bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of treatment failure after top‐hat procedure in squamous intraepithelial lesion
Authors: Chen Xuhao , Fan Birao , Jiang Lu , Nong Lin , Dong Ying , Tao Xia
Published: November 2020

Aim

The value of top‐hat procedure during loop electrosurgical excision procedure (LEEP) for squamous intraepithelial lesions had remained controversial. This study aimed to evaluate whether top‐hat specimens positive for cervical intraepithelial neoplasia (CIN) on histopathology can serve as an independent risk factor to predict treatment failure.

Methods

We reviewed the medical records of patients who underwent LEEP and top‐hat procedures in Peking University First Hospital between 2011 and 2016 and collected their follow‐up data until January 2019. We compared the pathological risk factor of treatment failure. Multivariate analysis was carried out to clarify the independent determinant of treatment failure. A Cox model was used to assess the influence of different variables on cumulative treatment failure rates.

Results

This study included 295 cases for short‐term treatment failure, and among them, 178 cases were used to study the long‐term. The presence of CIN in top‐hat was relevant to short‐term treatment failure (OR = 9.64, 95% CI 2.55–36.4) despite a clear margin. On multivariate analysis, top‐hat result (OR = 3.58, 95% CI 1.30–9.89), age ≥ 50 (OR = 10.2, 95%CI 3.64–28.3) and post‐treatment HPV 16/18 infection (OR = 2.35, 95%CI 1.19–4.63) were independent risk factors in predicting short‐term failure. In the Cox model, these factors were also associated with higher cumulative failure rates.

Conclusion

The current study supported the predictive value of top‐hat procedure in short‐term failure after LEEP. Typically, women with positive top‐hat need closer follow‐up despite their negative margin status. Older women with positive top‐hat findings and HPV 16/18 infections after the treatment suffer a higher risk of short‐term failure.
Comparison of machine learning algorithms for the prediction of five‐year survival in oral squamous cell carcinoma
Authors: Alkhadar Huda , Macluskey Michaelina , White Sharon , Ellis Ian , Gardner Alexander
Published: November 2020

Background/Aim

Machine learning analyses of cancer outcomes for oral cancer remain sparse compared to other types of cancer like breast or lung. The purpose of the present study was to compare the performance of machine learning algorithms in the prediction of global, recurrence‐free five‐year survival in oral cancer patients based on clinical and histopathological data.

Methods

Data were gathered retrospectively from 416 patients with oral squamous cell carcinoma. The data set was divided into training and test data set (75:25 split). Training performance of five machine learning algorithms (Logistic regression, K‐nearest neighbours, Naïve Bayes, Decision tree and Random forest classifiers) for prediction was assessed by k‐fold cross‐validation. Variables used in the machine learning models were age, sex, pain symptoms, grade of lesion, lymphovascular invasion, extracapsular extension, perineural invasion, bone invasion and type of treatment. Variable importance was assessed and model performance on the testing data was assessed using receiver operating characteristic curves, accuracy, sensitivity, specificity and F1 score.

Results

The best performing model was the Decision tree classifier, followed by the Logistic Regression model (accuracy 76% and 60%, respectively). The Naïve Bayes model did not display any predictive value with 0% specificity.

Conclusions

Machine learning presents a promising and accessible toolset for improving prediction of oral cancer outcomes. Our findings add to a growing body of evidence that Decision tree models are useful in models in predicting OSCC outcomes. We would advise that future similar studies explore a variety of machine learning models including Logistic regression to help evaluate model performance.
Increased Stress Concentration in Prosthesis, Adhesive Cement, and Periodontal Tissue with Zirconia RBFDPs by the Reduced Alveolar Bone Height
Authors: Sukumoda Erika , Nemoto Reina , Nozaki Kosuke , Omori Satoshi , Noda Michiko , Sato Miho , Takita Mina , Miura Hiroyuki
Published: November 2020

Purpose

To investigate the risk of debonding of resin‐bonded fixed dental prosthesis frameworks and the effects on the periodontal tissue in patients with reduced alveolar bone levels.

Materials and methods

The abutment teeth were the upper central incisor and the canine. Resin‐bonded fixed dental prosthesis framework fabricated using zirconia was set to models with five different alveolar bone levels. A 200‐N load (the maximum clenching force of the anterior teeth) was applied to the center of the pontic to analyze the internal stress on the framework, adhesive cement, and periodontal tissue using finite element analysis.

Results

The mean maximum principal stress generated in the framework was 25.33 and 29.35 MPa in the models with the normal and the lowest alveolar bone level, respectively. Regarding shear stress on the adhesive cement, stress concentration was observed on the connector side in all models, and it increased on the cervical side of the central incisor as the alveolar bone level decreased. In addition, the mean maximum and minimum principal strains generated on the periodontal ligament of the central incisor and canine tended to increase as alveolar bone loss progressed. Furthermore, the mean maximum principal stress on the cortical bone was the greatest in the model with the most significant bone loss at 5.10 MPa.

Conclusions

This study suggested that the risk of debonding and periodontal tissue damage might be higher when resin‐bonded fixed dental prosthesis frameworks were used in patients with reduced alveolar bone levels compared to those in a healthy state.
Perceptions of values over time and why they matter
Authors: Foad Colin M. G. , Maio Gregory G. R. , Hanel Paul H. P.
Published: November 2020

Objective

Extant research mostly treats values as being stable over time. Our research examined how people perceive values over time and whether or not these perceptions reflect motivational tensions between theoretically opposing values. We also assessed the viability of examining values over time to predict well‐being and future intentions.

Method

Four studies (N = 934) asked participants to report their values across past, present, and future settings. These temporal trajectories were analyzed across the four types of higher‐order values: self‐transcendence, self‐enhancement, openness, and conservation. Studies 3 and 4 assessed associations with well‐being. Study 4 assessed associations with self‐reported behavior over time.

Results

Across all four studies, participants perceived their values as being dynamic over time. Younger participants' trajectories did not reflect the motivational conflicts typically reported in values research, but Study 4 showed potential awareness in older age groups. Variability in temporal values correlated with well‐being, particularly for openness values. Future values predicted future intentions, even when controlling for present values.

Conclusion

This novel method of examining values provides new understanding into how people perceive the pursuit of values over time. Additionally, we show two ways that a temporal values measure can offer new insights into well‐being and future intentions.
Role of meditation to improve children's health: Time to look at other strategies
Authors: Wilson Nina A , Kenny Maura A , Peña Alexia S
Published: November 2020

In the United States, it is reported that up to 7 million of the population practice some form of meditation with the main purpose of improving emotional wellbeing and reducing stress. As the prevalence of mental health conditions continues to climb, other forms of health management strategies, including meditation practices, are increasingly used in adults. The evidence continues to emerge for the use of meditation as a way of managing health conditions in adults as demonstrated in systematic reviews and randomised controlled trials. There is also growing evidence evaluating the use of meditation practices and their potential benefits for child and adolescent health. Studies have identified improvements in mood and mental health conditions, school attendance and attention in the classroom in children and adolescents. This article aims to provide a perspective on commonly evaluated meditation types, such as Transcendental Meditation and mindfulness‐based stress reduction. The article also aims to discuss the available evidence for the use of meditation to improve health and general wellbeing of children, including the use of meditation programs in schools, the current downfalls and limitations to the existing literature around meditation, and important points that healthcare practitioners need to consider when discussing the use of meditation as an additional strategy to manage and improve health and wellbeing in children and adolescents.
Acute metabolic effects of melatonin—A randomized crossover study in healthy young men
Authors: Kampmann Ulla , Lauritzen Esben S. , Grarup Niels , Jessen Niels , Hansen Torben , Møller Niels , Støy Julie
Published: November 2020

Melatonin regulates circadian rhythm, but may also have effects on glucose homeostasis. A common G‐allele in the MTNR1B locus has been associated with an increased risk of type 2 diabetes (T2DM). We aimed to examine acute effects of high doses of melatonin on glucose metabolism with attention to MTNR1B genotype. Twenty men were examined in a double‐blinded, randomized crossover study on two nonconsecutive days with four doses of 10 mg oral melatonin or placebo. Insulin sensitivity and insulin secretion were assessed by an intravenous glucose tolerance test (IVGTT) and a hyperinsulinaemic‐euglycaemic clamp (HEC). Blood samples were drawn to determine the metabolic profile and MTNR1B rs10830963 genotype. Indirect calorimetry and blood pressure measurements were also performed. Insulin sensitivity index was significantly reduced on the melatonin day (P = .028) in the whole group and in homozygous carriers of the rs10830963 C‐allele (P = .041). Glucose during the IVGTT was unaffected, but there was a tendency towards lower insulin and C‐peptide levels in the first minutes after glucose administration in G‐allele carriers. Systolic blood pressure decreased and lipid oxidation increased significantly on the melatonin day in rs10830963 G‐allele carriers. Overall, our study reports that acute administration of melatonin in supra‐physiological doses may have a negative impact on insulin sensitivity.

Clinical trial registration number (clinicaltrial.gov): NCT03204877.
Dancing the Supply Chain: Toward Transformative Supply Chain Management
Authors: Wieland Andreas
Published: November 2020

Most of the theories that have dominated supply chain management (SCM) take a reductionist and static view on the supply chain and its management, promoting a global hunt for cheap labor and resources. As a result, supply chains tend to be operated without much concern for their broader contextual environment. This perspective overlooks that supply chains have become both vulnerable and harmful systems. Recent and ongoing crises have emphasized that the structures and processes of supply chains are fluid and interwoven with political‐economic and planetary phenomena. Building on panarchy theory, this article reinterprets the supply chain as a social–ecological system and leaves behind a modernist view of SCM, replacing it with a more contemporary vision of “dancing the supply chain.” A panarchy is a structure of adaptive cycles that are linked across different levels on scales of time, space, and meaning. It represents the world’s complexities more effectively than reductionist and static theories ever could, providing the basis for transformative SCM.
Within‐person associations between racial microaggressions and sleep among African American and Latinx young adults
Authors: Davenport Mattina A. , Landor Antoinette M. , Zeiders Katharine H. , Sarsar Evelyn D. , Flores Melissa
Published: November 2020

Emerging work suggests that experiences of racial discrimination may impact overall sleep health; however, there is limited work on the link between racial microaggressions and sleep. Using weekly diary data, the current study examined young adults’ weekly reports of racial microaggressions across 4 weeks, and their relation to weekly reports of sleep‐onset latency, reduced total sleep time and poorer sleep quality. This design allowed us to examine how within‐person fluctuations in racial microaggressions corresponded with young adults’ sleep. Data were collected among 140 African American (62.1%) and Latinx (37.9%) college students attending a Midwestern University. Students were randomly selected to participate; they were, on average, 20.70 years old (SD = 1.22) and the majority were female (69.3%). Participants self‐reported their racial microaggressions and sleep behaviours (i.e. sleep‐onset latency, total sleep time and sleep quality) each week (across 4 weeks). Multilevel modelling showed significant within‐person effects of racial microaggressions for sleep onset and sleep quality, but not for total sleep duration. Specifically, on weeks that individuals reported increases in racial microaggressions, they reported greater sleep‐onset duration and poorer sleep quality. The current findings provide preliminary evidence that racial microaggressions are associated with sleep‐onset durations and sleep quality among African American and Latinx young adults. Although racial microaggressions are often considered subtle, they may impact the sleep health of young adults in marginalized groups.
Does insufficient sleep affect how you learn from reward or punishment? Reinforcement learning after 2 nights of sleep restriction
Authors: Gerhardsson Andreas , Porada Danja K. , Lundström Johan N. , Axelsson John , Schwarz Johanna
Published: November 2020

To learn from feedback (trial and error) is essential for all species. Insufficient sleep has been found to reduce the sensitivity to feedback as well as increase reward sensitivity. To determine whether insufficient sleep alters learning from positive and negative feedback, healthy participants (n = 32, mean age 29.0 years, 18 women) were tested once after normal sleep (8 hr time in bed for 2 nights) and once after 2 nights of sleep restriction (4 hr/night) on a probabilistic selection task where learning behaviour was evaluated in three ways: as generalised learning, short‐term win–stay/lose–shift learning strategies, and trial‐by‐trial learning rate. Sleep restriction did not alter the sensitivity to either positive or negative feedback on generalised learning. Also, short‐term win–stay/lose–shift strategies were not affected by sleep restriction. Similarly, results from computational models that assess the trial‐by‐trial update of stimuli value demonstrated no difference between sleep conditions after the first block. However, a slower learning rate from negative feedback when evaluating all learning blocks was found after sleep restriction. Despite a marked increase in sleepiness and slowed learning rate for negative feedback, sleep restriction did not appear to alter strategies and generalisation of learning from positive or negative feedback.
Serum interleukin 17 concentrations in dogs with immune‐mediated hemolytic anemia
Authors: Cuq Benoît , Blois Shauna L. , Bédard Christian , Wood R. Darren , Abrams‐Ogg Anthony C. , Beauchamp Guy , Wood Geoffrey A.
Published: November 2020

Background

Increased serum interleukin 17 (IL‐17) concentration has been associated with the immunopathogenesis of autoimmune hemolytic anemia in humans. No data are available about IL‐17 in immune‐mediated hemolytic anemia (IMHA) of dogs.

Objectives

Monitor changes in serum IL‐17 concentration during the acute stages of IMHA in dogs, compared with results in healthy dogs, and its relationship with outcome.

Animals

Thirty‐one client‐owned dogs with primary IMHA and 27 healthy dogs.

Methods

Quantification of serum IL‐17 concentration using a commercially available ELISA kit at the time of admission (D0), after 48 hours (D2) and after 96 hours (D4) as compared to concentration in healthy dogs. The IMHA dogs were classified as survivors if discharged from hospital, or nonsurvivors for any cause of in‐hospital mortality.

Results

Mean serum IL‐17 concentration was higher in dogs with IMHA on admission compared with healthy dogs (D0), but this difference was not significant (mean, 19.52 pg/mL vs 10.52 pg/mL, respectively, P = .17). Throughout hospitalization, serum IL‐17 concentration significantly decreased in survivors. Serum IL‐17 concentration at D0 was not different between survivors and nonsurvivors, but surviving dogs had significantly lower serum IL‐17 concentration at D2 and D4 (P = .04 and P = .004, respectively) compared with nonsurviving dogs. No correlation was found between serum IL‐17 concentration and serum total bilirubin or lactate concentrations or CBC parameters.

Conclusion and Clinical Importance

Serum IL‐17 concentration remained significantly higher in nonsurviving IMHA dogs whereas it significantly decreased during hospitalization in survivors, making serum IL‐17 concentration a potential biomarker for severity and response to treatment in IMHA.
Disentangling multi‐species aggregate versus overlapping distributions
Authors: Chen Youhua , Shen Tsung‐Jen , Condit Richard
Published: November 2020

Aim: Single‐species distributions are well known to present random, aggregate, or regular patterns. However, at the community level, multi‐species aggregate distribution patterns are not simply the lumped aggregate distribution of each species in the community. Actually, the superimposition of specimens of different species on a distribution map can present an interacting distributional pattern: different species may overlap with each other (or conversely, avoid each other). To this end, other than aggregation, it is necessary to further quantify distributionally overlapping patterns of different species at the community level.

Methods and results: In this study, we combined the conspecific‐encounter index v and Moran's I index to disentangle community‐level distributional aggregation versus superimposition. Numerical simulations demonstrated that the two indices, calculated from biodiversity data collected using the sequential sampling of specimens along line transects, were effective and complementary in predicting multi‐species distribution patterns. The conspecific‐encounter index was sensitive to the change in the degree of distributional aggregation while being insensitive to the change in the distributionally overlapping pattern of different species at the community level. In contrast, Moran's I index can detect the change in the degree of distributional overlap while being insensitive to the change in the level of distributional aggregation at the community level. Moreover, through additional simulations, we showed that the conspecific‐encounter index was robust despite many specimens from dominant species being omitted in the sampling. Finally, an empirical test on the Barro Colorado Island (BCI) forest plot in Panama revealed that tree assemblages in that region presented both random and non‐overlapping distributions, the latter being reported herein for the first time.

Conclusions: The performance of Moran's I index and the conspecific‐encounter index are complementary when disentangling multi‐species aggregate versus overlapping distributions at the community level.
How reliable are motion‐triggered camera traps for detecting small mammals and birds in ecological studies?
Authors: Ortmann C. R. , Johnson S. D.
Published: November 2020

Ecological studies often require observations of animals and their behaviour. Motion‐activated cameras (camera traps) based on passive infrared detection (PIR) are a popular solution for recording animal activity in situations when it is impractical for humans to make sufficient observations. However, the reliability of these cameras for recording smaller vertebrates remains uncertain. We assessed the reliability of two widely used PIR camera traps (Bushnell 119740 and Moultrie 13068) for detecting small vertebrates. Specifically, we tested the effects of (1) camera trap model, (2) camera–subject distance and (3) animal class and size on the probability of detection. Brown rats moving across the ground were detected by the Bushnell camera with >80% probability at camera–subject distances ranging from 60 cm to 2 m, while the Moultrie camera was less efficient at distances >1 m. The probability of the Bushnell camera detecting birds feeding on flowers decreased from c. 80% at distances of 40–60 cm to <10% at 2 m and beyond. Larger birds (>20 g) were more likely to be detected than smaller birds (<15 g). Close‐focusing lenses on the Bushnell camera readily allow identification of individual bird species. These results help to establish guidelines for camera trap selection and placement in ecological studies of small terrestrial mammals and birds.
The NAFLD‐MAFLD debate: Eminence vs evidence
Authors: Fouad Yasser , Elwakil Reda , Elsahhar Medhat , Said Ebada , Bazeed Shamardan , Ali Gomaa Ahmed , Hashim Almoutaz , Kamal Enas , Mehrez Mai , Attia Dina
Published: November 2020

Debates are inevitable in science and could be a powerful tool for addressing controversial topics as it promotes critical thinking and inspires individuals to consider alternate viewpoints. However, debates can help only to identify the issues that need to be clarified to address this question, but it can never help resolve the controversy itself. In the era of evidence‐based medicine, the need for an evidence‐based debate is mandatory. Polarising opinions and major debate have recently arisen in hepatology on the nomenclature and diagnostic criteria for fatty liver disease associated with metabolic dysfunction (non alcoholic fatty liver disease [NAFLD]‐metabolic (dysfunction) associated fatty liver disease [MAFLD] debate). The aim of this viewpoint is to suggest a way to settle the debate through evidence. Descriptive review using PubMed to identify literature on the evidence and eminence‐based medicine and studies comparing MAFLD and NAFLD criteria. The emerging studies comparing the performance of diagnostic criteria of NAFLD and MAFLD represent the dawn of a new era for reframing the ongoing debate by acquisition of the mandatory evidence that will both resolve the debate and lead to novel avenues of research. In conclusion, the time has come to hold debate and focus on gathering and building the evidence to settle it. It does not matter who wins the debate and once there is robust evidence, we should all follow it wherever it leads.
Residual low HDV viraemia is associated HDV RNA relapse after PEG‐IFNa‐based antiviral treatment of hepatitis delta: Results from the HIDIT‐II study
Authors: Bremer Birgit , Anastasiou Olympia E. , Hardtke Svenja , Caruntu Florin Alexandru , Curescu Manuela G. , Yalcin Kendal , Akarca Ulus S. , Gürel Selim , Zeuzem Stefan , Erhardt Andreas , Lüth Stefan , Papatheodoridis George V. , Radu Monica , Idilman Ramazan , Manns Michael P. , Cornberg Markus , Yurdaydin Cihan , Wedemeyer Heiner
Published: November 2020

The role of low levels of HDV‐RNA during and after interferon therapy of hepatitis D is unknown. We re‐analysed HDV RNA in 372 samples collected in the HIDIT‐2 trial (Wedemeyer et al, Lancet Infectious Diseases 2019) with the Robogene assay (RA; Jena Analytics). Data were compared with the previously reported in‐house assay (IA). We detected HDV‐RNA in one‐third of samples previously classified as undetectable using the highly sensitive RA. Low HDV viraemia detectable at week 48 or week 96 was associated with a high risk for post‐treatment relapse, defined as HDV RNA positivity in both assays at week 120. HDV RNA relapses occurred in 10/15 (67%) patients with detectable low HDV RNA at week 48 and in 10/13 (77%) patients with low viraemia samples at week 96. In contrast, the post‐treatment relapse rate was lower in patients with undetectable HDV RNA in both assays during treatment.
Serum aromatic and branched‐chain amino acids associated with NASH demonstrate divergent associations with serum lipids
Authors: de Mello Vanessa D. , Sehgal Ratika , Männistö Ville , Klåvus Anton , Nilsson Emma , Perfilyev Alexander , Kaminska Dorota , Miao Zong , Pajukanta Päivi , Ling Charlotte , Hanhineva Kati , Pihlajamäki Jussi
Published: November 2020

Background & Aims

Non‐alcoholic fatty liver disease (NAFLD) has been associated with multiple metabolic abnormalities. By applying a non‐targeted metabolomics approach, we aimed at investigating whether serum metabolite profile that associates with NAFLD would differ in its association with NAFLD‐related metabolic risk factors.

Methods & Results

A total of 233 subjects (mean ± SD: 48.3 ± 9.3 years old; BMI: 43.1 ± 5.4 kg/m2; 64 male) undergoing bariatric surgery were studied. Of these participants, 164 with liver histology could be classified as normal liver (n = 79), simple steatosis (SS, n = 40) or non‐alcoholic steatohepatitis (NASH, n = 45). Among the identified fasting serum metabolites with higher levels in those with NASH when compared to those with normal phenotype were the aromatic amino acids (AAAs: tryptophan, tyrosine and phenylalanine), the branched‐chain amino acids (BCAAs: leucine and isoleucine), a phosphatidylcholine (PC(16:0/16:1)) and uridine (all FDRp < 0.05). Only tryptophan was significantly higher in those with NASH compared to those with SS (FDRp < 0.05). Only the AAAs tryptophan and tyrosine correlated positively with serum total and LDL cholesterol (FDRp < 0.1), and accordingly, with liver LDLR at mRNA expression level. In addition, tryptophan was the single AA associated with liver DNA methylation of CpG sites known to be differentially methylated in those with NASH.

Conclusions

We found that serum levels of the NASH‐related AAAs and BCAAs demonstrate divergent associations with serum lipids. The specific correlation of tryptophan with LDL‐c may result from the molecular events affecting LDLR mRNA expression and NASH‐associated methylation of genes in the liver.
Prevalence of liver cirrhosis in individuals with hepatitis B virus infection in sub‐Saharan Africa: Systematic review and meta‐analysis
Authors: Surial Bernard , Wyser Dominik , Béguelin Charles , Ramírez‐Mena Adrià , Rauch Andri , Wandeler Gilles
Published: November 2020

Background & Aims

Chronic hepatitis B virus (HBV) infection accounts for 30%‐50% of cirrhosis related deaths in sub‐Saharan Africa (SSA). Since HBV‐related cirrhosis is an indication for immediate antiviral therapy and cancer surveillance, we aimed to estimate the prevalence of cirrhosis among treatment‐naïve patients with chronic HBV infection in SSA.

Methods

We performed a systematic review of published articles which evaluated liver fibrosis stage among treatment‐naïve HBV‐infected individuals who presented to care in SSA. Our primary outcome was the prevalence of cirrhosis in HBsAg‐positive persons, which was estimated using random‐effects meta‐analysis. Risk factors for cirrhosis were explored using subgroup‐analyses and multivariable meta‐regression.

Results

Of 2129 articles identified, 17 met our eligibility criteria. The studies described 22 cohorts from 13 countries, including 13 cohorts (3204 patients) with chronic HBV mono‐infection and nine cohorts (688 patients) with HIV/HBV‐coinfection. Liver fibrosis was assessed using transient elastography (10 cohorts), APRI score (11 cohorts), and Fibrotest (one cohort). The pooled prevalence of cirrhosis was 4.1% (95% confidence interval [CI] 2.6‐6.4) among studies from primary care facilities or general population, compared to 12.7% (95% CI 8.6‐18.3) in studies performed in referral or tertiary care facilities (adjusted odds ratio 0.29, 95% CI 0.15‐0.56). We found no association between cirrhosis and age, gender, fibrosis test used or HIV‐coinfection.

Conclusions

Depending on the setting, between 4% and 13% of HBV‐infected individuals in SSA have cirrhosis and need immediate antiviral therapy. These estimates should be considered when planning HBV treatment strategies and resource allocation.
Host plant diet affects growth and induces altered gene expression and microbiome composition in the wood white (Leptidea sinapis) butterfly
Authors: Näsvall Karin , Wiklund Christer , Mrazek Veronika , Künstner Axel , Talla Venkat , Busch Hauke , Vila Roger , Backström Niclas
Published: November 2020

In a time with decreasing biodiversity, especially among insects, a detailed understanding about specific resource utilization strategies is crucial. The physiological and behavioural responses to host switches in phytophagous insects are poorly understood. Earlier studies indicate that a host plant switch might be associated with distinctive molecular and physiological responses in different lineages. Expanding the assessment of such associations across Lepidoptera will reveal if there are general patterns in adaptive responses, or if each switch event is more of a unique character. We investigated host plant preference, fitness consequences, effects on expression profiles and gut microbiome composition in two common wood white (Leptidea sinapis) populations with different host plant preferences from the extremes of the species distribution area (Sweden and Catalonia). Our results show that female Catalonian wood whites lack preference for either host plant (Lotus corniculatus or L. dorycnium), while Swedish females laid significantly more eggs on L. corniculatus. Individuals from both populations reared on L. dorycnium had longer developmental times and smaller body size as adults. This indicates that both environmental and genetic factors determine the choice to use a specific host plant. Gene expression analysis revealed a more pronounced response to host plant in the Catalonian compared to the Swedish population. In addition, host plant treatment resulted in a significant shift in microbiome community structure in the Catalonian population. Together, this suggests that population specific plasticity associated with local conditions underlies host plant utilisation in wood whites.
A multidecadal Bayesian trend analysis of harbor porpoise(Phocoena phocoena) populations off California relative to past fishery bycatch
Authors: Forney Karin A. , Moore Jeffrey E. , Barlow Jay , Carretta James V. , Benson Scott R.
Published: November 2020

Harbor porpoises,Phocoena phocoena, off California, comprise four recognized population stocks: Morro Bay (MOR), Monterey Bay (MRY), San Francisco‐Russian River (SFRR), and Northern California‐Southern Oregon (NCSO). The three southernmost stocks experienced substantial bycatch in gill net fisheries during the 1970s and 1980s. While the SFRR stock received full protection from gill nets in 1989, the MOR and MRY stocks continued to experience at least some bycatch through 2001–2002. We examined long‐term population trends for these four harbor porpoise stocks, based on two sets of systematic, aerial line‐transect surveys conducted off California during summer/fall of 1986–2017. We applied a Bayesian hierarchical framework to specify a process model of population density and an observation model of porpoise counts during line‐transect surveys. Growth rates were estimated for periods with and without bycatch. Posterior distributions indicate the MOR, MRY, and SFRR stocks, respectively, grew at 9.6%, 5.8%, and 6.1% per year after gill nets were largely or fully eliminated for each stock. Abundance off northern California appears stable or slightly increasing. This study provides a first empirical estimate of maximum net reproductive rate for harbor porpoise (at least 9.6%), and demonstrates that porpoise populations can recover from substantial gill net impacts if bycatch is eliminated.
Development of an FhbB based chimeric vaccinogen that elicits antibodies that block Factor H binding and cleavage by the periopathogen Treponema denticola
Authors: O'Bier Nathaniel S. , Patel Dhara T. , Oliver Lee D. , Miller Daniel P. , Marconi Richard T.
Published: November 2020

Treponema denticola is a proteolytic anaerobic spirochete and key contributor to periodontal disease of microbial etiology. As periodontal disease develops and progresses, T. denticola thrives in the hostile environment of the subgingival crevice by exploiting the negative regulatory activity of the complement protein, factor H (FH). FH bound to the cell surface receptor, FhbB (FH binding protein B), is competent to serve as a cofactor for the Factor I mediated‐cleavage of the opsonin C3b. However, bound FH is ultimately cleaved by the T. denticola protease, dentilisin. As the T. denticola population expands, the rate of FH cleavage may exceed its rate of replenishment leading to local FH depletion and immune dysregulation culminating in tissue and ligament destruction and tooth loss. The goal of this study was to develop a T. denticola FhbB based‐vaccine antigen that can block FH binding and cleavage and kill cells via antibody‐mediated bactericidal activity. Tetra (FhbB‐ch4) and pentavalent fhbB (FhbB‐ch5) chimerics were engineered to have attenuated FH binding ability. The chimerics were immunogenic and elicited high‐titer bactericidal and agglutinating antibody. Anti‐Fhb‐ch4 antisera blocked FH binding and cleavage by the T. denticola protease, dentilisin, in a dose dependent manner. Precedent for the use of FH binding proteins comes from the successful development of two FDA approved vaccines for type B Neiserria meningitidis. This study is the first to extend this approach to the development of a preventive or therapeutic vaccine (or monoclonal Ab) for periodontal disease.
Epithelioid haemangioma (angiolymphoid hyperplasia with eosinophilia subtype) involving the vermillion border of the lower lip
Authors: Robinson Liam , Lebaka Chidinyane S. , van Heerden Willie F. P.
Published: November 2020

Epithelioid vascular tumours include benign epithelioid haemangioma (EH) and epithelioid angiomatous nodule, low‐grade malignant epithelioid haemangioendothelioma and high‐grade epithelioid angiosarcoma. These tumours share epithelioid cell morphologies and intracytoplasmic vacuoles, with distinction based on differing architectural and nuclear features. This report highlights a case of EH, angiolymphoid hyperplasia with eosinophilia subtype, involving the vermillion border of the lower lip in an elderly female patient. The clinical and histological features, differential diagnosis, aetiopathogenesis, molecular basis and treatment options are discussed as part of a comprehensive review of this rare entity.
Midazolam dosage in intravenous conscious sedation
Authors: Irshad Hinna , Loke Stephanie , Lord Tim
Published: November 2020

Aim

Midazolam is the first‐line drug for intravenous conscious sedation in dentistry. A 5‐mL ampoule of midazolam (1 mg/mL) is a widely used preparation for a carefully titrated optimum sedation dose tailored to the individual patient. In past times at Liverpool University Dental Hospital, a 10‐mL pre‐filled syringe of midazolam (1 mg/mL) was used and with the transition to 5‐mL ampoules, a study was undertaken to assess whether this change had an impact on dosages delivered by sedationists.

Materials and methods

A retrospective study was carried out to include 100 patients who were sedated on the Oral Surgery department for a range of surgical procedures. A total of 50 patients were sedated using a 10‐mL pre‐filled syringe and 50 patients were sedated using 5‐mL ampoules. Data collection looked at the total midazolam dosage and other factors including operator, procedure complexity, ASA grade, sedation score and operating conditions score.

Results

There was a statistical difference between the mean dosages for both groups with an overall lower dose administered in patients who were sedated with 5‐mL ampoules.

Conclusions

The study suggested an impact of human factors when behavioural changes occur as a result of change in practice. The outcome of the study suggested revision of the factors which should influence midazolam dosage and are discussed in this study.
Artificial intelligence in the diagnosis of pediatric allergic diseases
Authors: Ferrante Giuliana , Licari Amelia , Fasola Salvatore , Marseglia Gian Luigi , La Grutta Stefania
Published: November 2020

Artificial intelligence (AI) is a field of data science pertaining to advanced computing machines capable of learning from data and interacting with the human world. Early diagnosis and diagnostics, self‐care, prevention and wellness, clinical decision support, care delivery, and chronic care management have been identified within the healthcare areas that could benefit from introducing AI. In pediatric allergy research, the recent developments in AI approach provided new perspectives for characterizing the heterogeneity of allergic diseases among patients. Moreover, the increasing use of electronic health records and personal healthcare records highlighted the relevance of AI in improving data quality and processing and setting‐up advanced algorithms to interpret the data. This review aimed to summarize current knowledge about AI and discuss its impact on the diagnostic framework of pediatric allergic diseases such as eczema, food allergy, and respiratory allergy, along with the future opportunities that AI research can offer in this medical area.
Novel SERPING1 gene mutations and clinical experience of type 1 hereditary angioedema from North India
Authors: Jindal Ankur K. , Rawat Amit , Kaur Anit , Sharma Dhrubajyoti , Suri Deepti , Gupta Anju , Garg Ravinder , Dogra Sunil , Saikia Biman , Minz Ranjana W. , Singh Surjit
Published: November 2020

Background

There is paucity of literature on long‐term follow‐up of patients with hereditary angioedema (HAE) from developing countries.

Objective

This study was carried out to analyze the clinical manifestations, laboratory features, and genetic profile of 32 patients (21 male and 11 female) from 23 families diagnosed with HAE between January 1996 and December 2019.

Methods

Data were retrieved from medical records of Paediatric Immunodeficiency Clinic, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Results

Median age at onset of symptoms was 6.25 years (range 1‐25 years), and median age at diagnosis was 12 years (range 2‐43 years). Serum complement C4 level was decreased in all patients. All patients had low C1‐esterase inhibitor (C1‐INH) quantitative level (type 1 HAE). SERPING1 gene sequencing could be carried out in 20 families. Of these, 11 were identified to have a pathogenic disease‐causing variant in the SERPING1 gene. While 2 of these families had a previously reported mutation, remaining 9 families had novel pathogenic variants in SERPING1 gene. Because of non‐availability of C1‐INH therapy in India, all patients were given long‐term prophylaxis (attenuated androgens or tranexamic acid (TA) or a combination of the 2). Life‐threatening episodes of laryngeal edema were managed with fresh‐frozen plasma (FPP) infusions. We recorded one disease‐related mortality in our cohort. This happened in spite of long‐term prophylaxis with stanozolol and TA.

Conclusions

We report largest single‐center cohort of patients with HAE from India. Attenuated androgens, fibrinolytic agents, and FPP may be used for management of HAE in resource‐limited settings.
Donor‐derived cell‐free DNA (dd‐cfDNA) for detection of allograft rejection in pediatric kidney transplants
Authors: Puliyanda Dechu P. , Swinford Rita , Pizzo Helen , Garrison Jonathan , De Golovine Aleksandra M. , Jordan Stanley C.
Published: November 2020

In pediatric transplantation, acute rejection is a major contributor of graft failure. Current approaches include kidney biopsy in response to graft dysfunction and/or the emergence of donor‐specific HLA antibodies (DSA). However, biopsy is associated with potential complications. Thus, there is a need for non‐invasive diagnostics. Detection of donor‐derived cell‐free DNA (dd‐cfDNA, AlloSure) > 1% is associated with rejection in adult kidney transplants. Here, we evaluate the utility of dd‐cfDNA for identifying allograft rejection in pediatric patients. Between 10/2017 and 10/2019, 67 patients, who underwent initial testing with dd‐cfDNA as part of routine monitoring or in response to clinical suspicion for rejection, were included. Biopsies were performed when dd‐cfDNA > 1.0% or where clinical suspicion was high. Demographics, dd‐cfDNA, antibody status, and biopsies were collected prospectively. Data were analyzed to determine predictive value of dd‐cfDNA for identifying grafts at risk for rejection. 19 of 67 patients had dd‐cfDNA testing as part of routine monitoring with a median dd‐cfDNA score of 0.37 (IQR: 0.19‐1.10). 48 of 67 patients who had clinical suspicion of rejection had median dd‐cfDNA score of 0.47 (0.24‐2.15). DSA‐positive recipients had higher dd‐cfDNA scores than those who were negative or had AT1R positivity alone (P = .003). There was no association between dd‐cfDNA score and strength of DSA positivity. 7 of 48 recipients had a biopsy with a dd‐cfDNA score <1%; two showed evidence of rejection. Neither DSA nor AT1R positivity was statistically associated with biopsy‐proven rejection. However, dd‐cfDNA >1% was diagnostic of rejection with sensitivity of 86% and specificity of 100% (AUC: 0.996, 0.98‐1.00; P = .002). dd‐cfDNA represents a non‐invasive method for early detection of rejection in pediatric renal transplants. Our study shows dd‐cfDNA to be highly predictive of histological rejection and superior to other indicators such as graft dysfunction or antibody positivity alone. Further studies are necessary to refine these initial observations.
Comparative analysis of outcomes and long‐term follow‐up of robot‐assisted pediatric kidney transplantation, with open counterpart
Authors: Bansal Amit , Maheshwari Ruchir , Chaturvedi Samit , Bansal Devanshu , Kumar Anant
Published: November 2020

How does the robotic kidney transplant fare against the open technique, in pediatric patients? No one knows. To address this question, this study compares the outcomes of robotic kidney transplants, with those of open transplant in these patients. This study was a retrospective analysis of outcomes (renal function and complications), of all pediatric patients (<18 years of age), who underwent kidney transplant at our institute, after 2014, till their last follow‐up. Fisher's exact test was used to compare proportions. Continuous variables were analyzed using Mann‐Whitney test. P value of <.05 was considered significant. Of the twenty‐five patients included, 21 belonged to open group, and 4 to the robotic group. Patients in the robotic group had significantly higher Re‐WIT (P value .002) and had lower analgesia requirement (P value .04). Median follow‐up period was 31 months. Both groups were comparable in terms of length of hospital stay, blood transfusion, and renal function post‐operatively till their last follow‐up. Three patients in the open group had surgical site infection as compared to none in the robotic group. All the patients had functioning grafts till their last follow‐up. Robotic transplant is safe and delivers functional results similar to open technique, with lesser pain and better cosmesis. Longer Re‐WIT in robotic transplant has no impact on post‐operative renal function. Ours is the first known effort to compare robotic technology with the established open technique of transplant in this population. A prospective randomized controlled trial should refine the results of the present study.
Long‐term outcome of transplant ureterostomy in children: A National Review
Authors: Costigan Caoimhe S. , Raftery Tara , Riordan Michael , Stack Maria , Dolan Niamh M. , Sweeney Clodagh , Waldron Mary , Kinlough Mairead , Flynn Joan , Bates Marie , Little Dilly M. , Awan Atif
Published: November 2020

Background

CAKUT are the most common cause of end‐stage renal failure in children (Pediatr Nephrol. 24, 2009, 1719). Many children with CAKUT have poor urinary drainage which can compromise post‐transplant outcome. Identifying safe ways to manage anatomical abnormalities and provide effective urinary drainage is key to transplant success. Much debate exists regarding optimum urinary diversion techniques. The definitive formation of a continent urinary diversion is always preferable but may not always be possible. We explore the role of ureterostomy formation at transplantation in a complex pediatric group.

Methods

We report six pediatric patients who had ureterostomy formation at the time of transplantation at the National Paediatric Transplant Centre in Dublin, Ireland. We compared renal function and burden of urinary tract infection to a group with alternative urinary diversion procedures and a group with normal bladders over a 5‐year period.

Results

There was no demonstrable difference in estimated glomerular filtration rate between the groups at 5‐year follow‐up. The overall burden of UTI was low and similar in frequency between the three groups.

Conclusions

Ureterostomy formation is a safe and effective option for temporary urinary diversion in children with complex abdominal anatomy facilitating transplantation; it is, however, important to consider the implications and risk of ureterostomy for definitive surgery after transplantation.
Vaccine‐induced protection against hepatitis B in pediatric solid organ transplant patients
Authors: Ball Michael , Liverman Rochelle , Serluco Anastacia , Yildirim Inci
Published: November 2020

Background

Vaccination against hepatitis B virus (HBV) has led to a worldwide reduction in disease burden and mortality. Vaccine immunogenicity data in transplanted children are limited, and vaccine‐induced protection may be reduced. We evaluated HBV vaccination coverage, seroprotection rates, and factors influencing vaccine immunity among pediatric solid organ transplant (SOT) patients.

Methods

We retrospectively identified patients ≤21 years of age evaluated for SOT and/or transplanted at our center between January 1, 2015, and December 31, 2018. A detailed chart review was conducted using a standard questionnaire to gather information on demographic, clinical, and laboratory features of patients’ HBV vaccination, and hepatitis B surface antibody (HBsAb) titers.

Results

A total of 381 patients undergoing evaluation and/or transplantation were included: 139 (36.5%) liver, 138 (36.2%) kidney, and 104 (27.3%) heart. Overall, HBsAb at evaluation was reactive in 216 (56.7%), indeterminate in 17 (4.5%), non‐reactive in 138 (36.2%), and not available in 10 (2.6%). Of those that completed a primary HBV vaccine series (n = 304), HBsAb was reactive in 164 (53.9%), indeterminate in 13 (4.3%), non‐reactive in 119 (39.1%), and not available in 8 (2.6%). For those up to date for age on HBV vaccinations with non‐reactive/indeterminate titers at evaluation, revaccination and a follow‐up HBsAb were available in 45 patients of which 33 (73.3%) seroconverted to a reactive HBsAb titer.

Conclusion

Vaccine‐induced protection against HBV infection among high‐risk pediatric SOT recipients can be improved by serology‐based intervention. Though the absence of HBsAb does not always indicate loss of protection, boosting or completing primary series is recommended.