bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel embedded system design for the detection and classification of cardiac disorders
Authors: Riaz Umair , Aziz Sumair , Umar Khan Muhammad , Zaidi Syed Azhar Ali , Ukasha Muhammad , Rashid Aamir
Published: June 2021

Phonocardiogram (PCG) signals hold significant prognostic and diagnostic information about cardiac health. Numerous PCG or heart sound based automated detection algorithms were previously proposed to assist the disease diagnosis process. Most of the previous studies only focused on algorithmic development. This study presents an intelligent, portable, and low‐cost embedded system for the classification of cardiac disorders associated with heart murmurs. Different stages corresponding to the developed embedded system implementation are summarized as follows: The first stage consists of the acquisition of PCG signals of both normal and patients from various hospitals with a customized and low‐cost stethoscope. The second stage describes the preprocessing, localization of S1 and S2 heart sounds, and the extraction of systole and diastole from a heart signal with an empirical mode decomposition integrated with the self‐developed algorithm. In the third stage, discriminant features are extracted to represent various cardiac classes of PCG signals in a compact manner. In the final stage of the algorithm, the k‐nearest neighbors classifier is trained and tested to distinguish between normal and four cardiac disorders. The proposed algorithm achieved 94% mean accuracy through comprehensive experimentation. The cardiac disorders classification algorithm is implemented on a RP‐based embedded system. Software application with an interactive graphical interface is also designed to assist users. The developed intelligent system is portable, low‐cost, and it enables regular patient‐monitoring. The proposed system has the potential to be employed at remote locations where the availability of doctors remains challenging.
Secretory carcinoma of the breast limited to the dermis: Cutaneous or breast primary?
Authors: Grinnell Madison , Yanala Ujwal , DiMaio Dominick
Published: June 2021

We offer a case of a 22‐year‐old woman who presented with a painless breast mass. Physical examination of the breast was unrevealing other than a palpable mass in close proximity to the nipple areolar region. No lymphadenopathy was noticed in the axilla or supraclavicular region. Sonographic assessment was performed and the findings were classified as Breast Imaging Reporting and Data System category 4. Because of the proximity of the mass to the skin surface, an excisional biopsy was performed. Final pathology disclosed a 5‐mm invasive carcinoma. On pathologic examination, histopathology and immunophenotyping supported the diagnosis of secretory carcinoma; however, whether the origin was from the breast parenchyma or skin tissue was not clearly discernable. Therefore, the patient was scheduled for sentinel lymph node biopsy with plans for axillary dissection if positive. While the overall prognosis for secretory carcinoma is good, with a low chance of metastasis, any ambiguity in breast mass diagnosis should be discussed in a multidisciplinary tumor board and should be treated aggressively particularly in younger patients.
An unusual case of T‐cell prolymphocytic leukemia mimicking a cutaneous vasculitis
Authors: Edmonds Nicole , Guerra Ricardo , Noland Mary‐Margaret B. , Schenck Olivia , Krasner Brett , Gru Alejandro A.
Published: June 2021

T‐cell prolymphocytic leukemia (T‐PLL) is an aggressive post‐thymic T‐cell malignancy, which accounts for 2% of mature lymphocytic leukemias in adults. Though typically presenting with a brief history of B symptoms, hepatosplenomegaly, and marked lymphocytosis, erythematous or nodular skin rashes involving the trunk or limbs may be seen in 25% to 30% of patients, as well as a purpuric rash in a periorbital distribution. Cutaneous involvement typically presents in the context of patients with an established history of T‐PLL, but it can less frequently present as an initial symptom heralding the diagnosis. An unusual case of T‐PLL is described, presenting initially as palmoplantar ulcerated nodules with an initial biopsy suggestive of perniosis, followed by rapid progression of dark violaceous and bright red papules throughout the body after initiation of obinutuzumab. The diagnosis of T‐PLL was subsequently fully supported by the clinical, laboratory, cytologic, and immunophenotypic findings. This case highlights the importance of a multidisciplinary team approach to address such rare and atypical presentations.
Significant contributions of combustion‐related NH3 and non‐fossil fuel NOx to elevation of nitrogen deposition in southwestern China over past five decades
Authors: Huang Hao , Song Wei , Liu Xue‐Yan
Published: June 2021

Anthropogenic nitrogen (N) emissions and deposition have been increasing over past decades. However, spatiotemporal variations of N deposition levels and major sources remain unclear in many regions, which hinders making strategies of emission mitigation and evaluating effects of elevated N deposition. By investigating moss N contents and δ15N values in southwestern (SW) China in 1954–1964, 1970–1994, and 2005–2015, we reconstructed fluxes and source contributions of atmospheric ammonium () and nitrate () deposition and evaluated their historical changes. For urban and non‐urban sites, averaged moss N contents did not differ between 1954–1964 and 1970–1994 (1.2%–1.3%) but increased distinctly in 2005–2015 (1.6%–2.3%), and averaged moss δ15N values decreased from +0.4‰ to +3.3‰ in 1954–1964 to −1.9‰ to −0.7‰ in 1974–1990, and to −4.8‰ to −3.6‰ in 2005–2015. Based on quantitative estimations, N deposition levels from the 1950s to the 2000s did not change in the earlier 20 years but were elevated substantially in the later 30 years. Moreover, the elevation of deposition (by 12.2 kg‐N/ha/year at urban sites and 4.6 kg‐N/ha/year at non‐urban sties) was higher than that of deposition (by 6.0 and 2.9 kg‐N/ha/year, respectively) in the later 30 years. This caused a shifted dominance from to in N deposition. Based on isotope source apportionments, contributions of combustion‐related NH3 sources (vehicle exhausts, coal combustion, and biomass burning) to the elevation of deposition were two times higher than volatilization NH3 sources (wastes and fertilizers) in the later 30 years. Meanwhile, non‐fossil fuel NOx sources (biomass burning, microbial N cycles) contributed generally more than fossil fuel NOx sources (vehicle exhausts and coal combustion) to the elevation of deposition. These results revealed significant contributions of combustion‐related NH3 and non‐fossil fuel NOx emissions to the historical elevation of N deposition in SW China, which is useful for emission mitigation and ecological effect evaluation of atmospheric N loading.
Ancient geological dynamics impact neutral biodiversity accumulation and are detectable in phylogenetic reconstructions
Authors: Herrera‐Alsina Leonel , Algar Adam C. , Bocedi Greta , Gubry‐Rangin Cecile , Lancaster Lesley T. , Mynard Poppy , Osborne Owen G. , Papadopulos Alexander S. T. , Creer Simon , Nangoy Meis , Fahri Fahri , Lupiyaningdyah Pungki , Sudiana I Made , Juliandi Berry , Travis Justin M. J.
Published: June 2021

Aim

Landmasses have been continuously modified by tectonic activity, the breakup and collision of landmasses is thought to have generated or suppressed ecological opportunities, altering the rates of speciation, dispersal and extinction. However, the extent to which the signatures of past geological events are retained in modern biodiversity patterns—or obliterated by recent ecological dynamics—remains unresolved. We aim to identify the fingerprint of different scenarios of geological activity on phylogenetic trees and geographic range size distributions.

Location

Global.

Time period

Geological time.

Major taxa studied

Theoretical predictions for any taxa.

Methods

We conducted spatially explicit simulations under a neutral model of range evolution, speciation and extinction for three different geological scenarios that differed in their geological histories. We set a limit on the number of populations that locally can coexist, which, along with the geographic boundaries of landmasses, influences the rate of range expansion.

Results

Our results demonstrate regions of similar size, age and ecological limits will differ in richness and macroevolutionary patterns based solely on the geological history of landmass breakup and collision even in the absence of species’ ecological differences, that is, neutrality. When landmasses collide, regional richness is higher, lineages exhibit more similar rates of speciation and phylogenetic trees are more balanced than in the geologically static scenario. Stringent local limits to coexistence yield lower regional diversity but in general do not affect our ability to distinguish geological scenarios.

Main conclusions

These findings provide an alternative explanation for existence of some hotspots of diversity in areas of high geological activity. Although a limit on the number of coexisting species largely influences regional diversity, its contribution to phylogenetic patterns is lower than variation in per‐capita rates of speciation and extirpation. Importantly, these findings demonstrate the potential for inferring past geological history from distributions of phylogenies and range sizes.
Use of electronic self‐administered bleeding assessment tool in diagnosis of paediatric bleeding disorders
Authors: Kaur Dominder , Kerlin Bryce A. , Stanek Joseph R. , O'Brien Sarah H.
Published: June 2021

Introduction

In the era of electronic medical records, pen‐and‐paper‐based physician‐administered bleeding assessment tools (BAT) remain under‐utilized in the clinical setting, as they are noted to be time‐consuming.

Aim

The current study reviews the use of an electronic self‐administered bleeding assessment tool (eBAT) prospectively in a paediatric haematology clinic and in comparison with a physician administered BAT (pBAT).

Materials and Methods

This was reviewed and approved in the current form because the aims statement includes the method regarding comparison of 2 groups. So no additional section required.

Results

A total of 94 BAT response pairs were available for analysis. The median time required for patients or parents to complete the eBAT was 8 min, with less than a third of the patients requiring over 10 min. The median bleeding scores noted in this study were 4 for both the BATs, with strong positive correlation between the eBAT and the physician administered bleeding questionnaire. The eBAT had a sensitivity of 93.8% (95% CI 82.8%–98.7%), a specificity of 34.8% (95% CI 21.4%–50.3%), a positive predictive value (PV) of 60.0% (95% CI 54.5%–65.2%) and a negative PV of 84.2% (95% CI 62.5%–94.5%) for identifying a bleeding disorder.

Conclusions

Findings indicate that eBAT is a valid and time‐efficient screening tool for evaluating patients’ bleeding symptoms, which can improve clinical applicability of BATs by reducing time for bleeding history review.
Pharmacokinetic, efficacy and safety evaluation of B‐domain‐deleted recombinant FVIII (SCT800) for prophylactic treatment in adolescent and adult patients with severe haemophilia A
Authors: Xue Feng , Zhao Xielan , Sun Jing , Zeng Xiaojing , Yang Fenge , Xu Ming , Yu Ziqiang , Gu Weiying , Feng Ying , Li Wenqian , Zheng Changcheng , Bi Hui , Xie Liangzhi , Gai Wenlin , Yang Renchi
Published: June 2021

Introduction

SCT800 is a recombinant human B‐domain‐deleted coagulation factor VIII (BDDrFVIII) developed in China.

Aim

To evaluate the repeat pharmacokinetics (PKs), efficacy, and safety of SCT800 in previously treated Chinese adolescent and adult patients with severe haemophilia A.

Methods

A phase III, multicentre, prospective, open‐label, single‐arm trial was conducted at 12 medical centres. Subjects received treatment for 24 weeks. PKs were assessed at the initial and repeated dosing 24 weeks later. The primary endpoint was annualized bleeding rate (ABR). Breakthrough bleeding episodes and inhibitor development were assessed.

Results

A total of 71 of 73 patients completed the study, and 18 were enrolled for the repeat PK investigation. Total exposure was 5643 exposure days. Overall, SCT800 showed comparable repeat PK profiles. The total ABR was 2.82 (95% confidence interval 2.01‐3.96). During prophylaxis, 43.8% of patients had no bleeding episodes. The majority (89.4%) of bleeding episodes were controlled with 1–2 injections of SCT800, the success rate (defined as ‘excellent’ or ‘good’ haemostatic response) for the treatment of bleeding episodes was 92.6%. The incidence of treatment‐related adverse events was 53.4%. Drug‐related AE incidence was 4.1%. The observed AEs were similar to those of other coagulation factor VIII, but lower in frequency. No subject developed an inhibitor, and no other safety concerns were identified.

Conclusions

SCT800 has robust PK characteristics, and is safe and efficacious for the prophylaxis and treatment of bleeding episodes in previously treated adolescent and adult patients with severe haemophilia A.
The management of deep caries in UK primary care: A nationwide questionnaire‐based study
Authors: Edwards David , Bailey Oliver , Stone Simon , Duncan Hal
Published: June 2021

Aim

To investigate current approaches and attitudes towards the management of deep caries in primary dental care within the United Kingdom (UK).

Methodology

Open distribution of an electronic questionnaire survey was undertaken to primary care dental professionals working in publicly funded National Health Service [NHS], privately funded, military and community dental services. Demographic variables investigated included the following: place of qualification, method of remuneration, level of restorative training, materials available, years qualified, appointment length and clinician type. Management variables focussed on case‐based scenarios. Univariate analyses of responses to questions were undertaken using χ2 tests with sequential Bonferroni correction. Variables with a statistical relationship of p ≤ .2 were selected for binary logistic regression modelling.

Results

A total of 657 responses were received. Practitioners with formal postgraduate qualifications (PGQ) were more likely (OR, 95%CI) to undertake further tests to aid diagnosis including: gaining a patient history (1.80, 1.01–3.20), periapical radiography (1.43, 1.01–2.03), cold pulp testing (2.079, 1.46–2.97) and electric pulp testing (1.65, 1.02–2.65). Rubber dam was infrequently used for deep caries management (29.2%). Non‐NHS practitioners were much more likely to use rubber dam (3.40, 2.15–5.37), as were those that had completed PGQ (2.24, 1.48–3.38). Non‐selective caries removal was used in deep caries by 41.4% of practitioners. Indirect pulp caps were carried out by 56.7% of practitioners. NHS practitioners were more likely to place calcium hydroxide (3.74, 1.97–7.15), whilst non‐NHS practitioners were more likely to place calcium silicate cements (CSCs) (3.303, 1.71–6.38) as were non‐UK graduates (5.63, 2.47–12.86) and those with PGQ (2.12, 1.17–3.87).

Conclusions

This UK survey highlights significant variation in the management of deep caries. There is lack of consensus regarding the use of a standard systematic approach to diagnosing disease, with a reliance on history and tests with poor specificity. Non‐selective caries removal for managing deep carious lesions remains common, with low rubber dam compliance underlining a lack of asepsis. Notably, a significant number of practitioners placed indirect pulp caps, but CSCs and GIC were not commonly used. At present, although clear guidelines are available this is not translating into consistent management approaches in practice, suggesting that better dissemination of current treatments is essential to undergraduate and postgraduate groups.
COVID‐19 vaccines and nanomedicine
Authors: Shapiro Robert S.
Published: June 2021

Background

The COVID‐19 virus‐induced pandemic has been the deadliest pandemic to have occurred in two generations, besides HIV/AIDS. Epidemiologists predicted that the SARS‐Cov 2 pandemic would not be able to be brought under control until a majority of the world’s population had been inoculated with safe and effective vaccines. A world‐wide effort to expedite vaccine development was successful. Previous research for vaccines to prevent SARS and MERS, also coronaviruses, was vital to this success. Nanotechnology was essential to this vaccine development. Key elements are presented here to better understand the relationship between nanomedicine and the COVID‐19 vaccine development.

Methods

NLM PubMed searches for COVID‐19 vaccines, nanotechnology and nanomedicine were done. There were 6911 articles screened, 235 of which were deemed appropriate to this subject and utilized here, together with two landmark nanomedicine texts used to expand understanding of the basic science of nanotechnology.

Results

SARS‐Cov 2, caused by the COVID‐19 virus, was first recognized in China in December of 2019 and was declared as a pandemic in March of 2020. The RNA sequence was identified in January of 2020. Within 4 months of the viral genome being released, over 259 vaccines had been in development. The World Health Organization (WHO) anticipated a vaccine with a 50‐80% efficacy to be developed within 1‐2 years. Ahead of schedule, the Food and Drug Administration (FDA) announced the emergency authorization approval for two mRNA vaccines within 11 month’s time. Nanotechnology was the key to the success of these rapidly developed, safe and effective vaccines. A brief review of pertinent basic science principles of nanomedicine are presented. The development of COVID vaccines is reviewed. Future considerations are discussed.

Conclusions

Control of the COVID‐19 SARS‐Cov2 pandemic benefitted from nanomedicine principles used to develop highly effective, yet very safe and relatively inexpensive vaccines. These nanovaccines can be much more easily altered to adjust for viral variants than traditional live or inactivated legacy‐type whole virus vaccines.
Urine albumin‐to‐creatinine ratio within the normal range and risk of hypertension in the general population: A meta‐analysis
Authors: Ren Fei , Li Mingzhu , Xu Hua , Qin Xiaowei , Teng Yanling
Published: June 2021

Inconsistent findings on the association between urine albumin‐to‐creatinine ratio (UACR) and risk of hypertension have been reported. This meta‐analysis sought to evaluate the association between the elevated level of UACR within the normal range and incident hypertension in the general population. We comprehensively searched PubMed and Embase databases until July 31, 2020. All longitudinal observational studies that assessed the association of elevated baseline level of UACR within the normal range with incident hypertension in the general population were included. The predictive value was estimated by pooling risk ratio (RR) with 95% confidence intervals (CI) for the highest versus the lowest category of UACR level. Nine articles (10 studies) involving 27 771 individuals were identified and analyzed. When compared with the lowest category of UACR, individuals with the highest UACR had a 1.75‐fold (RR 1.75; 95% CI 1.47–2.09; p < .001) higher risk of hypertension in a random effect model. Gender‐specific analysis indicated that the impact of UACR on the development of hypertension seemed to be stronger in women (RR 2.47; 95% CI 1.10–5.55; p = .029) than in men (RR 1.88; 95% CI 1.35–2.61; p < .001). An increased UACR within the normal range is independently associated with a higher risk of hypertension in the general population. Baseline UACR can be served as a predictor of incident hypertension in the general population.
Gankyrin activates the hedgehog signalling to drive metastasis in osteosarcoma
Authors: Wang Chongchong , Jing Juehua , Hu Xuyang , Yu Shuisheng , Yao Fei , Li Ziyu , Cheng Li
Published: June 2021

Gankyrin is a regulatory subunit of the 26‐kD proteasome complex and promotes the occurrence and progression of many malignancies. However, the role of gankyrin in osteosarcoma (OS) metastasis remains unclear. Hedgehog signalling has been shown to regulate stem cell homeostasis and cancer metastasis, but the mechanisms that activate this pathway in OS are still poorly understood. Here, a series of in vitro and in vivo assays were carried out to explore the function and mechanism of gankyrin regulating Hedgehog signalling in OS. We demonstrated that gankyrin promotes migration, invasion and regulates the expression of some stemness factors by up‐regulating Gli1 in OS. Importantly, our data showed an interaction between gankyrin and Gli1. Moreover, gankyrin suppresses the ubiquitin‐mediated degradation of Gli1 protein in OS. Gankyrin also significantly promotes the lung metastasis of OS in vivo. Our findings suggest that gankyrin drives metastasis and regulates the expression of some stemness factors in osteosarcoma by activating Hedgehog signalling, indicating that drug screening for compounds targeting gankyrin may contribute to the development of novel and effective therapies for OS.
Narrow band imaging for detection of gastric intestinal metaplasia and dysplasia: A systematic review and meta‐analysis
Authors: Desai Madhav , Boregowda Umesha , Srinivasan Sachin , Kohli Divyanshoo R. , Al Awadhi Sameer , Murino Alberto , Yu Lawrence Ho Khek , Dinis‐Ribeiro Doutor Mário , Sharma Prateek
Published: June 2021

Background and Aims

Gastric intestinal metaplasia (GIM), a precursor of gastric adenocarcinoma, is challenging to diagnose with white light endoscopy (WLE) and can be missed by random gastric biopsies. Narrowband imaging (NBI) may potentially improve the detection of GIM. However, pooled estimates from prospective studies are lacking.

Methods

Electronic databases were searched for studies comparing NBI and WLE alone for detection of GIM and synchronous dysplasia. Primary outcome was pooled detection rate of GIM by NBI compared with WLE in prospective studies. The secondary outcome was concurrent dysplasia detection.

Results

Ten studies were found eligible from 306 articles screened. Eight prospective studies were found eligible for primary endpoint of GIM detection. Two other retrospective studies were included for dysplasia detection. A total of 1366 subjects (694 males, 54.4 ± 5.08 years) underwent upper endoscopy. GIM was detected in 482 (35.3%) subjects. NBI detected GIM in 32% additional subjects (70% vs 38%, RR 1.79; 95% CI 1.34–2.37; P < 0.01). Subgroup analysis revealed newer NBI scopes (GIF260) detected significantly more GIM than WLE (RR 2.47; 95% CI 1.63–3.76; P < 0.01) but not the older (H180) NBI endoscopes (RR 1.33; 95% CI 0.93–1.88; P = 0.11). There was moderate heterogeneity between the studies (I2 = 63%). In five studies (n = 628) that reported dysplasia, there was no significant difference between NBI and WLE in dysplasia detection (RR 1.09; 95% CI 0.81–1.47; P = 0.58).

Conclusion

Narrowband imaging can significantly increase the detection of GIM when used in addition to standard white light exam during an upper endoscopy.
Mucosal microbial microenvironment in early gastric neoplasia and non‐neoplastic gastric disease
Authors: Li Fudong , Zhu He , Tao Ke , Xia Yan , Liu Mingqing , Wang Yu , Sun Yu , Cao Tingting , Chai Jiannan , Ni Fengming , Shi Bing , Xu Hong
Published: June 2021

Background and Aim

The biological characterization of microbial environment in early gastric cancer (EGC), other than Helicobacter pylori, is limited. This study aimed to explore the microbial microenvironment in chronic gastritis (CG), fundic gland polyps (FGPs), low‐grade intraepithelial neoplasia (LGIN), and EGC.

Methods

16S‐rRNA gene sequencing and bioinformatic analysis were performed on 63 individuals with 252 mucosal biopsies or endoscopic submucosal dissection margin samples from endoscopy.

Results

The microbiota in gastric LGIN functions analogously to EGC in terms of functional prediction. Neoplastic lesions showed a significant difference to CG or FGPs in beta diversity of the microbiota. Bacteria genera including Paracoccus, Blautia, Barnesiella, Lactobacillus, Thauera, Collinsella were significantly enriched in gastric neoplastic mucosa (LGIN and EGC) compared with non‐neoplastic tissues (CG and FGPs). While Pseudomonas and Kingella were depleted in neoplastic tissues. FGPs showed a distinctive microbial network system that negatively interacted with Helicobacter.

Conclusions

In terms of the mucosal microbial microenvironment, gastric LGIN and EGC showed no significant difference as early neoplastic lesions. We observed a coordinated microbial microenvironment that correlated negatively with Helicobacter.
Early postoperative feeding following surgery for upper gastrointestinal cancer: A systematic review
Authors: Carmichael Lauren , Rocca Rose , Laing Erin , Ashford Phoebe , Collins Jesse , Jackson Luke , McPherson Lauren , Pendergast Brydie , Kiss Nicole
Published: June 2021

Nutrition post major upper gastrointestinal (UGI) cancer surgery is a significant consideration known to affect postoperative recovery and the ability to tolerate adjuvant treatment. This systematic review assessed the effect of early oral feeding (EOF), compared to traditional timing of oral feeding, following major surgery for UGI cancer on postoperative complications, postoperative length of hospital stay (LOS), nutritional status and quality of life (QOL). The literature was searched up to March 9th 2020 using CINHAL, PubMed, MEDLINE, Embase, Scopus and Web of Science databases. Quality assessment was completed using the Academy of Nutrition and Dietetics quality criteria checklist. Fifteen articles were included, consisting of seven randomised controlled trials, six cohort studies and two non‐randomised trials, with a total of 2517 participants. The type and timing of EOF varied considerably across studies with limited reporting of energy and protein intakes from oral or enteral feeding. Fourteen studies assessed postoperative complications of which 13 reported no difference between EOF and standard care. Fourteen studies assessed postoperative LOS and of these, 13 reported a reduced length of stay in the EOF group. Four of 15 studies assessing nutritional status found no difference between groups. Three of 15 studies assessed QOL with inconsistent findings. This review found EOF reduced postoperative LOS and did not increase postoperative complications. However, the optimal timing for the introduction of EOF could not be established. Furthermore, the type of EOF varied considerably making comparison across studies challenging and demonstrates a need for internationally standardised definitions.
Auricular and periauricular melanomas have similar clinicopathologic factors and survival rates
Authors: Tas Faruk , Erturk Kayhan , Ferhatoglu Ferhat
Published: June 2021

Background

Auricular melanomas are rare malignancies, and conflicting reports regarding their clinical behaviors have been published so far.

Objective

In this study, we investigated the clinical features of the auricular melanomas and compared them with periauricular skin melanomas.

Methods

Data of 53 primary melanomas arising in auricular (n = 25) and periauricular regions (n = 28) were analyzed retrospectively.

Results

Demographic, histopathological, and clinical characteristics were found similar between auricular and periauricular melanomas (p > 0.05). Likewise, the recurrence rates for both groups were found to be similar (30%) (p = 0.9). The 5‐year relapse‐free survival rate of all patients was 57.4%, and no statistical difference was observed between the two groups—63.9% for auricular melanomas and 51.7% for periauricular melanomas (p = 0.5). Moreover, the 5‐year overall survival rate of all melanomas was 46.9%, and there was no statistical significance between the two groups—56.1% and 37.4% for auricular and periauricular melanomas, respectively (p = 0.4).

Conclusion

Auricular and periauricular melanomas share similar clinicopathologic features and outcomes.
Diabetic diarrhoea: A study on gastrointestinal motility, pH levels and autonomic function
Authors: Sangnes Dag A. , Dimcevski Georg , Frey Jakub , Søfteland Eirik
Published: June 2021

Background

Chronic diarrhoea is a common, but poorly investigated diabetes complication. Autonomic neuropathy is a leading pathophysiological theory founded on old, small studies. Studies of gastrointestinal motility and pH levels are lacking.

Objectives

Using new diagnostic methods, we aimed to find out if diabetic diarrhoea was associated with alterations in gastrointestinal motility, pH levels and autonomic function.

Methods

Fifty‐seven patients (42 women, 46 with type 1 diabetes) were prospectively included. Symptoms were evaluated with the gastrointestinal symptom rating scale, defining ≥4 points as cases with diarrhoea. Patients scoring <4 were used as controls. We used the wireless motility capsule to measure gastrointestinal transit times, pH levels and contractility parameters. Autonomic function was assessed by measuring heart rate variability, baroreflex sensitivity and orthostatic hypotension.

Results

Seventeen patients (30%) had diarrhoea. Compared with controls, cases had slower gastric emptying (21:46 vs. 4:14, h:min, p = 0.03) and faster colonic transit (18:37 vs. 54:25, p < 0.001). Cases had increased intraluminal pH in the antrum (2.4 vs. 1.2, p = 0.009), caecum (7.3 vs. 6.4, p = 0.008) and entire colon (7.1 vs. 6.7, p = 0.05). They also had a decreased pH difference across the pylorus (3.3 vs. 4.9, p = 0.004) and ileocaecal junction (0.6 vs 1.0, p = 0.009). The groups did not differ in autonomic function, but diastolic blood pressure drop correlated rs = −0.34 (p = 0.04) with colonic transit time.

Conclusions

Patients with diabetic diarrhoea had altered gastrointestinal transit and intraluminal pH levels, but minimal changes in autonomic function. Our results suggest that tests of gastrointestinal function are clinically useful in diabetic diarrhoea.
Plasmacytoma and plasma cell myeloma affecting the jaws: A multi‐institutional collaborative study
Authors: Souza Lucas Lacerda de , Cáceres Cinthia Verónica Bardález López de , Vargas Pablo Agustin , Lopes Márcio Ajudarte , Santos‐Silva Alan Roger , Silva Wagner Gomes da , Prado‐Ribeiro Ana Carolina , Brandão Thais Bianca , Pereira Juliana , Mesquita Ricardo Alves , Pontes Flávia Sirotheau Correa , González‐Arriagada Wilfredo Alejandro , Pedraza Ricardo Martinez , Andrade Bruno Augusto Benevenuto de , Romañach Mario José , Soares Ciro Dantas , Carvalho Maria Goretti Freire de , Pires Fabio Ramôa , Carlos Roman , Fonseca Felipe Paiva , Pontes Hélder Antônio Rebelo , de Almeida Oslei Paes
Published: June 2021

Background

Plasma cell neoplasms are characterized by the proliferation of a single clone of plasma cells with production of a monoclonal immunoglobulin. They can manifest as a single lesion (plasmacytoma) or as multiple lesions (multiple myeloma).

Methods

Paraffin‐embedded tissue blocks of patients microscopically diagnosed with plasma cell neoplasms in the jaws were retrieved from five pathology files. Data including clinical, radiographic, microscopic and immunohistochemical findings, treatment employed and follow‐up status were retrieved from the pathology reports.

Results

Fifty‐two cases were retrieved (mean age: 59.4 years) without sex predilection. The mandible was the most affected site (67.3%), usually associated with pain and/or paresthesia (53.8%). Lesions in other bones besides the jaws were reported for 24 patients (46.2%). Radiographically, tumours usually presented as poorly defined osteolytic lesions with unilocular or multilocular images, while microscopy revealed diffuse proliferation of neoplastic plasma cells with nuclear displacement and abundant eosinophilic cytoplasm. Two cases were classified as anaplastic, and amyloid deposits were found in two other cases. Immunohistochemistry was positive for plasma cell markers and negative for CD20 and CD3, and monoclonality for kappa light chain predominated. The overall survival rate after 5 years of follow‐up was 26.6%.

Conclusion

Plasma cell neoplasms are aggressive tumours with a poor prognosis and involvement of the jaws may be the first complaint of the patient. Thus, oral pathologists, head and neck surgeons and dentists should be aware of their clinical, radiographic and microscopic manifestations.
Beyond trauma: Decolonizing understandings of loss and healing in the Indian Residential School system of Canada
Authors: Burrage Rachel L. , Momper Sandra L. , Gone Joseph P.
Published: June 2021

Indigenous scholars and others who study the experiences of Indigenous communities have long criticized the psychocentric approach to trauma held by most clinical professionals. A recent example of this was the Canadian government's reparations for Indian Residential School system (IRS) survivors, which focused largely on individual psychological harms rather than broader effects of colonial oppression. Beginning in 1867 and continuing throughout the latter half of the twentieth century, Indigenous children were routinely removed from their home communities in Canada and placed into the IRS system, where they were frequently subject to physical, psychological, and sexual abuse. Using thematic analysis, this study draws on survivor testimonies from one residential school to explore how their descriptions of the effects and healing from IRS abuses differ from psychocentric understandings of trauma and loss. Results indicate that survivors describe IRS effects in sociocentric, ecocentric, and cosmocentric terms more so than psychocentric ones and place deep importance on healing through connection to family, culture, and community. To decolonize itself as a discipline and better serve Indigenous communities, the field of psychology must open up to understandings of trauma, loss, and healing that decentralize the individual, a difficult task given the discipline's psychocentric nature.
Population dynamics of sperm whales (Physeter macrocephalus) in Guadeloupe, French Caribbean: A mark‐recapture study from 2001 to 2013
Authors: Rinaldi Caroline , Rinaldi Renato , Laine Juliette , Barbraud Christophe
Published: June 2021

Sperm whales are present along the Caribbean islands in family groups of mature females, juveniles, and newborns. Their abundance and demographic rates remain poorly known. Using photo‐identification data, we estimated the abundance and annual survival of sperm whales in Guadeloupe from January to April 2001–2013. A total of 1,492 photographs of tail flukes were scored (ranging from 1 to 5) in terms of quality (Q) and marking (M) level. A total of 789 photographs were selected with Q ≥ 3 and M ≥ 3, corresponding to 109 individually identified adult females or immatures of both sexes. Capture histories were built and analyzed using the Pollock's robust design capture‐mark‐recapture model. The study consisted of 13 primary periods sequenced in 5–8 secondary periods. Mean annual survival rate of residents was 0.945, 95% CI [0.864, 0.979]. Abundance varied between years from 75 to 35 individuals. The geometric growth rate over the period 2001–2013 was 0.938, 95% CI [0.878, 0.997], suggesting a population decline of −6.2%/year. Sperm whales are moving between Guadeloupe and Dominica, with a high temporary emigration rate (0.163) and 50% of the individuals of Guadeloupe resighted in Dominica. These results highlight the fragility of the population and the necessity to consider it as one unit.
‘Pizza every day – why?’: A survey to evaluate the impact of COVID‐19 guidelines on secondary school food provision in the UK
Authors: Rose Kelly , O’Malley Claire , Brown Laura , Ells Louisa Jane , Lake Amelia A.
Published: June 2021

The nutritional requirements of adolescence and the reported poor UK eating behaviours of young people are a significant public health concern. Schools are recognised as an effective ‘place’ setting to enable improvement to nutrition outcomes. The COVID‐19 pandemic resulted in UK school closures from March 2020. In re‐opening in September 2020, schools were required to meet guidelines to ensure the minimised impact of COVID‐19 on the population (DfE 2020). We aimed to evaluate the impact of COVID‐19 school guidelines on secondary and post‐16 (16–18 years) food provision. An online survey was posted on 8th October to 1st December 2020, targeted at young people, parents and staff of secondary/post‐16 education establishments in the UK. Two hundred and fifty‐two responses were received, of which 91% reported a change in their school food provision, 77% reported time for lunch was shortened and 44% indicated the provision was perceived as less healthy during September 2020 (post‐lockdown school return) compared with March 2020 (pre‐lockdown). Analyses demonstrated that time, limited choice and healthiness impacted negatively upon young people's school food experience. The COVID‐19 pandemic has presented a huge challenge to the delivery of healthy school food to young people. Therefore, schools require more support in following national food standards and incorporating nutrition education and behaviour change strategies within current guidelines.
British Nutrition Foundation Healthy Eating Week 2020 – insights into the effect of COVID‐19 on eating and activity habits of adults and children in the UK
Authors: Theobald Claire , White Alex
Published: June 2021

This article provides an overview of the British Nutrition Foundation's Healthy Eating Week in 2020. Included is a summary of the Week, including resources developed, activities undertaken by participants, the results of two surveys of the impact of the COVID‐19 pandemic on the healthy eating habits and physical activity levels of children and adults in the UK and an evaluation of the Week, along with details for future plans.
UK Nutrition Research Partnership (NRP) workshop: Forum on advancing dietary intake assessment
Authors: de la Hunty Anne , Buttriss Judith , Draper John , Roche Helen , Levey Georgia , Florescu Ana , Penfold Naomi , Frost Gary
Published: June 2021

The development of better and more robust measures of dietary intake in free living situations was identified as a priority for advancing nutrition research by the Office of Strategic Coordination for Health Research (OSCHR) Review of Nutrition and Human Health Research in 2017. The UK Nutrition Research Partnership (NRP) sponsored a workshop on Dietary Intake Assessment methodology alongside its series of ‘Hot Topic’ workshops designed to accelerate progress in nutrition research by bringing together people from a range of different disciplines. The workshop on Dietary Intake Assessment methodology took place via Zoom over two half‐days in January 2021 and included 50 scientists from a wide range of disciplines. The problems with current methods of dietary assessment and how emerging technologies might address them were set out in pre‐recorded presentations and explored in panel discussions. Participants then worked in breakout groups to discuss and prioritise the research questions that should be addressed to best further the field and lead to improvements in dietary assessment methodology. Five priority research questions were selected. Participants were asked to brainstorm potential approaches for addressing them and were then asked to focus on one approach and develop it further. At the end of these sessions, participants presented their project ideas to the rest of the workshop and these will be reported back to the Medical Research Council. It is hoped that potential collaborative projects arising from these discussions will be taken forward in response to future funding calls.
Laboratory monitoring during treatment of onychomycosis in pediatric patients: A survey of provider perspectives and practices
Authors: Brockman Ross , Funk Tracy
Published: June 2021

Background/objectives

Literature regarding the cost and necessity of laboratory monitoring during oral antifungal treatment in adults has recently been published. However, consensus guidelines for the treatment and monitoring of pediatric patients with systemic antifungals for onychomycosis are lacking. We sought to evaluate both the practice trends and perspectives of pediatric dermatology providers who treat pediatric onychomycosis.

Methods

An electronic survey was administered to providers belonging to the Society for Pediatric Dermatology (SPD) and/or Pediatric Dermatology Research Alliance (PeDRA) regarding their clinical practice and reasoning for laboratory monitoring during the treatment of pediatric onychomycosis.

Results

One hundred and twenty‐one providers completed the survey (12.5%). 77% identified themselves as pediatric dermatologists. A majority practice in the academic setting (51%), and 54% were primarily only pediatric providers. All respondents prescribe oral terbinafine for onychomycosis. 88% of respondents always or almost always confirm the diagnosis of onychomycosis prior to prescribing oral terbinafine for onychomycosis. 39% always or almost always routinely order baseline laboratory tests while 40% never or almost never do. 41% never or almost never order monitoring laboratory tests during treatment while 32% always or almost always do. 91.5% have never discovered a significant reaction to terbinafine with routine monitoring.

Conclusion

Pediatric dermatology providers are very likely to confirm the diagnosis of onychomycosis prior to systemic treatment. Significant variability was found in pretreatment and treatment laboratory monitoring, reasons for laboratory monitoring or deferral of testing, and timing of testing among providers. Knowledge of current practice trends as well as provider perspectives may be useful in the future development of consensus guidelines.
Effects of the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant accident on behavioural and psychological symptoms of dementia among patients
Authors: Miyagawa Akemi , Kunii Yasuto , Gotoh Daisuke , Hoshino Hiroshi , Kakamu Takeyasu , Hidaka Tomoo , Kumakura Tetsuo , Fukushima Tetsuhito , Yabe Hirooki , Kawakatsu Shinobu
Published: June 2021

Background

The Great East Japan Earthquake triggered accidents at the Fukushima Daiichi Nuclear Power Plant, becoming the first complex disaster that included both a natural and a nuclear power disaster. This study examines how complex disasters affect patients with dementia.

Methods

Participants included the 331 people diagnosed with dementia out of the 2482 new patients (between January 2008 and December 2015) at a psychiatric hospital located in the indoor sheltering zones nearby mandatory evacuation zones. Medical records were retrospectively examined to identify the number of new patients with dementia, the severity, their chief complaints, and the behavioural and psychological symptoms of dementia (BPSD) types. BPSD were classified into the hyperactive BPSD group and the hypoactive BPSD group. The hyperactive BPSD group was further subdivided into the hyperactivity‐impulsivity‐irritability‐disinhibition‐aggression‐agitation group, which exhibited agitation, disinhibition, and irritability, and the psychosis group, which exhibited delusions and hallucinations. The hypoactive BPSD group included depression, inactivity, apathy, and anxiety. Results were divided into the period before the complex disaster (2008–2010) and after (2012–2015) and were compared. In addition, the post‐complex‐disaster period was subdivided into the early phase (2012–2013) and the late phase (2014–2015).

Results

The proportion of new patients with dementia increased significantly after the disaster. Although there was no change in patients' age and the disease's severity, the proportion of patients whose chief complaint was BPSD increased significantly after the disaster. Furthermore, there was a significant increase in the hyperactivity‐impulsivity‐irritability‐disinhibition‐aggression‐agitation group in the early post‐complex‐disaster phase and a significant increase in the psychosis group in the late post‐complex‐disaster phase.

Conclusion

This complex disaster caused increased consultations from patients with dementia and increased BPSD. Additionally, it increased participants' symptoms of agitation and irritability in the early post‐complex‐disaster phase and the proportion of hallucinations and delusions in the late post‐complex‐disaster phase.
Uniform (very) sharp bounds for ratios of parabolic cylinder functions
Authors: Segura Javier
Published: June 2021

Parabolic cylinder functions are classical special functions with applications in many different fields. However, there is little information available regarding simple uniform approximations and bounds for these functions. We obtain very sharp bounds for the ratio and the double ratio in terms of elementary functions (algebraic or trigonometric) and prove the monotonicity of these ratios; bounds for are also made available. The bounds are very sharp as and , and this simultaneous sharpness in three different directions explains their remarkable global accuracy. Upper and lower elementary bounds are obtained which are able to produce several digits of accuracy for moderately large and/or n.
The control of shear‐zone development and electric conductivity by graphite in granulite: An example from the Proterozoic Lofoten‐Vesterålen Complex of northern Norway
Authors: Engvik Ane K. , Gautneb Håvard , Baranwal Vikas C. , Rønning Jan‐Steinar , Knežević Solberg Janja , Liu Yunhe , Austrheim Håkon
Published: June 2021

Graphite impacts crustal rheology and electric conductivity in the lower crust. In a combined geophysical and geological study from the Proterozoic Lofoten‐Vesterålen Complex, Norway, we show the enrichment of graphite resulted in zones with strong schistosity and a sharp strain gradient towards host massive granulite gneiss. Increased graphite content resulted in high‐conductivity zones with true resistivity values <10 Ωm compared with a resistivity of >3,000 Ωm in the low‐conductive crust. The regionally distributed graphite zones contain up to 39% graphite with variable amounts of quartz, feldspars, biotite and pyroxenes and where graphite is present in stable assemblage to orthopyroxene. High‐ordered graphite and biotite with a strong‐preferred orientation define the well‐developed foliation. Our results demonstrate that graphite accounts for the high electric conductivity of this former Proterozoic lower‐crustal segment. The presence of graphite causes strain localisation in the granulite facies crust, reducing crustal strength and may thereby influence continental architecture and evolution of collision zones.