bluuebunny/crossref_metadata_2025 huggingface dataset:
A Critical Review of the Literature for Sales Educators 2.0
Authors: Cummins Shannon , Nielson Blake , Peltier James W. , Deeter-Schmelz Dawn
Published: July 2020

In this article, we review the recent expansion within the sales education literature from five primary journals and the business literature at large. The five primary journals are the Journal of Marketing Education, Marketing Education Review, Journal for the Advancement of Marketing Education, Journal of Education for Business, and the Journal of Personal Selling & Sales Management. Of the 119 identified articles published in the past 15 years, experiential learning, career development, and assessment were the three most prominent topics. Of these, 69% were published after the Cummins et al. review article “A Critical Review of the Literature for Sales Educator,” which was published in Journal of Marketing Education as a means of expanding sales education research. Future research opportunities in sales education are offered with suggested hypotheses for investigation. A reference table of classroom innovations is provided as an easy guide to instructors seeking vetted pedagogical enhancements.
Seeking Patterns in Chaos: Transactional Federalism in the Trump Administration’s Response to the COVID-19 Pandemic
Authors: Bowling Cynthia J. , Fisk Jonathan M. , Morris John C.
Published: July 2020

The federal government’s response the novel coronavirus (COVID-19) pandemic has been marked by a series of apparently disjointed, chaotic, and confusing statements and actions on the part of both the White House and federal agencies charged with coordinating the federal response. These actions have left many state governors (and citizens) in a position to address the effects of the pandemic in a haphazard and atomistic manner. In this essay, we contend that the actions of the Trump administration, and its relationships with states and local governments, can best be understood through a lens of what we refer to as “transactional federalism,” in which federalism relationships are governed by a set of exchanges between the president and states, and between states. We conclude by discussing the ramifications of this form of federalism.
Interdigital Commissural Approach for Morton’s Neuroma
Authors: Yañez Arauz Juan Manuel
Published: July 2020

Background:

Morton’s neuroma is a frequent cause of metatarsalgia. Operative treatment is indicated if nonoperative management has failed. The objective of the present study was to describe a technique of Morton’s neuroma excision by a minimally invasive commissural approach and evaluate the long-term outcome and complications.

Methods:

A retrospective study of 108 patients with Morton’s neuroma treated surgically with a commissural approach between September 1990 and December 2010 was performed. The surgical technique is described. Clinical outcomes and complications were evaluated. The average follow-up was 121 months. Eleven patients were men and 97 women. The average age was 49.4 years; 56.8% neuromas were at the third space and 43.2% at the second space. Six patients presented 2 neuromas in the same foot, and 9 patients had bilateral neuroma.

Results:

The visual analog scale (VAS) average pain score was 5.4 points preoperatively and 0.2 points at the final follow-up. The author found a significant difference between the VAS scores preoperatively and postoperatively ( P < .01). Excellent and good satisfaction outcomes were achieved in 93.6%. The postoperative complication incidence was 3%.

Conclusion:

The author believes a minimally invasive commissural approach has advantages over a dorsal or plantar incision. It is a simple and reproducible technique, with satisfactory outcomes, low complication rates, and a quick return to usual activities.

Level of Evidence:

Level IV, retrospective case series.
Intracoronary Administration of Allogeneic Cardiosphere-Derived Cells Immediately Prior to Reperfusion in Pigs With Acute Myocardial Infarction Reduces Infarct Size and Attenuates Adverse Cardiac Remodeling
Authors: Sousonis Vasileios , Sfakianaki Titika , Ntalianis Argirios , Nanas Ioannis , Kontogiannis Christos , Aravantinos Dionysios , Kapelios Chris , Katsaros Lampros , Nana Maria , Sampaziotis Dimitrios , Sanoudou Despina , Papalois Apostolos , Malliaras Konstantinos
Published: July 2020

Background:

Allogeneic cardiosphere-derived cells (CDCs) exert cardioprotective effects when administered intracoronarily after reperfusion in animal models of acute myocardial infarction (AMI). The “no-reflow” phenomenon develops rapidly post-reperfusion and may undermine the efficacy of cell therapy, due to poor cell delivery in areas of microvascular obstruction (MVO). We hypothesized that CDC-induced cardioprotection would be enhanced by cell administration prior to reperfusion, when microvasculature is still relatively intact, to facilitate widespread cell delivery within the ischemic area.

Methods and Results:

We studied 81 farm pigs; 55 completed the specified protocols. A dose-optimization study in infarcted pigs demonstrated that the doses of 5 million and 10 million CDCs are the maximum safe doses that can be administered intracoronarily at 5 minutes prior to and at 5 minutes post-reperfusion, respectively, without aggravating MVO. Quantification of acute cell retention by polymerase chain reaction demonstrated that cell delivery prior to reperfusion resulted in higher cardiac cell retention compared to delivery post-reperfusion. We then performed a randomized, placebo-controlled study to assess the long-term efficacy of intracoronary infusion of 5 million allogeneic CDCs, delivered at 5 minutes prior to reperfusion, in a porcine model of AMI. The CDC therapy resulted in decreased scar size, improved regional systolic function, and attenuation of adverse cardiac remodeling (manifested as preserved global systolic function, preserved end-systolic volume, and decreased interstitial fibrosis) compared to placebo at 30 days post-MI.

Conclusions:

Dose-optimized intracoronary infusion of allogeneic CDCs prior to reperfusion in a porcine model of AMI is feasible, safe and confers long-term benefits.
Study of the effects of shear piezoelectric actuators on the performance of laminated composite shells by an isogeometric approach
Authors: Nikoei Sajjad , Hassani Behrooz
Published: July 2020

This paper presents an isogeometric approach based on the Non-Uniform Rational B-Splines (NURBS) to investigate static and free vibration responses of smart composite shells integrated with shear piezoelectric actuators. The degenerated shell formulation according to the Mindlin-Reissner shell theory is combined with the isogeometric approach. To model the laminated smart shells, the Equivalent Single Layer (ESL) theory is used. To consider the electric potential in the shear piezoelectric actuator layers, a sub-layer approach is adopted that assumes linear variation in the thickness direction of the sub-layer. The effect of different mechanical and electrical boundary conditions on transverse deformation and natural frequencies of laminated smart shells by applying the electric field have been investigated. In the case studies, two parallel edges of the considered shell structures are assumed simply supported and the other two with an arbitrary combination of boundary conditions including clamped, free or simply supports. Also, open-circuit and closed-circuit conditions are used as electric boundary conditions. Investigation of the effects of the shear piezoelectric actuator layers on various factors, including the simultaneous mechanical and electrical loadings as well as the radius of curvature of the shell are amongst the objects of this paper. Also, several numerical examples are presented to demonstrate the efficiency and accuracy of the isogeometric approach in the study of shear effects of the piezoelectric actuator layers. The obtained results indicate the reliability and desirability of the proposed approach.
Cytokine Levels and Symptoms Among Women with Irritable Bowel Syndrome: Considering the Role of Hormonal Contraceptive Use
Authors: Kamp Kendra J. , Han Claire , Shulman Robert J. , Cain Kevin C. , Barney Pamela , Opp Mark R. , Chang Lin , Burr Robert L. , Heitkemper Margaret M.
Published: July 2020

Background:

Young to middle-aged women are more likely than men to be diagnosed with irritable bowel syndrome (IBS). Immune dysfunction may be present in IBS, however, few studies have tested whether hormonal contraceptive use is linked to inflammatory markers. The purpose of this study was to compare cytokine levels between women (ages 18–45) with and without IBS and with and without hormonal contraceptive use and to examine the relationships of cytokine levels to IBS gastrointestinal (GI) and non-GI symptoms within those using and not using hormonal contraceptives.

Methods:

Seventy-three women with IBS and 47 healthy control women completed questionnaires (demographics, hormonal contraceptive use) and kept a 28-day symptom diary. Fasting plasma and LPS-stimulated pro-inflammatory (IL-1β, IL-6, IL-12p40, IL-12p70, IL-8, and TNF-α) and anti-inflammatory (IL-10) cytokines were assayed.

Results:

No differences were found in plasma or stimulated cytokine levels between IBS and control women. Levels of IL-1β ( p = 0.04) and TNF-α ( p = 0.02) were higher among women who did not use hormonal contraceptives compared to women who used hormonal contraceptives. Among women with IBS, significant correlations were found between daily psychological distress and plasma IL-10, IL-12p70, IL-1β, IL-6, and IL-8 cytokine levels.

Conclusions:

These results suggest that hormonal contraceptive use might reduce IL-1β and TNF-α cytokine levels in women with IBS. The impact of hormonal contraceptive use on innate immune activation among women with IBS requires further research.
Sickness Questionnaire: A two-factor instrument reflecting physical and mental symptoms in the Chinese context
Authors: Tang Xiaoqing , Guan Qiujie , Duan Wenjie
Published: July 2020

The Sickness Questionnaire (SicknessQ) is a 10-item inventory used to measure sickness-related symptoms. This study extended its psychometric properties in the Chinese context. A total of 992 clinical and non-clinical participants from three samples were included. Exploratory and confirmatory factor analyses indicated a 9-item two-factor structure (mental and physical symptoms) of the Chinese version of Sickness Questionnaire (SicknessQ-C). The internal consistency of the two subscales in this instrument ranged from .71 to .85. The incremental and predictive validities of SicknessQ-C demonstrated that this instrument contributed more to explaining the variance of flourishing than the measurement of negative emotion symptoms.
Resistance/refusal: Politics of manoeuvre under diffuse regimes of governmentality
Authors: Prasse-Freeman Elliott
Published: July 2020

How do contemporary subjects navigate, withstand and even contest the particular governmental assemblages that define regimes of power today? The article addresses this question by considering ‘refusal’, which has emerged as an increasingly potent empirico-theoretical anthropological concept by, in part, marking an explicit contrast with the longer-standing concept of ‘resistance’. Through analysis of resistance and refusal literatures, and with reference to fieldwork with Burmese grassroots activists and Rohingya civil society actors, the article delineates resistance and refusal as divergent but intertwined tools for engaging different aspects of any given apparatus of power. Where resistance describes opposition to direct domination (sovereign modes of power, following Foucault’s schema), refusal describes the disavowals, rejections and manoeuvrings with and away from diffuse and mediated forms of power (governmentality). To the extent that contemporary apparatuses of power typically constitute a hybrid assemblage of sovereign and governmental forces, subjects of population groups draw upon both resistance and refusal tactics in their navigations of these apparatuses, navigations that refigure the collective resisting/refusing subject. Resistance and refusal hence operate in a quasi-dialectical relation, meaning that through a play of recursivity between apparent converse strategies (direct confrontation versus evasion) groups come to fortify stronger positions from which they can persist. Resistance and refusal not only constitute the conditions of each other’s possibility, sharpening the particular interventions that each makes, but demonstrate the necessity of a politics of manoeuvre in which subjects—as individuals and part of collective groups—oscillate between direct confrontation and governmental navigation.
Synthesis of unsymmetrical disulfides via the cross-dehydrogenation of thiols
Authors: Ren Shangfeng , Luo Nianhua , Liu Kunming , Liu Jin-Biao
Published: July 2020

Organosulfur compounds with unsymmetrical S–S bonds are usually called unsymmetrical disulfides and are widely used in the biological, medicinal, and chemical fields. Their versatility has guided the development of various new methods for the synthesis of disulfides. In recent years, the synthesis of disulfides by cross-dehydrogenation of thiols has attracted much attention due to its high atomic economy. Herein, this review summarizes progress toward the synthesis of unsymmetrical disulfides under chemical oxidation, electrooxidation, or photocatalysis by cross-dehydrogenation of thiols.
Colonoscopy is safe and not associated with higher pain scores in patients with hypermobility spectrum disorder: results from an exploratory prospective study
Authors: Beckers Abraham B. , Vork Lisa , Fikree Asma , de Ridder Rogier , Aziz Qasim , Masclee Ad , Keszthelyi Daniel
Published: July 2020

Background:

Patient perception of colonoscopy varies greatly. Young slender women and patients with irritable bowel syndrome (IBS) appear to be at risk for periprocedural pain. Recent evidence suggests a high prevalence of joint hypermobility related connective tissue disorders in this population. Therefore, we aimed to investigate whether hypermobility spectrum disorder (HSD) is associated with increased pain during colonoscopy.

Methods:

We prospectively included patients undergoing routine colonoscopy. Subjects were assessed for HSD using the 2017 criteria, and IBS and functional dyspepsia using the Rome III criteria. After colonoscopy and recovery from sedation, patients were asked to report pain scores on a 100-mm visual analogue scale (VAS). In addition, caecal intubation time was measured, endoscopists scored the difficulty of the procedure (100-mm VAS) and procedure-related adverse events were registered.

Results:

Of 200 included patients, 22 (11%) met criteria for HSD. A female predominance was observed in patients with HSD (86.4% versus 49.4%, p < 0.001). A crude linear regression model demonstrated that pain scores were 13.30 mm higher in patients with HSD versus non-HSD patients (95% CI 0.07 – 26.53, p = 0.049). When subsequently correcting for possible confounding factors, however, this difference in pain scores could be explained by a confounding effect of female gender. Caecal intubation time, perceived procedural difficulty and complication rate did not differ significantly between groups.

Conclusion:

HSD does not seem to be a predictor of painful colonoscopy, probably due to female gender as a confounding factor. In addition, performing colonoscopy is not more complicated in patients with HSD versus non-HSD patients, nor is it associated with more adverse events.
Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study
Authors: Pan Zhenyu , Yang Guozi , He Hua , Cui Jiuwei , Li Wei , Yuan Tingting , Chen Kunzhi , Jiang Tongchao , Gao Pengxiang , Sun Yanan , Cong Xiaofeng , Li Zhi , Wang Yongxiang , Pang Xiaochuan , Song Yuanyuan , Zhao Gang
Published: July 2020

Purpose:

A phase I/II study of intrathecal pemetrexed (IP) combined with involved-field radiotherapy (IFRT) was performed to determine feasibility, safety, and antitumor activity for leptomeningeal metastases (LM) from solid tumors.

Methods:

Participants first received induction IP administration, followed by concomitant radiotherapy within 3 days. The concomitant regimen consisted of IP (pemetrexed 10 mg, dexamethasone 5 mg, once per week, 4 times in 4 weeks) and IFRT (40 Gy in 20 fractions). Six participants were recruited to assess feasibility in phase I, and then 28 patients were recruited further. All patients were assessed to investigate safety, efficacy, and outcomes.

Results:

Between April 2018 and December 2018, 34 patients (male: 15; female: 19; median age: 56 years) were enrolled, including non-small-cell lung cancer (21), small-cell lung cancer (5), breast cancer (4), and others (4). Thirty-two patients received concurrent therapy and 25 (74%) patients completed the treatment. Major adverse events (AEs) consisted of myelosuppression, the elevation of hepatic aminotransferases, and radiculitis. Total AEs rate was 53% (18/34), including 6 (18%) patients with grade 3 and 1 (3%) with grade 4 AEs. The response rate was 68% (23/34). The median overall survival was 5.5 (0.3–16.6) months. Median neurological progression-free survival (NPFS) was 3.5 (0.3–15.2) months. Six-month NPFS rate was 47%. One-year survival rate was 21.6%.

Conclusion:

IP at a 10 mg dose on a schedule of 1–2 times per week presented good efficacy and safety in CSF. The concomitant regimen is an efficacious therapeutic option for LM patients with solid tumors.

Trial Registration:

This study (IPLM) was registered at https://register.clinicaltrials.gov [ClinicalTrials.gov identifier: NCT03507244].
Ankle Fractures: The Current State of Online Patient Information
Authors: Noback Peter C. , Trupia Evan P. , Dziesinski Lucas K. , Sarpong Nana O. , Trofa David P. , Vosseller J. Turner
Published: July 2020

Background. We assessed the quality, accuracy, and readability of websites for ankle fractures. Methods. Ankle Fracture, Broken Ankle, and Fibular Fracture were entered into 3 search engines. The first 25 results from each search were collected. Quality, accuracy, and readability were assessed by a custom rubric, 3 surgeons, and Fleisch-Kincaid grade level (FKGL), respectively. Results. A total of 57 websites were included: 24 were assigned to Ankle Fracture, 26 to Broken Ankle, and 7 to Fibular Fracture. The average quality score out of 36, accuracy score out of 12, and FKGL for all websites were 13.1 ± 6.8, 10.8 ± 1.2, and 9.6 ± 1.7, respectively. Websites assigned to the term Broken Ankle had a significantly lower New Dale-Chall score. Websites of lower FKGL and appearing earlier in results had significantly higher quality scores. Physician specialty societies (PSSs) had a significantly lower FKGL than websites of other types. Conclusion. The readability of patient materials is above the recommended level for ankle fractures. Encouragingly, a trade-off between readability and quality was not found. Patients should use search terms they are familiar with and prioritize websites that appear earlier in search results, are easier to read, and produced by PSSs.

Level of Evidence: Level 3
Earned Memory
Authors: Gloviczki Peter Joseph
Published: July 2020

I explore the pleasures of rereading Lapham on McLuhan after 17 years, with an eye toward the evolving and enduring elements of mediated society. Situated with a critical-cultural and embodied lens for sensemaking, I focus on the fixed and fluid capacities of and for interpretation.
Tricuspid valve infective endocarditis following intravenous administration of traditional and complementary medicine (T&CM)
Authors: Raja Shariff Raja Ezman , Kasim Sazzli , Abdul Rahman Effarezan
Published: July 2020

Right-sided infective endocarditis (IE) is often linked to intravenous drug abuse and healthcare-associated procedures involving catheters and device implantation. We report a rare occurrence of right-sided IE secondary to intravenous use of traditional and complementary medicine (T&CM).
Flat ontology and geography
Authors: Ash James
Published: July 2020

Human geographers are increasingly drawing upon a range of philosophical positions that espouse a more or less flat ontological approach for theorising a range of phenomena. These approaches differentiate between entities in terms of degree rather than kind in order to avoid essentialist, hierarchical or binary modes of thought. To achieve this, they understand the differences between entities as relational. Building upon these perspectives, this article offers a flat ontology that differentiates between things according to their form, which can be identified through a process of de-determination. The concepts of form and de-determination offer a supplement to existing flat ontological approaches by accounting for the difference of entities in terms of where their qualities begin and end as well as their location within a particular set of relations. To demonstrate how the concept of form and de-determination can be applied, I turn to the example of the legal and regulatory debates in the US around the difference between semi-automatic and automatic weapons that have arisen through the development of bump stocks: weapon accessories that allow semi-automatic rifles to mimic fully automatic fire.
Super giant basal cell carcinoma in an autistic patient: A case report
Authors: Hudson Emma , Abu Hilal Mohannad
Published: July 2020

Basal cell carcinoma is the most common skin cancer in the world and is generally treated when small in size with an excellent prognosis. Rarely, basal cell carcinoma will grow to be larger than 5 cm, at which point they are termed giant basal cell carcinoma. Giant basal cell carcinoma comprises only 0.5% of all basal cell carcinoma, but is associated with impaired quality of life and increased risk of metastasis. When a basal cell carcinoma grows to over 20 cm in size, it is termed super giant basal cell carcinoma. Here, we report a case of both a super-giant basal cell carcinoma and a giant basal cell carcinoma developing over 10–12 years on the upper back and anterior chest wall of an autistic male. Generally, this presentation is associated with neglect on the part of the patient. This case report demonstrates a super-giant basal cell carcinoma developing secondary to patient neglect in the context of comorbid mental illness.
High- Versus Low-Energy Acetabular Fracture Outcomes in the Geriatric Population
Authors: Cecil Alexa , Yu Jonathan W. , Rodriguez Viviana A. , Sima Adam , Torbert Jesse , Satpathy Jibanananda , Perdue Paul , Toney Clarence , Kates Stephen
Published: July 2020

Introduction:

High-energy mechanisms of acetabular fracture in the geriatric population are becoming increasingly common as older adults remain active later in life. This study compared outcomes for high- versus low-energy acetabular fractures in older adults.

Materials and Methods:

We studied outcomes of 22 older adults with acetabular fracture who were treated at a level-I trauma center over a 4-year period. Fourteen patients were categorized as low-energy mechanism of injury, and 8 were identified as a high-energy mechanism. We analyzed patient demographics with univariate logistic regressions performed to assess differences in high- and low-energy group as well as patient characteristics compared with surgical outcomes.

Results:

Most high-energy mechanisms were caused by motor vehicle collision (n = 4, 50.0%), with most having posterior wall fractures (50.0%). Among patient characteristics, the mechanism of injury, hip dislocation, fracture types, and fracture gap had the largest differences between energy groups effect size (ES: 2.45, 1.43, 1.36, and 0.83, respectively). The high-energy group was more likely to require surgery (odds ratio [OR] = 2.80, 95% CI: 0.26-30.70), develop heterotopic bone (OR = 4.33, 95% CI: 0.33-57.65), develop arthritis (OR = 3.60, 95% CI: 0.45-28.56), and had longer time to surgery (mean = 4.8 days, standard deviation [SD] = 5.8 days) compared to low-energy group (mean = 2.5 days, SD = 2.3 days).

Discussion:

The results of this case series confirm previous findings that patients with high-energy acetabular fractures are predominantly male, younger, and have fewer comorbidities than those who sustained low-energy fractures. Our results demonstrate that the majority of the high-energy fracture patients also suffered a concurrent hip dislocation with posterior wall fracture and experienced a longer time to surgery than the low-energy group.

Conclusion:

Geriatric patients who sustained high-energy acetabular fractures tend to have higher overall rates of complications, including infection, traumatic arthritis, and heterotopic bone formation when compared with patients with a low-energy fracture mechanism.
A Consensual Qualitative Research Exploration of School Counselor Multicultural Education Behaviors
Authors: Merlin-Knoblich Clare , Moss Lauren , Cholewa Blaire , Springer Sarah I.
Published: July 2020

In this consensual qualitative research study, we explored how school counselors enact multicultural education behaviors by studying the experiences of 10 practicing school counselors. We also examined barriers that prevent school counselors from implementing multicultural education. Participants described acknowledging their contexts, being influenced by intrapersonal factors and awareness of others, and implementing different types of interventions. We discuss implications for practicing school counselors to navigate barriers and enact multicultural education in their schools.
Awe of Intangible Cultural Heritage: The Perspective of ICH Tourists
Authors: Su Xinwei , Li Xi , Wang Yingchuang , Zheng Zhiming , Huang Yuanshui
Published: July 2020

Emotion is an important motivation and experience for tourists, and awe is one of the most anticipated emotional experiences in the travel sector. Previous studies of awe have focused on the natural environment and cultural landscapes, but little research has been conducted on awe in relation to intangible cultural heritage. The current study constructs a research framework that explores the relationship between involvement, experience quality, and loyalty. We adopted a self-administered questionnaire to survey visitors who engaged with the beliefs and customs associated with the sea goddess Mazu on Meizhou Island, China. A total of 450 questionnaires were distributed, and 393 valid questionnaires were returned. Through analysis of the response data, we established that awe is an outcome variable of involvement and experience quality, as well as an antecedent variable of loyalty. Moreover, our findings verify the mediating role of awe between involvement and loyalty, and between experience quality and loyalty. In addition, through a multigroup analysis of male and female tourists, we found a significant difference in the influence of awe on loyalty between the genders. This study is the first to examine awe in relation to intangible cultural heritage, and its findings have valuable practical implications.
Plastome phylogenomic study of Gentianeae (Gentianaceae): widespread gene tree discordance and its association with evolutionary rate heterogeneity of plastid genes
Authors: Zhang Xu , Sun Yanxia , Landis Jacob B. , Lv Zhenyu , Shen Jun , Zhang Huajie , Lin Nan , Li Lijuan , Sun Jiao , Deng Tao , Sun Hang , Wang Hengchang
Published: July 2020

Background

Plastome-scale data have been prevalent in reconstructing the plant Tree of Life. However, phylogenomic studies currently based on plastomes rely primarily on maximum likelihood inference of concatenated alignments of plastid genes, and thus phylogenetic discordance produced by individual plastid genes has generally been ignored. Moreover, structural and functional characteristics of plastomes indicate that plastid genes may not evolve as a single locus and are experiencing different evolutionary forces, yet the genetic characteristics of plastid genes within a lineage remain poorly studied.

Results

We sequenced and annotated 10 plastome sequences of Gentianeae. Phylogenomic analyses yielded robust relationships among genera within Gentianeae. We detected great variation of gene tree topologies and revealed that more than half of the genes, including one (atpB) of the three widely used plastid markers (rbcL, atpB and matK) in phylogenetic inference of Gentianeae, are likely contributing to phylogenetic ambiguity of Gentianeae. Estimation of nucleotide substitution rates showed extensive rate heterogeneity among different plastid genes and among different functional groups of genes. Comparative analysis suggested that the ribosomal protein (RPL and RPS) genes and the RNA polymerase (RPO) genes have higher substitution rates and genetic variations among plastid genes in Gentianeae. Our study revealed that just one (matK) of the three (matK, ndhB and rbcL) widely used markers show high phylogenetic informativeness (PI) value. Due to the high PI and lowest gene-tree discordance, rpoC2 is advocated as a promising plastid DNA barcode for taxonomic studies of Gentianeae. Furthermore, our analyses revealed a positive correlation of evolutionary rates with genetic variation of plastid genes, but a negative correlation with gene-tree discordance under purifying selection.

Conclusions

Overall, our results demonstrate the heterogeneity of nucleotide substitution rates and genetic characteristics among plastid genes providing new insights into plastome evolution, while highlighting the necessity of considering gene-tree discordance into phylogenomic studies based on plastome-scale data.
Genome-wide analysis of microsatellite and sex-linked marker identification in Gleditsia sinensis
Authors: Li Jianjun , Ye Chenglin
Published: July 2020

Background

Gleditsia sinensis Lam. (Leguminosae), a dioecious perennial arbor, demonstrates important medicinal properties and economic value. These properties can be harnessed depending on the sex of the plant. However, the sex of the plants is difficult to identify accurately through morphological methods before the flowering.

Results

We used bulked segregant analysis to screen sex-specific simple sequence repeat (SSR) markers in G. sinensis. Five male and five female plants were pooled to form the male and female bulks, respectively, and subjected to whole-genome sequencing. After high-throughput sequencing, 5,350,359 sequences were obtained, in which 2,065,210 SSRs were searched. Among them, the number of duplicated SSRs was the highest. The male plants could reach 857,874, which accounted for 60.86% of the total number of male plants. The female plants could reach 1,447,603, which accounted for 56.25% of the total model of the female plants. Among all the nucleotide repeat types, the A/T-rich motif was the most abundant. A total of 309,516 female strain-specific SSRs were selected by clustering. After designing the primers, the male and female gene pools were amplified, and five pairs of primers (i.e., 27, 34, 36, 39, and 41) were found to amplify the differential bands in the male and female gene pools. Using the five pairs of primers, we performed PCR verification on 10 individuals of known sex, which constructed the gene pool. The female plants amplified a single fragment of lengths (i.e., 186, 305, 266, 203, and 260 bp) and no male plant strip, thereby completing the identification of the male and female sexes of the G. sinensis.

Conclusions

This study provides accurate sex identification strategies between female and male plants, thus improving the utilization rate of G. sinensis resources.
Efficacy and safety of ambrisentan in Chinese patients with connective tissue disease-pulmonary arterial hypertension: a post-hoc analysis
Authors: Li Mengtao , Jing Zhi-Cheng , Li Yang , Huo Yong , Yu Zaixin , Zhang Gangcheng , Zhu Ping , Liu Jinming , Ji Qiushang , Wu Bingxiang , Zhong Jinhua , Wang Pingping , Zhu Wenjing , Zeng Xiaofeng
Published: July 2020

Background

The efficacy and safety of ambrisentan has been previously evaluated in Chinese patients with pulmonary arterial hypertension (PAH). This post-hoc analysis assessed the efficacy and safety of ambrisentan in a subgroup of connective tissue disease (CTD) patients with PAH.

Methods

In this open-label, single-arm study, patients received ambrisentan 5 mg once daily for 12 weeks, followed by 12-week dose titration period (dose up to 10 mg). Efficacy endpoints included change from baseline in exercise capacity (measured by 6-min walk test [6MWT]), N-terminal pro B type natriuretic peptide (NT-proBNP) plasma levels, WHO Functional Class (FC) and Borg Dyspnoea Index (BDI) scores from baseline to weeks 12 and 24. Safety endpoints included time to clinical worsening and incidence of adverse events (AEs).

Results

In total, 71 Chinese patients with CTD-PAH were included in this analysis. Ambrisentan treatment significantly improved exercise capacity (6MWT) from baseline (mean: 366.4 m) to week 12 (63.8 m, p < 0.001) and week 24 (73.2 m, p < 0.001). A significant reduction in NT-proBNP levels was observed from baseline (mean: 1837.5 ng/L) to week 12 (− 1156.8 ng/L, p < 0.001) and week 24 (− 1095.5 ng/L, p < 0.001). BDI scores decreased significantly at week 12 (− 0.6, p < 0.001) and week 24 (− 0.4, p = 0.002) from baseline (mean: 2.7). The WHO FC improved in 29 (40.8%) and 34 (47.9%) patients at weeks 12 and 24, respectively. Adverse events were reported in 52 (73.2%) patients. One patient (1.4%) experienced clinical worsening at week 24.

Conclusion

Ambrisentan showed significant improvement in exercise capacity and no clinical worsening in the majority of Chinese patients with CTD-PAH in the 24-week treatment period. The AEs observed in the CTD-PAH subgroup were consistent with the known safety profile of ambrisentan in the overall Chinese PAH population.

Trial registration

ClinicalTrial.gov Identifier, https://clinicaltrials.gov/, NCT01808313 Registration date (first time): February 28, 2013.
Distribution pattern and prognosis of metastatic lymph nodes in cervical posterior to level V in nasopharyngeal carcinoma patients
Authors: Jiang Chaoyang , Gao Hui , Zhang Ling , Li Hua , Zhang Tao , Ma Ji , Liu Bisheng
Published: July 2020

Background

Lymph node metastasis in the cervical region posterior to level V (PLV) can occurs in patients with nasopharyngeal carcinoma (NPC), but the significance of lymph node metastasis in this region and the delineation of the radiotherapy target area have not been reported. We aimed to explore the distribution pattern and prognosis of metastatic lymph nodes in the PLV region in patients with NPC.

Methods

We retrospectively studied 605 cases of NPC diagnosed by pathological detection from December 2011 to November 2017. The nodal distribution at each level was assessed in accordance with the Radiation Therapy Oncology Group (RTOG) guidelines proposed in 2013. The central points of the metastatic lymph nodes of the PLV region in the patients were recreated proportionally on the CT images of a standard patient with N0 NPC in reference to the normal anatomy of the PLV area. The correlation between the PLV region and the other levels, the nodal location, and the characteristics and prognosis of the PLV region were analyzed.

Results

Lymph node metastasis occurred in 557 (92.06%) of 605 patients. There were 30 patients (4.95%) with lymph node metastasis in the PLV region. A total of 49 metastatic lymph nodes from the PLV region were counted, and the mean vertical distance of the central point of each lymph node from the anterior surface of the trapezius muscle was 14 mm. Linear regression correlation analysis suggested that lymph node metastasis in the PLV region was associated with ipsilateral level IVa (P = 0.018), level Va, level Vb, and level Vc lymph node metastasis (all P <  0.001). The 5-year OS, PFS, LRFS, and DMFS of 29 patients with lymph node metastasis in the PLV region were 41.6, 27.7, 89.1, and 47.3%, respectively. Multivariate analysis showed that lymph node metastasis in the PLV region was an independent prognostic factor for DMFS (P <  0.05).

Conclusion

NPC patients with lymph node metastasis in the PLV region had a poor prognosis and a high risk of distant metastasis. We recommend that the margin of the PLV region may be a new cervical lymph node segment for NPC.
Trifocal diffractive intraocular lens implantation in patients after previous corneal refractive laser surgery for myopia
Authors: Li Qiu-Mei , Wang Feng , Wu Zhe-Ming , Liu Zhen , Zhan Chuan , Chen Bing-Heng , Sima Jing , Stieger Knut , Li Shao-Wei
Published: July 2020

Background

With the difficulties in IOL power calculation and the potential side effects occurring postoperatively, multifocal IOL implantation after previous corneal refractive surgery are rarely reported especially for the trifocal IOL. Herein we report the clinical observation of trifocal IOL implantation in patients with previous myopia excimer laser correction. In this study, a multi-formula average method was performed for the IOLs power calculation to improve the accuracy. Visual and refractive outcomes were analyzed, and the subjective quality of patients’ life was evaluated by questionnaires survey.

Methods

This retrospective case series included patients with previous myopia excimer laser correction who underwent femtosecond laser assisted phacoemulsification and trifocal IOL (AT LISA tri 839 MP) implantation. Follow-up was done at 1-day, 1-month and 3-month to assess the visual outcomes. Outcome measures were uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction, defocus curve, and subjective quality of vision.

Results

Twenty-one Eyes from sixteen patients (14 eyes with previous laser in situ keratomileusis and 7 eyes with previous photorefractive keratectomy) were included. Mean postoperative spherical equivalent (SE) at 3-month was − 0.56 D ± 0.49 SD, wherein, 10 eyes (47.6%) were within ±0.50 D of the desired emmetropia and 19 eyes (90.5%) were within ±1.0 D. Mean monocular UDVA, UIVA and UNVA (logMAR) at last visit were 0.02 ± 0.07, 0.10 ± 0.10, and 0.15 ± 0.11 respectively. Three patients (19%) reported halos and glare in postoperative 3 months, two of them needed to use spectacles to improve the intermediate visual acuity. Fifteen patients (94%) reported a satisfaction score of ≥3.5 out of 4.0, without any difficulty in daily activity. Thirteen patients (81%) did not need spectacles at all distances, while the other 3 patients (19%) used spectacles for near-distance related visual activity. Mean composite score of the VF-14 questionnaire was 95.00 ± 7.29 out of 100.

Conclusions

Trifocal IOL implantation after myopia excimer laser correction could restore good distance, intermediate visual acuity and acceptable near visual acuity, and provide accurate refractive outcomes as well as high spectacles independence rate.
Impact of a smoking cessation program on smoking prevalence and food security among food pantry users – a study protocol for a pragmatic cluster randomised controlled trial
Authors: Simmet Anja , Teut Michael , Schleicher Romy , Bschaden Andreas , Stroebele-Benschop Nanette
Published: July 2020

Background

Among food pantry users there is a high prevalence of both smoking and food insecurity, which may be related to one another. This study aims to evaluate the impact of a smoking cessation program carried out in food pantries on the smoking status and the food security status of food pantry users.

Methods / design

Before starting the cluster randomised controlled trial, stakeholders will be engaged to adapt a behavioural group counselling program for smoking cessation to the needs of the food pantry users in a pre study. Food pantry users and workers as well as other experts, such as smoking cessation trainers, social workers, and psychologists, will be involved, using the world café technique and telephone interviews and a qualitative thematic analysis for data analysis to design the concept of the intervention program will be applied. In the second phase, the impact of the intervention on the smoking status and on food insecurity will be investigated by a cluster randomised controlled trial. A total of 416 food pantry users across 32 clusters (food pantries) in Berlin, Germany, should be recruited and randomly assigned to either the intervention group or the waiting list control group. The intervention will consist of a behavioural group counselling program for smoking cessation, specially tailored for food pantry users, as well as optional nicotine replacement therapy and the implementation of environmental smoking reduction measures in the food pantries. The primary outcomes 6 months after the treatment will be self-reported continuous smoking abstinence, validated by exhaled carbon monoxide (< 10 ppm of carbon monoxide), and increased food security level (the percentage of participants with an improved food security level).

Discussion

This study will be the first long-term investigation into the effect of a smoking cessation program on smoking status and food insecurity. The results of this study will inform the implementation of smoking cessation programs in food pantries throughout Germany.

Trial registration

Prospectively registeredDRKS00020037. Registered 29 April 2020
Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis
Authors: Yu Ganpeng , Xiang Wang , Zhang Tianqing , Zeng Liuting , Yang Kailin , Li Jun
Published: July 2020

Background

Osteoarthritis (OA) is the commonest form of inflammatory joint disease. Unfortunately, to date, there is no appropriate treatment for OA. Boswellia serrata was considered as a potent anti-inflammatory, anti-arthritic and analgesic agent that may be a drug for OA.

Methods

In this meta-analysis, data from randomized controlled trials were obtained to assess the effects of Boswellia or its extract versus placebo or western medicine in patients with OA. The primary outcomes included visual analogue score (VAS), WOMAC pain, WOMAC stiffness, WOMAC function and lequesne index.

Result

Seven trials involving 545 patients were included. Compared with the control group, Boswellia and its extract may relieve the pain [VAS: (WMD -8.33; 95% CI -11.19, − 5.46; P<0.00001); WOMAC pain: (WMD -14.22; 95% CI -22.34, − 6.09; P = 0. 0006)] and stiffness [WOMAC stiffness: (WMD -10.04; 95% CI -15.86, − 4.22; P = 0. 0007)], and improve the joint’s function [WOMAC function: (WMD -10.75; 95% CI -15.06, − 6.43; P<0. 00001); lequesne index: (WMD -2.27; 95% CI -3.08, − 1.45; P<0. 00001)].

Conclusion

Based on current evidence, Boswellia and its extract may be an effective and safe treatment option for patient with OA, and the recommended duration of treatment with Boswellia and its extract is at least 4 weeks.
Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare – systematic review
Authors: Nicholson E. , McDonnell T. , De Brún A. , Barrett M. , Bury G. , Collins C. , Hensey C. , McAuliffe E.
Published: July 2020

Introduction

Health systems offer access to unscheduled care through numerous routes; however, it is typically provided by general practitioners (GPs), by emergency medicine doctors in in emergency departments (EDs) and by GPs in out-of-hours GP services such as practitioner cooperatives. Unscheduled healthcare constitutes a substantial portion of healthcare delivery. A systematic review was conducted to establish the factors that influence parents’ decision making when seeking unscheduled healthcare for their children. The systematic review question was “What are the factors that influence the decision making of parents and families seeking unscheduled paediatric healthcare?”

Method

Five databases (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and four grey literature databases (Proquest, Lenus, OpenGrey, Google Scholar) were searched. The titles and abstracts of 3746 articles were screened and full-text screening was performed on 177 of these articles. Fifty-six papers were selected for inclusion in the review. Data relating to different types of unscheduled health services (namely primary care, the emergency department and out-of-hours services) were extracted from these articles. A narrative approach was used to synthesise the extracted data.

Results

Several factors were identified as influencing parental preferences and decision making when seeking unscheduled healthcare for their children. A number of the included studies identified pre-disposing factors such as race, ethnicity and socioeconomic status (SES) as impacting the healthcare-seeking behaviour of parents. Unscheduled healthcare use was often initiated by the parent’s perception that the child’s condition was urgent and their need for reassurance. The choice of unscheduled service was influenced by a myriad of factors such as: waiting times, availability of GP appointments, location of the ED, and the relationship that the parent or caregiver had with their GP.

Conclusion

Policy and planning initiatives do not always reflect how patients negotiate the health system as a single entity with numerous entry points. Altering patients’ behaviour through public health initiatives that seek to improve, for instance, health literacy or reducing emergency hospital admissions through preventative primary care requires an understanding of the relative importance of factors that influence behaviour and decision making, and the interactions between these factors.
In situ gel drug delivery system for periodontitis: an insight review
Authors: Yadav Ravishankar , Kanwar Indu Lata , Haider Tanweer , Pandey Vikas , Gour Vishal , Soni Vandana
Published: July 2020

Background

Periodontitis is a microbial disease that leads to inflammation in the tooth-supporting tissues of the oral cavity that is common among the elderly. It is initiated by oral inflammation induced by bacterial dysbiosis. Choosing an appropriate antimicrobial agent with the right course of drug administration is the key to successful periodontal therapy. In recent times, with more biomarkers and the development of new technologies, several point-of-care testing (POCT) platforms have been developed for the diagnosis and monitoring of periodontitis. This review focuses on oral microbiology and the pathogenesis of periodontitis as well as recent insights into the in situ gel system for periodontitis.

Design

An exhaustive search was conducted in the following scientific databases Science Direct, Springer, Pub Med, and Google Scholar to review all relevant literatures. This is a comprehensive narrative review of the literature, summarizing the perspectives of the authors.

Results

Novel in situ forming gel is introduced at the site that shows a promising potential to overcome one of the main practical obstacles associated with the treatment of local periodontitis: partial adhesion to the surrounding tissue, causing in the accidental expulsion of at least parts of the implants from patient’s pockets. This results in a large residence time of the system at the site of action and uncertainty of the final exposure to the drug.

Conclusion

From the reviewed literature, it is concluded that experimental evidence suggests that the in situ gel-forming systems can be useful in treating several common diseases of the oral cavity. Future research should focus on clinical studies to be performed for the in situ gel to make a significant contribution to periodontitis.

Graphical abstract