More importantly, CD4+ but not CD8+ T cells nor B cells restored the intestinal barrier function in recombination activating gene 1−/− mice. Thus, CD4+ T cells are necessary and sufficient for maintaining the intestinal barrier function, indicating that the spread of an intracellular bacterium from the small intestine to the large intestine is regulated by an immunological barrier. This study has also laid a foundation for further illuminating the mechanisms by which a CD4+ T cell‐dependent intestinal barrier regulates bacterial spreading in the gut.
Shaping the Balkan corridor: Development and changes in the migration route 2015–16
Authors: Abikova Jana , Piotrowicz Wojciech
Published: February 2021

In 2015–16, Europe witnessed the biggest refugee crisis since the Second World War. Over a million people moved via different migration routes. The key route was the Balkan corridor running from Turkey, via Greece, to Central, Western and Northern Europe. The aim of this paper is to describe the development and changes in the route and provide an analysis of transit via Balkan countries, looking at factors that influenced the shape of the corridor. This refugee crisis was challenging for European countries and the whole European Union (EU). This corridor was unique, being de facto formalized semi‐legal territory, which the EU had never faced before. An official reaction to the crisis was necessary due to the substantial number of people who were on the move, seeking to cross the Balkan countries in the fastest manner possible. Therefore, the response was focused on arranging transport and providing only short‐term accommodation. This paper uses the PESTLE framework to examine the key political, economic, social, technological, legal and environmental aspects that influenced the Balkan corridor, as well as changes in the route over time and responses to them. The role of the media in shaping the corridor is also acknowledged, thus resulting in a PESTLE‐M framework. Findings from the research are important, as it is likely that the EU will face a similar crisis in the near future. Therefore, there is a need to prepare and develop a plan in case such a situation arises.
The dietary knowledge measurement instruments in diabetes: A systematic psychometric review
Authors: Montagut‐Martínez Pedro , Pérez‐Cruzado David , Gutiérrez‐Sánchez Daniel
Published: February 2021

Aims

To identify, critically appraise, and summarize instruments to measure dietary knowledge in patients with diabetes mellitus type 1 or 2.

Design

Psychometric systematic review.

Data sources

A comprehensive search was carried out during March 2020 in the followed databases: Medline, Web of Science, Open Grey, Cochrane Library, COSMIN database, and Scielo.

Review Methods

In accordance with the most up‐to‐date COnsensus‐based Standards for the selection of health status Measurement INstruments methodology (COSMIN) and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statements. A systematic review of the measurement properties of the instruments that assess the level of dietary knowledge in the diabetic population was carried out. The COSMIN checklist was used to assess the measurement properties of existing patient‐reported outcome measures to select the most appropriate outcome measurement instrument. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020186516).

Results

Nine instruments were identified. The Michigan Diabetes Knowledge Test (DKT) was the questionnaire included in the largest volume of studies. The Diabetes Knowledge Questionnaire (DKQ) was the questionnaire with the most evaluated psychometric characteristics. The Personal Diabetes Questionnaire (PDQ) was the second with the highest number of psychometric characteristics evaluated and with a better score regarding the quality of the evidence.

Conclusion

According to the quality methodological results; DKT, DKQ and PDQ are the recommended instruments to assess dietary knowledge in people with diabetes types 1 and 2.

Impact statement

What problem did the study address?

One of the main factors that lead to greater difficulty for patients with diabetes mellitus is dietary management, and it is necessary to evaluate whether the patient has sufficient knowledge about dietetics to practice a healthy diet.

What were the main findings?

Nine instruments were identified that were specifically designed to assess dietary knowledge in patients with diabetes mellitus (DM) type 1 or 2. Michigan Diabetes Knowledge Test, Diabetes Knowledge Questionnaire, and Personal Diabetes Questionnaire are the recommended instruments to assess dietary knowledge in people with diabetes.

Where and on whom will the research have impact?

The evaluation of this construct is very useful both in clinical practice; at hospital, community and primary care levels, in patients with type 1 and / or 2 diabetes mellitus (DM), as in research.
Holocene heathland development in temperate oceanic Southern Hemisphere: Key drivers in a global context
Authors: Adeleye Matthew Adesanya , Haberle Simon Graeme , Harris Stephen , Hopf Felicitas Viktoria‐Louise , Connor Simon , Stevenson Janelle
Published: February 2021

Aim

Understanding long‐term heathland development is key in mitigating their current attrition globally. However, such knowledge is limited in Australia and the wider Southern Hemisphere. We aim to identify potential climatic and environmental drivers of Holocene heathland development in temperate‐oceanic Australia (Bass Strait), and also assess the applicability of Iversen's conceptual model of interglacial vegetation development to the area.

Location

Bass Strait, southeast Australia.

Taxon

Monotoca, Epacris, Sprengelia and Restionaceae.

Methods

We used multiple sedimentary pollen and charcoal records from truwana/Cape Barren Island (CBI) in Bass Strait to reconstruct vegetation and fire history. We also used rarefaction analysis on pollen records to estimate floristic richness for all sites, and magnetic susceptibility and organic content were derived for two of the four sites as proxies for local sedimentary changes. Reconstructed vegetation and fire histories were then compared to independent records of climate and sea‐level change in temperate Australia, using a Detrended Correspondence Analysis ordination, to identify major drivers of heathland development.

Results

Major heathland expansion occurred on truwana/CBI between the early and mid‐Holocene in response to sea‐level rise, high effective precipitation, reduced seasonality and increased Indigenous burning. Increasing seasonality, low effective precipitation, El Niño‐Southern Oscillation intensification, stable sea level, and decreased fire activity drove the expansion of scrub and woodland at the expense of heathland in the late Holocene. The overall vegetation development on truwana/CBI fits poorly with the classic Iversen conceptual model of interglacial vegetation development in the Northern Hemisphere, due to the significant role of interglacial sea‐level rise on truwana/CBI. Therefore, a modified model, which takes into account the role of sea‐level change, is proposed for Southern Hemisphere‐temperate‐oceanic settings.

Main conclusions

Heathland developments in both hemispheres reflect some level of homogeneity, considering the roles of increased Indigenous burning and reduced seasonality in both hemispheres. Frequent, controlled burning strategies are recommended to maintain heathland on truwana/CBI.
Tricuspid valve annuloplasty and mitral valve replacement are associated with bradyarrhythmia after mitral valve surgery
Authors: Herrmann Florian E. M. , Schleith Anne‐Sophie , Graf Helen , Sadoni Sebastian , Hagl Christian , Bagaev Erik , Juchem Gerd
Published: February 2021

Introduction

Mitral valve surgery has developed into a strong subspecialty of cardiac surgery with operative techniques and outcomes constantly improving. The development of bradyarrhythmias after mitral valve surgery is not completely understood.

Methods

We investigated a cohort of 797 patients requiring mitral valve surgery with and without concomitant procedures. Incidences and predictors of pacemaker requirement as well as survival were analyzed.

Results

In the complete follow‐up period (median follow‐up time: 6.09 years [95% confidence interval [CI]: 5.94–6.22 years, maximum 8.77 years) 80 patients (10% of the complete cohort) required pacemaker implantation for bradyarrhythmia. The cumulative rate of pacemaker implantation was 6.4% at 50 days (48 patients) with most (54.2%) requiring pacing for atrioventricular block. Mitral valve replacement (odds ratio [OR]: 1.905; 95% CI: 1.206–3.536; p = .041) and tricuspid ring annuloplasty (OR: 2.348; 95% CI: 1.165–4.730, p = .017) were identified as operative risk factors of pacemaker requirement after mitral valve surgery. Insulin‐dependent diabetes mellitus was also identified as a predictor of pacemaker requirement (OR: 4.665; 95% CI: 1.975–11.02; p = .001). There was no difference in survival in the paced and unpaced groups.

Conclusions

After mitral valve surgery, a relevant subgroup of patients requires pacemaker implantation—most for atrioventricular block. We identified mitral valve replacement and tricuspid ring annuloplasty as significant operative risk factors and insulin‐dependent diabetes mellitus as a demographic risk factor. While anatomic relationships help explain the operative risk factors the role of diabetes mellitus is not completely understood.
Premature battery depletion of EMBLEM subcutaneous implantable cardioverter‐defibrillators
Authors: Ip James E.
Published: February 2021

The EMBLEM subcutaneous implantable cardioverter defibrillator (S‐ICD) has an expected longevity of 7 years. In August 2019, Boston Scientific released an advisory regarding a limited subset of ~400 S‐ICDs that exhibited an increased likelihood of an electrical component malfunction causing accelerated battery depletion. We observed several cases of nonadvisory S‐ICD early battery depletion and sought to systematically evaluate the cohort of EMBLEM devices implanted and followed in our medical center. Out of 118 nonadvisory EMBLEM S‐ICDs with a median time to most recent follow‐up after implant of 735 days (interquartile range 375–1219 days), there were four premature battery failures identified. Serial device interrogations showed a sudden reduction in battery life at 1 195, 1 205, 1 300, and 678 days after implant. The number of shocks delivered during the lifetime of the devices did not explain the premature depletion. There was a sudden departure from the gradual linear decrease in battery longevity observed over time. We are the first to report a signal of premature battery depletion among S‐ICD EMBLEM devices that were not among the initial advisory devices. The prevalence of premature battery failure in our cohort was 3.4%, occurring at an average of 1 095 days. Following these reports, Boston Scientific issued an advisory on EMBLEM devices in December 2020 extending beyond the initial advisory subset. The current projected occurrence rate for hydrogen‐induced accelerated battery depletion is 3.7% at 5 years. Increased surveillance of this potential device issue and mitigation to identify patients at risk for this is warranted.