bluuebunny/crossref_metadata_2025 huggingface dataset:
Myasthenia gravis associated with anti‐MuSK antibodies developed after SARS‐CoV‐2 infection
Authors: Assini Andrea , Gandoglia Ilaria , Damato Valentina , Rikani Klaudio , Evoli Amelia , Del Sette Massimo
Published: January 2021

Introduction

Since the onset of the novel coronavirus pandemic, several neurological complications secondary to SARS‐CoV‐2 infection have been reported, affecting central nervous system, peripheral nervous system and neuromuscular junction.

Case report

We present the case of a 77‐year‐old man who developed bulbar myasthenia gravis (MG) eight weeks after SARS‐CoV‐2 infection. The search for serum antibodies against the acetylcholine receptor and the muscle‐specific tyrosine kinase (MuSK), performed by radioimmunoassay (RIA), and the search of low‐density lipoprotein receptor‐related protein 4 antibodies, performed by immunohistochemistry, resulted negative, while anti‐MuSK antibodies were detected by cell‐based assay (CBA). The patient was treated with pyridostigmine (60 mg four times a day) with unsatisfactory clinical response, followed by immunosuppressive therapy (azathioprine 1.5 mg/kg/day) with improvement of MG symptoms after two months of treatment.

Discussion

Several viral diseases have been described as associated with the onset of MG, although the underlying mechanisms are not yet fully understood. Similarly, a growing number of scientific reports suggest a correlation between SARS‐CoV‐2 infection and autoimmune diseases. The interest of our case lies in the timing of the MG onset (after 2 months from infection), together with the unusual late onset of anti‐MuSK MG. These elements suggest that coronavirus infection may act as a trigger of the disease. We confirm the importance of CBA in the serological diagnosis of RIA‐negative MG.
cnm‐Positive Streptococcus mutans and diffusion‐weighted imaging hyperintensities in acute intracerebral hemorrhage
Authors: Shiga Yuji , Aoki Shiro , Hosomi Naohisa , Nomura Ryota , Nakamori Masahiro , Nezu Tomohisa , Tachiyama Keisuke , Kamimura Teppei , Kinoshita Naoto , Shimomura Ryo , Hayashi Yuki , Matsushima Hayato , Imamura Eiji , Ueno Hiroki , Wakabayashi Shinichi , Nakano Kazuhiko , Kohriyama Tatsuo , Maruyama Hirofumi
Published: January 2021

Background

Strains of Streptococcus mutans expressing the cell surface collagen‐binding protein, Cnm, encoded by cnm (cnm‐positive S. mutans), are associated with hypertensive intracerebral hemorrhage (ICH) and the occurrence of cerebral microbleeds (CMBs). Small diffusion‐weighted imaging (DWI) hyperintensities in patients with acute ICH are also associated with CMBs. However, the association between cnm‐positive S. mutans and DWI hyperintensities is unclear. Hence, this study aimed to investigate the association between cnm‐positive S. mutans and DWI hyperintensities in patients with acute ICH.

Methods

Patients with acute ICH were prospectively registered at three hospitals. Dental plaque specimens were collected within 4 days after admission, and cnm‐positive S. mutans was detected using the polymerase chain reaction. Magnetic resonance imaging at 14 ± 5 days after admission was used to evaluate DWI hyperintensities and CMBs.

Results

A total of 197 patients were enrolled in this study. cnm‐positive S. mutans was detected in 30 patients (15.2%), and DWI hyperintensities were observed in 56 patients (28.4%). Patients with cnm‐positive S. mutans had a higher frequency of DWI hyperintensities (50.0% vs 24.6%; p = 0.008) and a higher number of CMBs (5.5 vs 1.5; p < 0.001) than those without cnm‐positive S. mutans. Multivariable logistic analysis revealed that the presence of cnm‐positive S. mutans was independently associated with DWI hyperintensities (OR 2.38; 95% CI 1.01–5.61; p = 0.047) after adjusting for several confounding factors.

Conclusion

This study found an association between the presence of cnm‐positive S. mutans and DWI hyperintensities in patients with acute ICH.
Response to Zöller et al.'s critique on “Potential short‐term earthquake forecasting by farm‐animal monitoring”
Authors: Wikelski Martin , Mueller Uschi , Scocco Paola , Catorci Andrea , Desinov Lev V. , Belyaev Mikhail Y. , Keim Daniel , Pohlmeier Winfried , Fechteler Gerhard , Mai Paul Martin
Published: January 2021

Zöller et al. (Ethology, 2020) criticize our original publication (Wikelski et al., Ethology, 126(9), 2020, 931) for obvious reasons: we only observed the behavior of one group of farm animals before, during and after one earthquake series in one area of the world. It is clear that no earthquake predictions are possible, and should not be attempted, from this data set. However, what we show is that there is important information within this animal collective pertaining to potential future local forecasting of earthquakes when combined with traditional data sources. We maintain that combining Zöller et al.'s (2020) modeling tools with the adequate use of our data can stimulate novel ways of earthquake forecasting. Future studies should combine both approaches.
The Good, the Dead, and the Other: Chronicles of a Nepali Phantasmicide
Authors: Poletti Samuele
Published: January 2021

Is an experience the private matter of an inner individual self? The phantasmicide committed by Laxmi in Sinja, Nepal, with the assistance of his uncle suggests otherwise. The perception of a wandering spirit in Nepal, like that of a dragon in the Middle Ages, demonstrates how subjective experiences may sometimes acquire independence in the blurred margins where reality merges with imagination. This line of reasoning finds support in the indigenous view of personhood, according to which a person actualizes as a multitude of situational souls emerging in reaction to circumstances—circumstances to which these reactions may also be pinned. Instead of an outward projection of psychological life, the intersubjective life of the spirit coprotagonist of this affair encourages envisaging experiences as partially independent phenomena capable of acting back upon the experiencing self and being acted upon in turn as other free‐standing subjects. Highlighting the mutual inextricability of private interiority and worldly events, the chronicle of this Nepali phantasmicide fosters thus an alternative to psychological transference pointing toward an Intersubjective‐I that avoids constraining self and world within rigid boundaries. [intersubjectivity, experience, transference, situationality, personhood, Nepal]
Abdominal aortic thromboembolism and subsequent pelvic limb myositis secondary to colitis and septicaemia in a 5‐day‐old Oldenburg colt
Authors: Pezzanite L. , Frank C. , Koch D. , Moss A. , Landolt G.
Published: January 2021

This case report describes the clinical progression of a 5‐day‐old Oldenburg colt presented for acute severe right hindlimb lameness. The foal had diarrhoea at presentation, and over the next 24 h became tachycardic and febrile with cold extremities in the hindlimbs and began to bear weight on the dorsum of both hind fetlocks. Diagnostic work‐up included physical examination, radiography, ultrasonography and clinicopathological testing. Treatment consisted of antibiotics, anti‐inflammatories, gastroprotectants, oral di‐tri‐octahedral smectite, hyperimmune plasma and isotonic crystalloid fluids for diarrhoea. Bandages and splints were applied to the hindlimbs to assist ambulation and prevent weightbearing on the dorsum of the fetlocks. The foal developed oedema of both hindlimbs, and ultrasonographic evaluation revealed gas pockets within the subcutaneous tissues. An ultrasound‐guided aspirate of the right hindlimb oedema was submitted for cytology, which revealed presumed Clostridial spores, and culture, which yielded heavy growth of Escherichia coli. Surgical fenestration of the hindlimbs was performed due to suspected Clostridial myositis. The foal continued to decline clinically and was humanely subjected to euthanasia. Post‐mortem evaluation revealed septicaemia and thromboembolism of the terminal abdominal aorta resulting in partial obstruction of blood flow to the pelvic limbs with resultant bacterial myositis (Clostridium [suspected] and Escherichia coli [confirmed]). In summary, thrombosis is a potential sequela to coagulopathy seen in septicaemia and should be considered a differential diagnosis in neonatal foals presenting for lameness.
Longitudinal Associations Between Mother–Child and Father–Child Closeness and Conflict From Middle Childhood to Adolescence
Authors: Xie Mingjun , Nuttall Amy K. , Johnson Deborah J. , Qin Desiree B.
Published: January 2021

Objective

The present study aimed at examining the longitudinal associations between closeness and conflict in mother–child and father–child relationships from middle childhood to adolescence.

Method

Using six‐wave longitudinal data of mother–child and father–child relationships from Grades 1 to 9 from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development study (N = 1,105 families; 79% European White, 21% ethnic minorities), the present study used multivariate longitudinal modeling to address the research goal.

Results

For mother–child relationships, higher levels of conflict at Grade 1 were significantly associated with slower increases in conflict and greater declines in closeness over time, while controlling for the effects of demographic variables. Moreover, findings suggest coordination of change across mothers and fathers, such that sharper decreases in closeness (or increases in conflict) between mothers and children were associated with sharper decreases in closeness (or increases in conflict) between fathers and children.

Conclusion

The present study contributes to the literature by elucidating the complexities of the dynamic changes in parent–child relationships and highlighting the importance of including both mothers and fathers in the same model.

Implications

Our findings have important implications for family practitioners and education and intervention programs aimed at supporting families in coping with the challenges in tuning parent–child relationships during adolescence.
Climate‐driven range shifts reduce persistence of competitors in a perennial plant community
Authors: Usinowicz Jacob , Levine Jonathan M.
Published: January 2021

Forecasting the impacts of climate change on species persistence in diverse natural communities requires a way to account for indirect effects mediated through species interactions. In particular, we expect species to experience major changes in competition as they track favorable climates. Here, we combine experimental data with a recently developed theoretical framework based on coexistence theory to measure the impact of climate‐driven range shifts on alpine plant persistence under climate change. We transplanted three co‐dominant alpine perennial species to five elevations, creating a maximum of 5°C increase in average growing‐season temperature. We statistically modeled species' demographic rates in response to the environment and interpolated species' intrinsic ranges—the environmental mapping of reproduction in the absence of competition. We used low‐density population growth rates—species' initial rate of invasion into an established community—as a metric of persistence. Further analysis of low‐density growth rates (LGRs) allowed us to parse the direct impacts of climate change from indirect impacts mediated by shifting competition. Our models predict qualitatively different range shifts for each species based on the climate conditions under which growth rates are maximized and where they are zero. Overall, climate change is predicted to increase the intrinsic (competition free) growth rates of all species, as warmer and wetter conditions increase the favorability of alpine habitat. However, these benefits are entirely negated by increased competition arising from greater overlap between competitors in their intrinsic ranges. Species were highly dispersal limited, which can prevent species from tracking shifting intrinsic ranges by reducing population spread rates. Yet dispersal limitation also promoted species' persistence because it promotes persistence mechanisms. Our study demonstrates the complex pathways by which climate change impacts species' persistence by altering their competitive environment, and highlights how a persistence framework based on LGRs can help disentangle impacts.
Improving the experience of older people with colorectal and breast cancer in patient‐centred cancer care pathways using experience‐based co‐design
Authors: Moser Albine , Melchior Inge , Veenstra Marja , Stoffers Esther , Derks Elvira , Jie Kon‐Siong
Published: January 2021

Background

Patient and public involvement (PPI) in quality improvement of oncological care pathways for older patients are rare.

Objectives

Improve the care pathway experience of older cancer patients and explore lessons learned regarding how to engage this vulnerable group.

Design

Experience‐Based Co‐Design. Setting and participants: Older cancer patients, their caregivers and healthcare professionals within colorectal and breast cancer care pathways.

Interventions: Co‐design quality improvement teams.

Main outcome measures: Colorectal cancer care pathway touchpoints were (a) availability of a contact person during diagnostic, treatment and aftercare phases; (b) collaboration between physicians and different hospital departments; (c) continuous relationship with same physician; (d) respectful treatment; (e) and information transfer with primary care. Breast cancer care pathway touchpoints were (a) comprehensive information package and information provision, (b) care planning based on patient preferences, (c) continuity of patient–professional relationship and (d) specialized care in case of vulnerability. Challenges related to PPI included (a) ability of older cancer patients to be reflective, critical and think at a collective level; (b) gaining support and commitment of professionals; (d) overcoming cultural differences and power inequalities; and (e) involving researchers and facilitators with appropriate expertise and position.

Conclusion

This multidisciplinary quality improvement project revealed several challenges of PPI with older cancer patients and their caregivers. Research teams themselves need to assume the role of facilitator to enable meaningful PPI of older cancer patients.

Patient or Public Contribution

Patient and caregiver representatives and advocates were involved in the design, conduct, analysis, interpretation of the data and preparation of this manuscript.
Differences in hypertension and prehypertension among people living with and without HIV in China: role of HIV infection and antiretroviral therapy
Authors: Xu X , Lin H , Chen X , Zhu B , Shen W , Ning C , Qiao X , Xu X , Shi R , Liu X , Wong FY , He N , Ding Y
Published: January 2021

Objectives

Hypertension is a growing health concern in people living with HIV (PLWH). However, association between HIV infection and hypertension is equivocal.

Methods

In all, 1472 PLWH and 2944 HIV‐negative individuals frequency‐matched by age and sex were derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China. Prehypertension was defined as systolic blood pressure (BP) of 120–139 mmHg and/or diastolic blood pressure of 80–89 mmHg.

Results

Despite the fact that prevalence of hypertension was overall lower among PLWH than among HIV‐negative people (21.1% vs. 29.1%, P < 0.001), it was similar at ages 18–29 (7.6% vs. 8.5%) and 30–44 years (17.1% vs. 18.5%) but significantly lower in PLWH at ages 45–59 (26.1% vs. 40.7%) and 60–75 years (37.1% vs. 57.3%). Prehypertension prevalence was consistently higher in PLWH across all age groups. In the model adjusting for traditional risk factors, HIV infection was associated with hypertension (adjusted odds ratio [aOR] = 1.27, 95% confidence interval: 1.04–1.55) and prehypertension (aOR = 1.77, 95% CI: 1.51–2.08), and attenuated after additional adjustment for abdominal obesity. Age‐stratified analysis showed that these associations of HIV with hypertension were observed at ages 18–29 and 30–44 years and associations with prehypertension were observed at ages 18–29, 30–44 and 45–59 years only. Years since HIV diagnosis and stavudine use were the HIV‐specific factors independently associated with hypertension or/and prehypertension.

Conclusions

HIV infection is independently associated with prehypertension and hypertension especially at younger ages, and this risk may increase as treatment becomes prolonged. Our findings reinforce the urgent necessity for active BP screening and control strategies be adopted for PLWH in China.
Intentional replantation and Biodentine root reconstruction. A case report with 10‐year follow‐up
Authors: Chaniotis A. , Kouimtzis T.H.
Published: January 2021

Aim

To describe the innovative use of intentional replantation for Biodentine root reconstruction of a previously treated immature maxillary central incisor with vertically extended crown root fracture and root detachment.

In the present case, the intentional replantation of a failing, previously treated maxillary central incisor with a vertical crown/root fracture in a 12‐year‐old male patient is reported. The gross extrusion of gutta‐percha points beyond the apex and the pre‐existing extensive, trauma related, distal cervical dentinal detachment justified the intentional replantation treatment plan as an option for tooth retention. After controlling the infection by oral administration of antibiotics, the immature tooth was extracted atraumatically and kept in gauze embedded with tooth replantation medium. The apical third of the immature fractured tooth was treated with ultrasonics and an MTA plug (MTA Angelus White, Londrina, Brazil). The distal cervical dentinal root defect was reconstructed with Biodentine (Septodont, St. Maur‐des‐Fosses, France). The tooth was reinserted and stabilized to the adjacent teeth for 2 weeks. The total extraoral time before replantation was 25 min. In the 10 years since the initial trauma (9 years after the intervention) radiographic and clinical evaluation revealed uneventful healing of the periapical lesion, normal mobility and no detectable signs of external replacement resorption.

Key learning points

Intentional replantation may provide a viable treatment alternative in cases of severe complicated crown/ root fractures

Biodentine may be useful in the reconstruction of external root defects in crown root fractured traumatic dental injuries
Consumers’ perception of different types of food markets in Mexico
Authors: Escobar‐López Sttefanie Y. , Espinoza‐Ortega Angélica , Moctezuma‐Pérez Sergio , Chávez‐Mejía Cristina , Martínez‐García Carlos G.
Published: January 2021

Developing countries such as Mexico have diverse food retail channels classified into three main groups: Supermarkets in their diverse variants (hypermarkets, medium and small supermarkets, and gourmet supermarkets); traditional food supply channels classified in Traditional markets, Tianguis, and grocery stores and Alternative markets. Despite the wide array of options, there is a lack of information on consumers’ perceptions of these different spaces. Therefore, the objective of the present study was to analyse consumers’ perceptions of Traditional markets, Tianguis, Supermarkets and Alternative markets in central Mexico. A questionnaire was applied with three sections: free word association (FWA), purchase habits and socioeconomic aspects. Four hundred and eighty consumers were surveyed, 120 in each type of market. The words mentioned during the FWA were grouped according to category and dimension and were analysed with a chi‐squared test. The relationship between categories and markets was analysed by multiple correspondence analysis and the remaining variables by descriptive statistics. Supermarkets were related to processed foods and nonfood items and were considered accessible, practical and modern spaces. Traditional markets and Tianguis were perceived as traditional and associated with social commitment and fresh foods but were also perceived as lacking in infrastructure, insecure and impractical. Alternative markets were viewed as innovative spaces offering alternative foods, albeit expensive. The interviewed consumers were mostly women. Those approached in Supermarkets and Alternative markets tended to be millennials, and in Tianguis and Traditional markets tended to belong to Generation X (born between 1965 and 1982). Also, most of those in Alternative markets had university or postgraduate degrees. In conclusion, consumers had a clear perception of the different types of markets as well as their advantages and disadvantages. This study contributes to empirical knowledge on the persistence of traditional markets and the incorporation of alternative markets in developing countries in spite of the growth of Supermarkets.
How I investigate minimal residual disease in acute lymphoblastic leukemia
Authors: Correia Rodolfo P. , Bento Laiz C. , de Sousa Flávia A. , Barroso Rodrigo de S. , Campregher Paulo V. , Bacal Nydia S.
Published: January 2021

Minimal Residual Disease (MRD) is the most important independent prognostic factor in acute lymphoblastic leukemia (ALL) and refers to the deep level of measurable disease in cases with complete remission by conventional pathologic analysis, especially by cytomorphology. MRD can be detected by multiparametric flow cytometry, molecular approaches such as quantitative polymerase chain reaction for immunoglobulin and T‐cell receptor (IG/TR) gene rearrangements or fusion genes transcript, and high‐throughput sequencing for IG/TR. Despite the proven clinical usefulness in detecting MRD, these methods have differences in sensitivity, specificity, applicability, turnaround time and cost. Knowing and understanding these differences, as well as the principles and limitations of each technology, is essential to laboratory standardization and correct interpretation of MRD results in line with treatment time points, therapeutic settings, and clinical trials. Here, we review the methodological approaches to measure MRD in ALL and discuss the advantages and limitations of the most commonly used techniques.
Food and Drug Administration insights on clinical study of weight‐loss devices intended for adolescent patients
Authors: Marrone April K. , Venkataraman‐Rao Priya , Gottschalk Laura
Published: January 2021

Background

Medical devices intended for weight loss may provide clinically meaningful benefit to children who are overweight and have obesity; however, no device has been approved by the U.S. Food and Drug Administration (FDA) for use in patients below 18 years of age. Encouragingly, FDA regularly sees new device designs because the field of weight‐loss devices is advancing rapidly. As more devices for weight loss are in development, their use in adolescent populations is expected to follow, but supporting data are needed.

Objectives

This report describes efforts that FDA has taken to understand the unmet clinical need, understand how pediatric patients might benefit from a weight‐loss device, and provide considerations for how to best design weight‐loss device clinical studies considering device‐specific patient risk for adolescents.

Methods

We review the recommendations provided to the FDA in 2005 via a Pediatric Advisory Committee meeting and discuss feedback received in 2018 through our Network of Experts programme.

Results

FDA encourages weight‐loss device manufacturers and academic researchers to collect data through properly controlled trials so that more treatment options can be accessible to pediatric patients.

Conclusions

FDA remains open to considering risk‐based clinical study designs incorporating pediatric patients and will continue to take into account the risk to adolescent study participants when determining whether the benefit–risk evidence supports initiation of an adolescent weight‐loss device study.
Invariant natural killer T cells balance B cell immunity
Authors: Leadbetter Elizabeth A. , Karlsson Mikael C. I.
Published: January 2021

Invariant natural killer T (iNKT) cells mediate rapid immune responses which bridge the gap between innate and adaptive responses to pathogens while also providing key regulation to maintain immune homeostasis. Both types of important iNKT immune responses are mediated through interactions with innate and adaptive B cells. As such, iNKT cells sit at the decision‐making fulcrum between regulating inflammatory or autoreactive B cells and supporting protective or regulatory B cell populations. iNKT cells interpret the signals in their environment to set the tone for subsequent adaptive responses, with outcomes ranging from getting licensed to maintain homeostasis as an iNKT regulatory cell (iNKTreg) or being activated to become an iNKT follicular helper (iNKTFH) cell supporting pathogen‐specific effector B cells. Here we review iNKT and B cell cooperation across the spectrum of immune outcomes, including during allergy and autoimmune disease, tumor surveillance and immunotherapy, or pathogen defense and vaccine responses. Because of their key role as influencers, iNKT cells provide a valuable target for therapeutic interventions. Understanding the nature of the interactions between iNKT and B cells will enable the development of clinical interventions to strategically target regulatory iNKT and B cell populations or inflammatory ones, depending on the circumstance.
Experiences of nurses who have children when caring for COVID‐19 patients
Authors: Coşkun Şimşek Didem , Günay Ulviye
Published: January 2021

Aim

This study was conducted to examine the experiences and feelings of nurses who have children when caring for patients with coronavirus disease (COVID‐19).

Background

The COVID‐19 pandemic has affected the whole world, including Turkey where this study was conducted. Nurses are among healthcare professionals who are intensively working at the forefront during this pandemic. Countries are implementing many policies to fight this pandemic. Turkey also has implemented protective measures related to travel, sports, and cultural activities and has prohibited social meetings.

Method

The study was conducted with 26 nurses working in COVID‐19 clinics of two hospitals in eastern Turkey between May and July 2020 using a qualitative descriptive design.

Findings

Nurses who had children longed for their children and worried about them. They were afraid of getting infected with the disease and transmitting it. Based on content analysis, the themes of the study were determined as follows: (1) longing (longing for children and longing for the pre‐pandemic period), (2) fear (fear of transmitting the disease and fear of death), (3) despair, (4) concern (concern resulting from working in a different clinic, concern resulting from lack of knowledge, and concern resulting from lack of protective equipment), and (5) professional responsibility (professional awareness and love for the profession).

Conclusion

Nurses were away from their families for a long time because of the fear of getting infected with COVID‐19 and transmitting it. They longed for their children and experienced desperation, fear, and anxiety. They loved their profession and were not considering quitting their profession.

Implications for nursing and health policy

Nurses working in COVID‐19 units wear protective equipment and work for a long time under difficult conditions. In addition, nurses who have children are separated from their children because of the fear of transmitting COVID‐19. Therefore, nurses caring for COVID‐19 patients should alternately be replaced by nurses working in other services. They should be given the opportunity to rest and spend time with their loved ones if they are not carriers of COVID‐19.
Effects of a mobile phone application for graduate nurses to improve central venous catheter care: A randomized controlled trial
Authors: Huang Xiang Ling , Tsao Ying , Chung Hui‐Chun , Creedy Debra K.
Published: January 2021

Aim

To develop and test a mobile phone application (app) for graduate nurses on the use and care of central venous catheters.

Design

A randomized controlled trial was conducted at a teaching hospital in the central east coast of Taiwan.

Methods

Recruitment occurred from 1 August 2019 ‐31 October 2019. All graduates (N = 90) attending a 2‐week induction program attended a lecture and completed a 10‐item questionnaire on central venous catheter assessment and care at the end of Week 1 (Time 1). Volunteers were then randomly allocated to receive a link to the learning app on their mobile phone (n = 39 Group A) or control condition (N = 40 Group B). One week later, all graduates completed the knowledge assessment (Time 2) and a simulated clinical assessment with a mannequin. Skills were assessed using an 11‐item, direct observation of procedural skills form. Only data from consenting participants were analysed.

Results

Compared with controls, nurses receiving the intervention reported significantly better knowledge (t = −7.98, p < .001, CI = 20.9~34.8) and skill scores (t = 2.83, p = .006, CI = 1.14~6.61). More frequent use of the mobile phone app was associated with higher knowledge (r = 0.39, p = .02, CI = 0.11~0.99) and skills (r = 0.42, p = .008, CI = 0.17~1.03).

Conclusion

Mobile app instruction for graduate nurses on central venous catheter care increased specific knowledge and skills compared with conventional methods of instruction.

Impact statement

Implementation of mobile phone application technology can be considered a feasible means to proactively provide training and education. Mobile phone apps could be developed for a range of clinical procedures and various settings. Future studies with a larger sample and a longitudinal follow‐up are warranted to confirm results.
Place of apremilast in the real‐life treatment of patients with plaque psoriasis
Authors: Gisondi P. , Geat D. , Girolomoni G.
Published: January 2021

Linked article: M. Augustin et al. J Eur Acad Dermatol Venereol 2021; 35: 123–135. https://doi.org/10.1111/jdv.16431.
Another beneficial effect of phototherapy
Authors: Eberlein B.
Published: January 2021

Linked article: J.M. Bae et al. J Eur Acad Dermatol Venereol 2021; 35: 222–229. https://doi.org/10.1111/jdv.16830.
Development of a 3D spheroid cell culture system from fish cell lines for in vitro infection studies: Evaluation with Saprolegnia parasitica
Authors: Faber Marc N. , Sojan Jerry M. , Saraiva Marcia , van West Pieter , Secombes Christopher J.
Published: January 2021

Understanding the ways in which pathogens infect host cells is essential to improve and develop new treatment strategies. This study aimed to generate a novel in vitro infection model by establishing a reproducible 3D spheroid cell culture system that may lead to a reduced need for animals in fish disease research. 2D models (commonly cell lines) cannot replicate many key conditions of in vivo infections, but 3D spheroids have the potential to provide bridging technology between in vivo and in vitro systems. 3D spheroids were generated using cells from rainbow trout (Oncorhynchus mykiss) cell lines, RTG‐2 and RTS‐11. The RTG‐2 spheroids were tested for their potential to be infected upon exposure to Saprolegnia parasitica spores. Positive infiltration of mycelia into the spheroids was verified by confocal microscopy. As a closer analogue of in vivo conditions encountered during infection, the straightforward model developed in this study shows promise as an additional tool that can be used to further our understanding of host–pathogen interactions for Saprolegnia and possibly a variety of other fish pathogens.
Reply to: Comment on Predicting In‐Hospital Mortality in COVID‐19 Older Patients with Specifically Developed Scores
Authors: Covino Marcello , De Matteis Giuseppe , Burzo Maria Livia , Franceschi Francesco , Sandroni Claudio
Published: January 2021

This letter comments on the letter by Alain Putot
A histone H3K27me3 reader cooperates with a family of PHD finger‐containing proteins to regulate flowering time in Arabidopsis
Authors: Qian Feng , Zhao Qiu‐Yuan , Zhang Tie‐Nan , Li Yu‐Lu , Su Yin‐Na , Li Lin , Sui Jian‐Hua , Chen She , He Xin‐Jian
Published: January 2021

Trimethylated histone H3 lysine 27 (H3K27me3) is a repressive histone marker that regulates a variety of developmental processes, including those that determine flowering time. However, relatively little is known about the mechanism of how H3K27me3 is recognized to regulate transcription. Here, we identified BAH domain‐containing transcriptional regulator 1 (BDT1) as an H3K27me3 reader. BDT1 is responsible for preventing flowering by suppressing the expression of flowering genes. Mutation of the H3K27me3 recognition sites in the BAH domain disrupted the binding of BDT1 to H3K27me3, leading to de‐repression of H3K27me3‐enriched flowering genes and an early‐flowering phenotype. We also found that BDT1 interacts with a family of PHD finger‐containing proteins, which we named PHD1–6, and with CPL2, a Pol II carboxyl terminal domain (CTD) phosphatase responsible for transcriptional repression. Pull‐down assays showed that the PHD finger‐containing proteins can enhance the binding of BDT1 to the H3K27me3 peptide. Mutations in all of the PHD genes caused increased expression of flowering genes and an early‐flowering phenotype. This study suggests that the binding of BDT1 to the H3K27me3 peptide, which is enhanced by PHD proteins, is critical for preventing early flowering.
Expression of SARS‐CoV‐2 entry factors in human oral tissue
Authors: Sawa Yoshihiko , Ibaragi Soichiro , Okui Tatsuo , Yamashita Junro , Ikebe Tetsuro , Harada Hiroyuki
Published: January 2021

The distribution of cells expressing SARS‐CoV‐2 entry factor angiotensin‐converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) in human oral tissues were tested. The investigation was conducted with normal flesh tissue and paraffin‐embedded specimens. The ACE2 and TMPRSS2 expression was detected with all subjects in the normal mucosa of the keratinized stratified squamous epithelia of the tongue and non‐keratinized stratified squamous epithelia of the lip and cheek. It was found that ACE2 is expressed in the cytoplasm and on the cell membrane mainly in the stratum granulosum of the epithelia while the TMPRSS2 is strongly expressed on the cell membrane mainly in the stratum granulosum and stratum spinosum, but not in the stratum basale. Antibodies’ reactions for ACE2 and TMPRSS2 were not observed in the nuclei or keratin layer. The expression of ACE2 and TMPRSS2 in the oral epithelia appears to be general, and the expression was also observed in the mucous and serous acini of the labial glands. The SARS‐CoV‐2 may transiently attach to the oral mucosa and the minor salivary glands which are present under all of the oral mucosa. The oral cavity can be considered an important organ for SARS‐CoV‐2 attachment and may provide a preventive medical avenue to guard against COVID‐19 by preventing saliva from scattering.
Beneficial effects of an alkaline topical treatment in patients with mild atopic dermatitis
Authors: Jurecek Ludovit , Rajcigelova Tana , Kozarova Andrea , Werner Tanja , Vormann Juergen , Kolisek Martin
Published: January 2021

Background

Atopic dermatitis (AD) is the most common cause of eczema. The skin condition affects millions of people worldwide. Severe cases of AD demand systemic treatment, but most AD cases rely on local therapy with topical corticosteroids, emollients, and moisturizing agents to alleviate eczema. Commonly, derma‐cosmetics with a pH around 5.5 are used to treat eczematous lesions (EL). However, evidence is currently amassing that the use of mildly alkaline topical creams is beneficial for AD‐related eczema treatment because of its effect on the inflammation in the skin.

Aims

To test an alkaline two‐phase care concept for the treatment of eczema.

Patients/Methods

An open‐label study of 25 patients with eczema associated with mild AD. Patients were treated with Alkaline Build Up Caring Cream INTENSIVE and Alkaline Build Up Caring Cream PLUS+ (both Siriderma®) for eight weeks. Dermatological, biochemical, and questionnaire‐based examinations were conducted prior to the trial and after its completion.

Results

Topical administration of slightly alkaline creams led to small and statistically insignificant increases of skin pH. Clinical examination at the end of the observation period revealed a significant decrease of total eczematous‐affected skin area, a significant decrease in average severity scores of EL, and significant improvements in patient‐reported outcome parameters. Blood tests did not reveal any significant changes, except for small but significant increases in IL‐8 and monocytes.

Conclusion

Mildly alkaline topical creams seem to provide soothing effects on eczema‐related skin inflammation and thus might contribute to treatment of local symptoms of eczema in patients with mild AD.
Knowledge and current practices of ICU nurses regarding aerosol therapy for patients treated with invasive mechanical ventilation: A nationwide cross‐sectional study
Authors: Zhang Chuanlin , Mi Jie , Wang Xueqin , Lv Shunqiao , Zhang Zeju , Nie Zhi , Luo Xinyi , Gan Ruiying , Zou Yujun , Chen Xiaoya , Fan Lu , Chen Yu , Zhao Huanhuan , Liao Guoyu
Published: January 2021

Aims and objectives

This study aimed to determine the knowledge and current practices of ICU nurses regarding aerosol therapy for patients with invasive mechanical ventilation in China.

Background

Aerosol therapy is a routine operation for intensive care unit (ICU) nurses; however, evidence of the knowledge and current practices of ICU nurses regarding aerosol therapy for patients with invasive mechanical ventilation is insufficient in China.

Design

A total of 433 hospitals in 92 cities (including 31 capital cities) in 31 provinces in China participated in the study.

Methods

A questionnaire was used to investigate the knowledge and current practices of ICU nurses regarding aerosol therapy for patients treated with invasive mechanical ventilation, including 42 questions covering five aspects: sociodemographic information, aerosolisation devices, atomised drugs, atomisation operation and atomisation‐related knowledge. Descriptive analyses of the distribution of the sample are reported as percentages and medians. Univariate and multivariate analysis was used to detect the factors of the interviewee's atomisation knowledge and practices scores. A STROBE checklist was used to guide the reporting of the research.

Results

Of the 1995 questionnaires that were returned, 1978 were analysed. Bronchodilators and glucocorticoids were the most frequently administered drugs. Seventy‐four per cent of the total respondents reported placing a filter on the expiratory limb during aerosol therapy, and 47% of these reported that the filter was changed once a day. Only 13% of the respondents reported always turning the heating humidifier off during aerosol therapy, and 48% never did. Knowledge about the optimal droplet size or atomisation yield was poor. Work experience in the ICU and frequency of atomisation training were the independent influencing factors for atomisation knowledge and practice scores (F = 279.653, p < .001; F = 120.556, p < .001, respectively).

Conclusions

The knowledge of ICU nurses about the optimal implementation of aerosol therapy is poor, and the current scientific knowledge about optimal implementation seemed to be applied infrequently. Atomisation‐related training should be strengthened, especially for nurses with junior titles and with less work experience.

Relevance to clinical practice

Improving the level of ICU nurses’ atomisation practice ability is helpful to ensure patient safety. In clinical work, atomisation expert consensus can be used to carry out relevant training and standardise atomisation operation.
Interventions and strategies aimed at clinical academic pathway development for nurses in the United Kingdom: A systematised review of the literature
Authors: Henshall Catherine , Kozlowska Olga , Walthall Helen , Heinen Anna , Smith Rebecca , Carding Paul
Published: January 2021

Aims and objectives

To review interventions and strategies designed to progress UK clinical academic career pathways in nursing and identify barriers and facilitators to aid wider implementation.

Background

For over a decade, the UK political agenda has promoted the entry of nurses into clinical academic roles. Partnerships between the National Health Service and academia are known to increase nursing recruitment, retention and quality of care. However, there remains a lack of nurses working in these partnership roles.

Design

A systematised review was conducted. An electronic database search was carried out in PubMed, CINAHL, the British Nursing Database and PsychInfo for articles published between September 2006 to June 2020. A narrative approach to data synthesis was used, and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were followed.

Results

Ten papers were included in the review. The authors reported a range of programmes, pathways and toolkits. Pathway outcome measures included numbers of nurses recruited onto clinical academic programmes, clinical academic programmes completed, nursing research outputs, impact on clinical practice and impact on nursing recruitment. Barriers and facilitators to pathway development included funding, clinical and research time constraints, infrastructure, strong and strategic clinical academic leadership and effective partnership working. The quality of the included studies was mixed; more high‐quality, evidence‐based programmes need to be developed and rigorously evaluated.

Conclusions

The findings can inform nursing clinical academic research pathway development internationally, by identifying key drivers for success. Sustained and cohesive implementation of clinical academic research pathways is lacking across the UK.

Relevance to Clinical Practice

Strong, strategic leadership is required to enable progression of clinical academic nursing research pathway opportunities. Clinical nursing practitioners need to collaborate with external partners to enable development of clinical academic pathways within the nursing profession; this can lead to improvements in patient care and high‐quality clinical outcomes.
The knowledge, perceptions, and attitudes toward vaccination in pregnancy, pertussis, and pertussis vaccination during pregnancy among pregnant women in Hong Kong
Authors: Cheung Wing Lam , Law Jessica Y. P.
Published: January 2021

Aims

The Centre for Health Protection of Hong Kong has issued a recommendation on pertussis vaccination during pregnancy to protect infants against pertussis. This study aimed to explore the knowledge, perceptions, and attitudes toward pertussis vaccination during pregnancy among pregnant women in Hong Kong.

Methods

This was a cross‐sectional study conducted over a 6‐week period from August 17 to September 30 2019 among pregnant women in an obstetrics department in a regional public hospital in Hong Kong. Information on participants' demographics, medical, and immunization history, their knowledge, perception and attitudes, toward pertussis vaccination during pregnancy were gathered. Point‐biserial correlation coefficients were used to determine correlation between variables.

Results

Only 112 (24.6%) women knew that pertussis vaccination can be given during pregnancy and 53 (11.6%) recognized that antenatal pertussis vaccination should be given in each pregnancy. Despite poor knowledge on the vaccination, over 80% of women showed an intention to receive pertussis vaccination during pregnancy. Fifty‐two (71.3%) women expressed that recommendations by healthcare professionals may alter their decision on vaccination uptake. The score in the knowledge section and the perception to the vaccination positively correlated with the intention to be vaccinated. Those who were given advice by healthcare professionals were more likely to indicate an intention to receive the vaccination.

Conclusion

Pregnant women in Hong Kong are likely to accept antenatal pertussis vaccination despite the poor knowledge on vaccination in pregnancy and antenatal pertussis vaccination. Recommendations by healthcare professionals are a key factor affecting women's decision on vaccination uptake.
Serum interleukin‐6, interleukin‐17A, and tumor necrosis factor‐alpha in patients with recurrent aphthous stomatitis
Authors: Shen Chenlu , Ye Weijia , Gong Lijun , Lv Kejia , Gao Bicong , Yao Hua
Published: January 2021

Background

Recurrent aphthous stomatitis remains the most common disease of the oral mucosa. The aim of this study was to investigate the clinical significance of serum interleukin‐6, interleukin‐17A, and tumor necrosis factor‐alpha in recurrent aphthous stomatitis.

Methods

Using flow cytometry analysis, we detect the level of serum interleukin‐2, interleukin‐6, interleukin‐17A, tumor necrosis factor‐alpha, and interferon‐gamma in 127 patients with recurrent aphthous stomatitis and 20 healthy control cases; compare; and analyze the correlation of each index.

Results

The levels of serum interleukin‐2, interleukin‐6, tumor necrosis factor‐alpha, and interferon‐gamma in the recurrent aphthous stomatitis group were higher than in the control group, and the differences were statistically significant (P < .05). There was no significant difference in interleukin‐17A between the two groups.

Conclusion

The levels of serum interleukin‐6 and tumor necrosis factor‐alpha in recurrent aphthous stomatitis patients were significantly increased. Considering that serum TNF‐α was mostly within the normal range, its role in the pathology of RAS needed to be further explored.
Association between filum terminale internum length and pain in Cavalier King Charles spaniels with and without syringomyelia
Authors: Sparks Courtney R. , Woelfel Christian , Robertson Ian , Olby Natasha J.
Published: January 2021

Background

Lumbar syringomyelia (SM), lumbosacral pain, and more caudal spinal cord termination are reported in Cavalier King Charles spaniels (CKCS). Data are lacking on the clinical relevance of alterations in their spinal cord terminal structures.

Objectives

To compare spinal cord termination level and filum terminale internum length (FTIL) with presence of lumbar SM and clinical signs in CKCS.

Animals

Forty‐eight CKCS.

Methods

In this prospective study, pain was quantified using owner and clinician assessments. Vertebral level of spinal cord and dural sac termination, presence of SM, and FTIL were determined from sagittal magnetic resonance imaging (MRI) sequences. Kappa and intraclass correlation (ICC) analyses determined interobserver reliability. The MRI findings were compared to owner and clinician‐reported pain quantification.

Results

Interobserver reliability was good for spinal cord and dural sac termination (kappa = 0.61 and 0.64, respectively) and excellent for FTIL (ICC: 92% agreement). The spinal cord terminated at 6th lumbar vertebra in 1, 7th lumbar vertebra in 31, and the sacrum in 15 dogs, and termination level was associated with lumbar SM (P =.002) but not clinical signs. Mean FTIL was 2.9 ± 1.08 mm; it was associated with owner‐reported pain (P =.033)and spinal palpation scores (P =.023). Painful CKCS without SM had shorter FTIL compared to normal CKCS and painful CKCS with SM (P =.02).

Conclusions

Painful CKCS without SM have decreased distance between the termination of the spinal cord and dural sac, suggesting a shorter FTIL. More caudal spinal cord termination is associated with development of lumbar SM.