bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of CRISPR‐Cas systems in Leptospira reveals potential application of CRISPR in genotyping of Leptospira interrogans
Authors: Xiao Guohui , Yi Yusi , Che Rongbo , Zhang Qinchao , Imran Muhammad , Khan Abidullah , Yan Jie , Lin Xu'ai
Published: March 2019

Leptospirosis is a zoonotic disease caused by pathogenic Leptospira. However, understanding of the pathogenic mechanism of Leptospira is still elusive due to the limited number of genetic tools available for this microorganism. Currently, the reason for the genetic inaccessibility of Leptospira is still unknown. It is well known that as an acquired immunity of bacteria, Clustered Regularly Interspaced Short Palindromic Repeat‐CRISPR‐associated gene (CRISPR‐Cas) systems can help bacteria against invading mobile genetic elements. In this study, the occurrence and diversity of CRISPR‐Cas systems in 41 genomes of Leptospira strains were investigated. Three subtypes (subtype I‐B, subtype I‐C and subtype I‐E) of CRISPR‐Cas systems were identified in both pathogenic and intermediate Leptospira species but not in saprophytic species. Noteworthy, the majority of pathogenic species harbor two different types of CRISPR‐Cas systems (subtype I‐B and subtype I‐E). Furthermore, Cas2 protein of subtype I‐C in L. interrogans exhibited a metal‐dependent DNase activity in a nonspecific manner. CRISPR spacers in subtype I‐B are highly conserved within the same serovars and hypervariable across different serovars of L. interrogans. Based on the subtype I‐B CRISPR arrays, the serotypes of different L. interrogans strains were easily identified. Investigation of the origin of CRISPR spacers showed that 192 spacers (23.5%) matched to mobile genetic elements, indicating CRISPR‐Cas systems may play an important role in the defense of foreign invading DNA.
Technology‐enhanced learning: Rethinking the term, the concept and its theoretical background
Authors: Passey Don
Published: March 2019

This theoretical paper is concerned with problematising the rethinking of theoretical backgrounds associated with one of the commonly used educational technology terms (fields)—technology‐enhanced learning—in the wider context of scholarship. Examples will show that the term itself is now used beyond its apparent, stated scope, that it is used in a number of varied ways, and that this is in itself problematic. The ways in which the term is used will be identified, and from these a strategic categorisation to rethink the use of the single term in areas of scholarship (particularly research and teaching) will be proposed, offering terms specifically encompassing the realms in which technologies are being used. From this categorisation, it will be shown that each specific category is based on different conceptions related to or arising from practice. Consequently, ways that theoretical backgrounds should be considered will be explored in each case. While existing theoretical backgrounds enable conceptual underpinnings in some of those cases, in other cases it will be shown that there are currently no fully developed theories or limited theoretical frameworks available. The paper will conclude by identifying key research areas needed if we are to develop and take pertinent aspects of scholarship further forward.
Ex vivo fluorescence confocal microscopy: the first application for real‐time pathological examination of prostatic tissue
Authors: Puliatti Stefano , Bertoni Laura , Pirola Giacomo M. , Azzoni Paola , Bevilacqua Luigi , Eissa Ahmed , Elsherbiny Ahmed , Sighinolfi Maria C. , Chester Johanna , Kaleci Shaniko , Rocco Bernardo , Micali Salvatore , Bagni Ilaria , Bonetti Luca Reggiani , Maiorana Antonino , Malvehy Josep , Longo Caterina , Montironi Rodolfo , Bianchi Giampaolo , Pellacani Giovanni
Published: March 2019

Objective

To report the first application of ex vivo fluorescence confocal microscopy (FCM) ‐ a novel optical technology that is capable of providing fast microscopic imaging of unfixed tissue specimens‐ in the urological field assessing its diagnostic accuracy for non neoplastic and cancerous prostate tissue (prostatic adenocarcinoma) compared to the 'gold standard' histopathological diagnoses.

Patients and methods

In all, 89 specimens from 13 patients with clinically localised prostate cancer were enrolled into the study. All patients underwent robot‐assisted laparoscopic radical prostatectomy with fresh prostatic tissue biopsies taken at the end of each intervention using an 18‐G biopsy punch. Specimens were randomly assigned to the three collaborating pathologists for evaluation. Intra‐ and inter‐observer agreement was tested by the means of Cohen's κ. The diagnostic performance was evaluated on receiver operating characteristic curve analysis.

Results

The overall diagnostic agreement between FCM and histopathological diagnoses was substantial with a 91% correct diagnosis (κ = 0.75) and an area under the curve of 0.884 (95% confidence interval 0.840–0.920), 83.33% sensitivity, and 93.53% specificity.

Conclusion

FCM seems to be a promising tool for enhanced specimens' reporting performance, given its simple application and very rapid microscopic image generation (<5 min/specimen). This technique may potentially be used for intraoperative pathological specimens' analysis.
The synthetic seismic expression of the Messinian salinity crisis from onshore records: Implications for shallow‐ to deep‐water correlations
Authors: Roveri M. , Gennari R. , Ligi M. , Lugli S. , Manzi V. , Reghizzi M.
Published: March 2019

The onshore–offshore correlation of sedimentary successions is a common problem in basin analysis, but it becomes critical for the full understanding of the Messinian salinity crisis (MSC), a complex array of palaeoenvironmental events which affected the Mediterranean basin at the end of the Miocene. The outcrop records show that the Messinian stratigraphic architectures may be highly complex as the deposits of the different MSC evolutionary stages can be lithologically similar and separated by erosional surfaces and/or morphostructural highs. The correct definition of the nature and stratigraphic position of Messinian deposits in offshore areas through seismic data may be almost impossible, especially where core data are sparse. To bridge the gap between onshore and offshore records, we have built synthetic seismic sections from well‐constrained outcrop successions. Our results provide useful insights and warnings for the interpretation of offshore data, pointing out that MSC units having different age, nature and depositional settings, may show similar seismic facies and geometries. Conversely, the same deposit may result in different seismic facies, either with parallel and high‐amplitude reflections or even transparent or chaotic due to interference patterns of seismic reflections related to dominant frequency. It follows that a correct interpretation of the nature and age of deep‐seated Messinian deposits can only be obtained through the integration of seismic and core data, and considering the onshore record. The application of our approach to the Balearic Promontory results in an alternative interpretation with respect to previous models. We show that this offshore area has good analogues in the onshore of the Betic Cordillera and includes both shallow and intermediate depth sub‐basins that underwent a strong post‐Messinian subsidence.
A 5‐year longitudinal cohort study on crown to implant ratio effect on marginal bone level in single implants
Authors: Ramaglia Luca , Di Spirito Federica , Sirignano Massimiliano , La Rocca Michele , Esposito Umberto , Sbordone Ludovico
Published: March 2019

Background

A 5‐year longitudinal cohort study was carried out to evaluate the influence of anatomical crown to implant ratio (CIR) on peri‐implant marginal bone level (MBL) in single implants.

Materials and Methods

The longest possible implants, according to the availability of pristine bone, were inserted, one per patient, among periodontally healthy teeth in consecutively recruited subjects. CIR and MBL changes were measured on standardized radiographs. The relationship between MBL and multiple predictors was investigated. A statistical analysis suitable for mixed type distributions was conducted: for the discrete component a logistic regression model was used and for the continuous component the impact of the variables on MBL was examined by using robust nonparametric comparison tests.

Results

Seventy‐eight dental implants were inserted in 34 mandibles and 44 maxillae, with one stage procedure in 40 cases and two stage in 38 cases. Thirty‐five implants were <10 mm, while 43 were ≥ 10 mm long; 28 implants had a CIR ≤1 and 50 had a CIR >1. No drop‐outs or implant loss were observed. Bone loss occurred only in a few cases, measuring less than 0.5 mm and being significantly more pronounced for implant length ≥10 mm, for lower CIR values and for the two stage procedure.

Conclusion

Higher CIR values were not related to increased peri‐implant bone loss; a <10 mm long implant insertion may be safely considered for reduced bone heights.
Combined assessment of left atrial volume parameters for predicting recurrence of atrial fibrillation following pulmonary vein isolation in patients with paroxysmal atrial fibrillation
Authors: Soga Fumitaka , Tanaka Hidekazu , Mochizuki Yasuhide , Mukai Jun , Suto Makiko , Takada Hiroki , Hatani Yutaka , Matsuzoe Hiroki , Hatazawa Keiko , Sano Hiroyuki , Ooka Junichi , Shimoura Hiroyuki , Matsumoto Kensuke , Fukuzawa Koji , Hirata Ken‐ichi
Published: March 2019

Objectives

Our aim was to test the hypothesis that comprehensive simplified left atrial (LA) assessment derived from routine echocardiography may be more useful than assessment of LA volume alone for predicting atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI).

Methods

We studied 156 patients with paroxysmal AF (PAF) who had undergone PVI. Echocardiography was performed within two days before PVI. Maximum (Max‐LAVi) and minimum LA volume index (Min‐LAVi) were calculated with the biplane modified Simpson's method, and then normalized to the body surface area. On the basis of previous findings, the predefined cutoff value of Max‐LAVi for AF recurrence was set at Max‐LAVi ≥ 34 mL/m2. ΔLA volume index (ΔLAVi) was also calculated as Max‐LAVi minus Min‐LAVi. The follow‐up period after PVI was 24 months.

Results

AF recurrence was observed in 35 patients. Multivariate logistic regression analysis showed that ΔLAVi (odds ratio [OR]: 1.131; 95% confidence interval [CI]: 1.057‐1.221; P < 0.001) was an independent predictor of AF recurrence. Sequential logistic regression models for predicting AF recurrence revealed that a model based on clinical variables including age, gender and AF duration (χ2 = 1.65) was improved by the addition of Max‐LAVi ≥ 34 mL/m2 (χ2 = 13.8; P < 0.001), and further improved by the addition of ΔLAVi (χ2 = 18.2; P = 0.036). Of note is that only 1.02 ± 0.10 minutes per patient was needed to obtain a comprehensive LA assessment that included Max‐LAVi, Min‐LAVi, and ΔLAVi.

Conclusion

This easy‐to‐use comprehensive simplified LA approach from routine echocardiography may well have clinical implications for better management of PAF patients.
Gender gap in self‐employment: The role of risk attitudes
Authors: Hayduk Iryna , Williams Donald R.
Published: March 2019

This paper examines the link between the willingness to take risk and the gender gap in self‐employment in the transition economy, where for decades entrepreneurship was considered a crime. Using rich data on risk preferences and entrepreneurial activities, we show that male–female risk tolerance differential is the main determinant of the gender gap in self‐employment in Ukraine. The decomposition results indicate that up to 38% of the gap can be attributed to this factor. Robustness tests support the validity of the baseline findings by suggesting that the results are not confounded by such factors as being unemployed before starting a current job, having a self‐employed household member, or living in a relatively wealthy household before transitioning to self‐employment.
Outcomes of conventional transarterial chemoembolization for hepatocellular carcinoma ≥10 cm
Authors: Miyayama Shiro , Kikuchi Yuzo , Yoshida Masanori , Yamashiro Masashi , Sugimori Natsuki , Ikeda Rie , Okimura Kotaro , Sakuragawa Naoko , Ueda Teruyuki , Sanada Taku , Watanabe Hiroyuki , Notsumata Kazuo
Published: March 2019

Aim

To retrospectively evaluate the outcomes of conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) ≥10 cm.

Methods

Twenty‐five patients with naïve HCC ≥10 cm (mean maximum tumor diameter, 130 ± 27.6 mm; single [n = 12], 2–9 [n = 6], and ≥10 [n = 7]) without extrahepatic spread treated with cTACE were eligible. Five (20%) had vascular invasion. Two to three stepwise cTACE sessions using iodized oil ≤10 mL in one cTACE session were scheduled. When the tumor recurred, additional cTACE was repeated on demand, if possible. Overall survival (OS) rates were calculated using the Kaplan–Meier method. The prognostic factors were evaluated using uni‐ and multivariate analyses.

Results

Stepwise cTACE sessions were completed for 20 (80%) patients, but could not be completed for four (16%). In the remaining (4%) patient, the whole tumor was embolized in one session. Additional treatment, mainly cTACE, was undertaken for 19 (76%) patients. The OS rates at 1, 3, and 5 years were 68, 34.7, and 23.1%, respectively. A tumor number of three was a significant prognostic factor (P = 0.020) and the 1‐, 3‐, and 4‐year OS rates in patients with ≤3 and ≥4 tumors were 81.3 and 33.3, 55.6 and 11.1, and 38.9% and 0%, respectively. Whole tumor embolization and the serum level of protein induced by vitamin K absence or antagonist‐II were also significant prognostic factors (P < 0.001 and P = 0.042, respectively). Bile duct complications requiring additional interventions developed in two (8%) patients.

Conclusion

Conventional TACE is safe and effective for huge HCCs, but has limited effects in cases with four or more tumors.
Effect of surface treatments and aging on phase transformation and flexural strength of different Y‐TZP ceramics
Authors: Okutan Yener , Yucel Munir T.
Published: March 2019

This study aimed to evaluate the influence of surface treatments and artificial aging on surface roughness (Ra), phase transformation, and flexural strength of yttria‐stabilized tetragonal zirconia polycrystalline (Y‐TZP) ceramics. Two‐hundred and eighty specimens from four types of Y‐TZP were divided into seven groups, according to the surface treatments and aging used: control, air‐abrasion, air‐abrasion + aging, grinding, grinding + aging, erbium: yttrium‐aluminum‐garnet (Er:YAG) laser, Er:YAG laser + aging. The Ra values were measured using a profilometer. X‐ray diffraction (XRD) analysis was performed to determine phase transformation. Specimens were subjected to a three‐point bending test and loaded until fracture. Scanning electron microscope (SEM) and atomic force microscope (AFM) analyses were performed on one specimen per group. Grinding and air‐abrasion groups exhibited higher Ra values than the others (P < 0.05). The differences in the roughness and flexural strength values between the laser and control groups were not significant. For all materials, the highest amount of monoclinic phase was found after air‐abrasion. Grinding groups showed lower flexural strength values compared with the control groups (P < 0.05), while there was no significant difference between the control and air‐abrasion groups. Aging did not affect the roughness and flexural strength (P > 0.05). The grinding process is not recommended in clinical usage for Y‐TZP because of the remarkable decrease in flexural strength and reliability.
A 10‐year retrospective cohort study of the management of toxic epidermal necrolysis and Stevens‐Johnson syndrome in a New South Wales state referral hospital from 2006 to 2016
Authors: Chan Linda , Cook David K.
Published: March 2019

Importance

Toxic epidermal necrolysis (TEN) and Stevens‐Johnson syndrome (SJS) are life‐threatening severe cutaneous drug reactions. There have been no Australian data published since 2007.

Objective

To explore whether there is an association between prognosis and the type of systemic immune‐modulation treatment administered in a cohort of patients with SJS, SJS‐TEN overlap, and TEN at the New South Wales State SJS/TEN referral center – Concord Repatriation General Hospital.

Methods

This is a retrospective, single center, cohort study of patients admitted with SJS/TEN from January 1, 2006, to December 31, 2016, at Concord Repatriation General Hospital. Data on demographic information, the causative agent, treatment, and final survival outcome were analyzed.

Results

Forty‐two patients included: 26 (62%) with TEN, six (14%) with SJS/TEN overlap, and 10 (24%) with SJS. Overall mortality was 19% (n = 8), and seven suffered TEN. The average age of those who died was 60 years. Eighty‐one percent of patients were managed within the burn unit. Twenty‐nine patients (70%) received IVIG within this group; 13 individuals also received systemic corticosteroids. Seven (17%) were managed with corticosteroid therapy alone. The incidence of death was 0% in the combined IVIG and corticosteroid group.

Conclusion

This series of 42 patients contributes valuable information to a serious condition with low global incidence and high mortality. There appears to be an apparent reduced mortality in the group of SJS/TEN patients managed with combined IVIG and corticosteroid. Larger cohorts are required to validate this relationship due to the risk of bias inherent to the retrospective study design and small sample size.
Improving survival in patients with hepatocellular carcinoma related to chronic hepatitis C and B but not in those related to non‐alcoholic steatohepatitis or alcoholic liver disease: a 20‐year experience from a national programme
Authors: Hassan Ibrahim , Gane Edward
Published: March 2019

Background

Hepatocellular carcinoma (HCC) is the most rapidly increasing cause of cancer mortality in New Zealand due to endemic hepatitis B virus (HBV) infection and recent hepatitis C virus (HCV) and obesity epidemics.

Aim

To describe the changing landscape of HCC referred to a national HCC service over a 20‐year period, including trends in underlying liver disease, screening uptake and access to curative treatments, and to determine the impact of screening on outcomes with a comparison between screened detected and non‐screened detected cases.

Methods

All newly diagnosed cases of HCC referred to New Zealand Liver Transplant Unit between 1998 and 2017 were included. Data on patient demographics, liver disease aetiology, screening status and treatment modalities were collected.

Results

HCC diagnosis rates have increased from 24 cases in 1998 to 250 in 2017, an increase of 20% per annum. The total of 1985 HCC cases was divided into three cohorts (Era 1: 1998–2009; Era 2: 2009–2014; Era 3: 2014–2017), each comprising 661–662 patients. During the study period, overall survival improved (P = 0.005). The proportion with screen‐detected HCC was similar across the three cohorts (44% in Era 1, 42% in Era 2 and 47% in Era 3). Five‐ and 10‐year survival was higher in screen‐detected cases (49 and 43%) than in non‐screen detected cases (14 and 10%), P < 0.0001. Survival was higher in patients with HCV and HBV than in those with non‐alcoholic steatohepatitis (NASH) or alcoholic liver disease (ALD) – 5 and 10‐year survival was 40 and 34% in HCV‐HCC, 30 and 26% in HBV–HCC, 15 and 14% in NASH‐HCC, 13 and 10% in ALD‐HCC, P < 0.0001.

Conclusion

Better outcomes in patients with HBV‐ or HCV‐related HCC than in those with NASH‐related or ALD‐related HCV may reflect better screening uptake and better access to curative therapies.
Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials
Authors: Prado Ivana Meyer , Carcavalli Larissa , Abreu Lucas Guimarães , Serra‐Negra Júnia Maria , Paiva Saul Martins , Martins Carolina Castro
Published: March 2019

Objective

To determine whether distraction techniques (DT) reduce children's/adolescent's anxiety and fear during dental treatment.

Methods

Randomized controlled trials (RCTs) in which any type of DT were used to manage dental anxiety and dental fear in children/adolescents were included. A systematic search of PubMed, Web of Science, Scopus, Cochrane Library, Lilacs, and Google Scholar was conducted. Two independent reviewers selected studies, extracted data, assessed methodological quality of studies using the Cochrane Collaboration's Risk of Bias tool (CCRBT), and approached certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Data were analysed descriptively.

Results

Twenty studies covering several types of DT (audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys) were included. Qualitative analysis showed with very low certainty of evidence that DT effectively reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure. CCRBT evaluation identified many methodological issues in included studies.

Conclusion

There is a very low certainty of evidence that DT can be effective in managing children's/adolescents’ dental fear and anxiety during dental treatment. The heterogeneity of methodologies and findings in the studies, however, suggests more robust, and well‐executed RCTs are needed.
Effect of fairness on channel choice of the mobile phone supply chain
Authors: Wang Ningning , Fan Zhi‐Ping , Chen Xu
Published: March 2019

This paper considers a one‐service operator, one‐handset manufacturer mobile phone supply chain (MPSC), and examines how the nature and level of both the handset manufacturer's fairness concerns and the operator's fairness concerns affect the decision of pricing, subsidizing, and channel choice between an unlocked channel and a bundled channel. Our analysis shows that in most circumstances, the MPSC will choose the bundled channel as long as the price elasticity is higher; however, this property is invalid under certain conditions. Our analysis further shows that the introduction of fairness may have significant effects on channel choice decisions. First, the manufacturer's fairness may hinder the MPSC from choosing the bundled channel when the channel power between the operator and the manufacturer is sufficiently asymmetric. Second, when the manufacturer is almost neck‐and‐neck with the operator, the manufacturer's fairness concerns may be conducive to the deployment of the bundled channel. Third, the bundled channel would never be a reasonable choice for both the operator and the MPSC when the manufacturer has a relatively powerful status, in particular under the situation when the manufacturer has strong fairness concerns. Fourth, the operator's fairness concerns are always detrimental to the bundled cooperation which is different from the effect of the manufacturer's fairness concerns, and the bundled channel would never be a reasonable choice for the MPSC when the operator is extremely powerful.
Pricing against supply disruption under duopolistic competition
Authors: Wang Xinping , Sun Shengnan
Published: March 2019

This paper investigates two pricing policies against supply disruption for a supply chain with vertical product differentiation as well as an external competitor who sells similar products. Market‐chasing pricing policy aims at minimizing the market share loss, while profit‐chasing pricing policy aims to minimize the profit loss under supply disruption. Stackelberg games are established to analyze the equilibrium pricing behaviors with both pricing policies under supply disruption. It is shown that the effectiveness of market‐chasing pricing policy depends on the competitive power of the manufacturer and competitor, while profit‐chasing pricing policy is always helpful for the manufacturer to reduce her profit loss under supply disruption. Furthermore, to minimize market share loss, firms need to lower both the price of the disrupted product and the undisrupted product. But firms can lower the price of the disrupted product only and increase the price of other undisrupted products to minimize the profit loss.
Diagnostic reproducibility of epinephrine drug challenge interpretation in suspected long QT syndrome
Authors: Churet Maxime , Luttoo Khaled , Hocini Mélèze , Haïssaguerre Michel , Sacher Frédéric , Duchateau Josselin
Published: March 2019

Introduction

The epinephrine challenge has been proposed to improve the diagnosis of congenital long QT syndrome (LQTS). The aim of the study was to evaluate the diagnostic reliability of the epinephrine provocative test for LQTS diagnosis, taking into consideration intra‐ and interobserver variability in the interpretation of the test.

Methods and Results

A retrospective analysis of 79 consecutive epinephrine provocative tests was conducted. Epinephrine was administered following a standardized protocol at two doses: 0.05 and 0.10 µg kg−1 min−1. Electrocardiograms were blindly read twice by three different operators at ≥1‐week interval. QT and RR intervals were collected at rest and at each dose, as well as final operator interpretation of the test. There was a high interobserver reproducibility of corrected QT measurements with an intraclass correlation (ICC) of 0.74 (95% confidence interval, 0.66‐0.80) but a low interobserver reproducibility on the final interpretation with a κ of 0.31. Intraobserver reproducibility of corrected QT was very good (ICC 0.93; 0.91‐0.95), but still resulted in an only moderate intraobserver reproducibility in the final diagnosis (κ of 0.47). Perceived certainty of at least 1 reading by 2 operators (N = 62 tests) increased interobserver reproducibility compared with baseline (κ = 0.43).

Conclusion

Inter‐ and intraobserver agreement in the interpretation of the epinephrine provocation test for LQTS is poor to modest. Complexity in interpretation varies from one case to the next. The low reliability of this test encourages a reconsideration of its importance in the clinical management of patients with suspected LQTS.
Childhood neurodevelopmental difficulties and risk of adolescent depression: the role of irritability
Authors: Eyre Olga , Hughes Rachael A. , Thapar Ajay K. , Leibenluft Ellen , Stringaris Argyris , Davey Smith George , Stergiakouli Evie , Collishaw Stephan , Thapar Anita
Published: March 2019

Background

Children with neurodevelopmental disorders are at increased risk of developing depression. Irritability predicts depression in the general population and is common in children with neurodevelopmental disorders. Thus, it is possible that irritability in children with neurodevelopmental disorders contributes to the link with later depression. This study aimed to (a) examine the association between childhood neurodevelopmental difficulties and adolescent depression and (b) test whether irritability explains this association.

Methods

Children with any neurodevelopmental difficulty at the age of 7–9 (n = 1,697) and a selected, comparison group without any neurodevelopmental difficulty (n = 3,177) were identified from a prospective, UK population‐based cohort, the Avon Longitudinal Study of Parents and Children. Neurodevelopmental difficulties were defined as a score in the bottom 5% of the sample on at least one measure of cognitive ability, communication, autism spectrum symptoms, attention‐deficit/hyperactivity symptoms, reading or motor coordination. The Development and Well‐Being Assessment measured parent‐reported child irritability at the age of 7, parent‐reported adolescent depression at the age of 10 and 13, and self‐reported depression at the age of 15. Depression measures were combined, deriving an outcome of major depressive disorder (MDD) in adolescence. Logistic regression examined the association between childhood neurodevelopmental difficulties and adolescent MDD, controlling for gender. Path analysis estimated the proportion of this association explained by irritability. Analyses were repeated for individual neurodevelopmental problems.

Results

Childhood neurodevelopmental difficulties were associated with adolescent MDD (OR = 2.11, 95% CI = 1.24, 3.60, p = .006). Childhood irritability statistically accounted for 42% of this association. On examining each neurodevelopmental difficulty separately, autistic, communication and ADHD problems were each associated with depression, with irritability explaining 29%–51% of these links.

Conclusions

Childhood irritability appears to be a key contributor to the link between childhood neurodevelopmental difficulties and adolescent MDD. High rates of irritability in children with autistic and ADHD difficulties may explain elevated rates of depression in the neurodevelopmental group.
Port wine stain treatment outcomes have not improved over the past three decades
Authors: van Raath M.I. , Chohan S. , Wolkerstorfer A. , van der Horst C.M.A.M. , Storm G. , Heger M.
Published: March 2019

Background

Since the early ‘80s, the pulsed dye laser has been the standard treatment tool for non‐invasive port wine stain (PWS) removal. In the last three decades, a considerable amount of research has been conducted to improve clinical outcomes, given that a fraction of PWS patients proved recalcitrant to laser treatment. Whether this research actually led to increased therapeutic efficacy has not been systematically investigated.

Objective

To analyse therapeutic efficacy in PWS patients globally from 1986 to date.

Methods

PubMed was searched for all available PWS trials. Studies with a quartile percentage improvement scale were included, analysed and plotted chronologically. Treatment and patient characteristics were extracted. A mean clearance per study was calculated and plotted. A 5‐study simple moving average was co‐plotted to portray the trend in mean clearance over time. The data were separately analysed for multiple treatment sessions in previously untreated patients.

Results

Sixty‐five studies were included (24.3% of eligible studies) comprising 6207 PWS patients. Of all patients, 21% achieved 75–100% clearance. Although a few studies reported remarkably good outcomes in a subset of carefully selected patients, there was no upward trend over time in mean clearance.

Conclusion

The efficacy of PWS therapy has not improved in the past decades, despite numerous technical innovations and pharmacological interventions. With an unwavering patient demand for better outcomes, the need for development and implementation of novel therapeutic strategies to clear all PWS is as valid today as it was 30 years ago.
The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo‐ovarian abscess
Authors: Alay Ismail , Kaya Cihan , Karaca Ibrahim , Eren Ecem , Hosgoren Murat , Aslanova Fidan , Cengiz Huseyin , Ekin Murat , YaSar Levent
Published: March 2019

Aim

We aimed to compare the neutrophil‐to‐lymphocyte ratio (NLR) in tubo‐ovarian abscess (TOA) patients who responded to medical treatment or who underwent surgical intervention due to medical treatment failure.

Methods

The files of the patients, hospitalized in our Obstetrics and Gynecology Department with TOA diagnosis between August 2015 and December 2017, were evaluated retrospectively. The conservative management group was comprised of 38 of the 81 patients (46.9%) who responded to sole medical treatment with the triple antibiotic regimen (gentamicin‐clindamycin‐ampicillin) and the surgical intervention group was comprised of 43 patients (53.1%) who did not respond to medical treatment and needed further surgery and/or interventional radiologic abscess drainage. Demographic and clinical data, imaging findings, and laboratory results including NLR were compared between two groups.

Results

There were statistically significant differences between the groups in terms of age, TOA diameter, white blood cell and neutrophil counts, and NLR levels (P < 0.05). The mean NLR was 7.4 ± 5.8 for the conservative management group and 10.3 ± 5.8 for the surgical intervention group (P = 0.004). The area under the curve (AUC) for NLR was 0.69 (threshold value was ≥6.97, 95% confidence interval, sensitivity 79.1%, specificity 57.9%). On multiple regression analysis, a significant correlation was identified between age, NLR and resistance to the medical treatment.

Conclusion

Neutrophil‐to‐lymphocyte ratio and age are significantly higher in patients with medical treatment failure and NLR could be used as a novel marker in addition to white blood cell in the prediction of medical treatment failure in TOA patients.
Machine learning and its potential applications to the genomic study of head and neck cancer—A systematic review
Authors: Patil Shankargouda , Habib Awan Kamran , Arakeri Gururaj , Jayampath Seneviratne Chaminda , Muddur Nagaraj , Malik Shuaib , Ferrari Marco , Rahimi Siavash , Brennan Peter A.
Published: March 2019

Background

Machine learning (ML) is powerful tool that can identify and classify patterns from large quantities of cancer genomic data that may lead to the discovery of new biomarkers, new drug targets, and a better understanding of important cancer genes. The aim of this systematic review was to evaluate the existing literature and assess the application of machine learning of genomic data in head and neck cancer (HNC).

Materials and methods

The addressed focused question was “Does machine learning of genomic data play a role in prognostic prediction of HNC?” PubMed, EMBASE, Scopus, Web of Science, and gray literature from January 1990 up to and including May 2018 were searched. Two independent reviewers performed the study selection according to eligibility criteria.

Results

A total of seven studies that met the eligibility criteria were included. The majority of studies were cohort studies, one a case‐control study and one a randomized controlled trial. Two studies each evaluated oral cancer and laryngeal cancer, while other one study each evaluated nasopharyngeal cancer and oropharyngeal cancer. The majority of studies employed support vector machine (SVM) as a ML technique. Among the included studies, the accuracy rates for ML techniques ranged from 56.7% to 99.4%.

Conclusion

Our findings showed that ML techniques for the analysis of genomic data can play a role in the prognostic prediction of HNC.
Historical Trends in Concerns About Social Issues Across Four Decades Among U.S. Adolescents
Authors: Oosterhoff Benjamin , Wray‐Lake Laura , Palmer Cara A. , Kaplow Julie B.
Published: March 2019

This study examined adolescents’ concerns about social issues and how these concerns have changed over historical time. Separate cohorts of U.S. high school seniors (N = 110,953; 51.1% female) reported their worries about four social issues (crime/violence, economic problems, hunger/poverty, race relations) every year from 1976 to 2015. Youth were most concerned with crime/violence, followed by economic problems, hunger/poverty, and race relations. Adolescents’ social concerns varied by demographic characteristics and cohort, paralleling specific historical events and appearing responsive to the political challenges of the time. Initiatives seeking to engage youth within the political process may benefit from providing opportunities for teens to participate in civic activities aimed to address these issues.
The miR‐3940‐5p inhibits cell proliferation of gingival mesenchymal stem cells
Authors: Han Xiao , Yang Haoqing , Cao Yangyang , Ge Lihua , Han Nannan , Zhang Chen , Fan Zhipeng , Yao Rui
Published: March 2019

Objectives

Drug‐induced gingival overgrowth (DIGO) is a well‐recognized side effect of nifedipine (NIF). However, the molecular mechanisms of DIGO are still unknown. Here, we explored the possible role of miR‐3940‐5p in DIGO using NIF‐treated gingival mesenchymal stem cells (GMSCs).

Material and methods

CFSE and cell cycle assays were used to examine cell proliferation. The alkaline phosphatase (ALP) activity assay, Alizarin Red staining, quantitative calcium analysis, and osteogenesis‐related gene expression were used to examine osteo/dentinogenic differentiation.

Results

The CFSE assay showed that NIF enhanced cell proliferation, and the over‐expression of miR‐3940‐5p inhibited the proliferation of GMSCs with or without NIF stimulation. Cell cycle assays revealed that the cell cycle was arrested at the G0/G1 phase. Furthermore, it was found that the over‐expression of miR‐3940‐5p upregulated p15INK4b, p18INK4c, p19INK4d, and Cyclin A and downregulated Cyclin E in GMSCs with or without NIF treatment. In addition, the over‐expression of miR‐3940‐5p enhanced ALP activity and mineralization in vitro and increased the expression of the osteo/dentinogenic differentiation markers DSPP and DMP1 and the key transcription factor DLX5 in GMSCs.

Conclusions

miR‐3940‐5p inhibited cell proliferation, enhanced the osteo/dentinogenic differentiation of GMSCs, and might play a role in DIGO as a potent agent in the treatment of nifedipine‐induced gingival overgrowth.
Persistent subcutaneous CSF leak after removal of epidural catheter
Authors: Rusy Lynn M. , Dziamski Anna E. , Amin Sapan J. , Weisman Steven J.
Published: March 2019

We report the case of an 11‐month‐old boy with Wilm's tumor, who underwent nephrectomy. Postoperative pain was managed with a lumbar epidural for 3 days, with the formation of a persistent cerebral spinal fluid cutaneous fistula.
The potential of plant systems to break the HIV‐TB link
Authors: Habibi Peyman , Daniell Henry , Soccol Carlos Ricardo , Grossi‐de‐Sa Maria Fatima
Published: March 2019

Tuberculosis (TB) and human immunodeficiency virus (HIV) can place a major burden on healthcare systems and constitute the main challenges of diagnostic and therapeutic programmes. Infection with HIV is the most common cause ofMycobacterium tuberculosis(Mtb), which can accelerate the risk of latent TB reactivation by 20‐fold. Similarly, TB is considered the most relevant factor predisposing individuals to HIV infection. Thus, both pathogens can augment one another in a synergetic manner, accelerating the failure of immunological functions and resulting in subsequent death in the absence of treatment. Synergistic approaches involving the treatment of HIV as a tool to combat TB and vice versa are thus required in regions with a high burden of HIV and TB infection. In this context, plant systems are considered a promising approach for combatting HIV and TB in a resource‐limited setting because plant‐made drugs can be produced efficiently and inexpensively in developing countries and could be shared by the available agricultural infrastructure without the expensive requirement needed for cold chain storage and transportation. Moreover, the use of natural products from medicinal plants can eliminate the concerns associated with antiretroviral therapy (ART) and anti‐TB therapy (ATT), including drug interactions, drug‐related toxicity and multidrug resistance. In this review, we highlight the potential of plant system as a promising approach for the production of relevant pharmaceuticals for HIV and TB treatment. However, in the cases of HIV and TB, none of the plant‐made pharmaceuticals have been approved for clinical use. Limitations in reaching these goals are discussed.
A mutation in Waxy gene affects amylose content, starch granules and kernel characteristics of barley (Hordeum vulgare)
Authors: Li Qiao , Pan Zhifen , Liu Juan , Deng Guangbing , Long Hai , Zhang Haili , Liang Junjun , Zeng Xingquan , Tang Yawei , Tashi Nyima , Yu Maoqun
Published: March 2019

Waxy barley referred to as low‐amylose or amylose‐free has special advantages in nutrition composition and food processing. Waxy gene encoding granule–bound starch synthase I (GBSSI) is responsible for amylose synthesis in barley. The G3935‐to‐T in Waxy gene has been previously found in amylose–free barley. In this study, G3935‐to‐T was proved to co‐segregate with the waxy phenotype of barley, but has no obvious effect on GBSSI catalytic activity and starch chain length distribution. However, recombinant inbred lines with G3935‐to‐T in Waxy gene are of significant modification in starch granules morphology and pasting properties, increase of grain β‐glucan content, and decrease of thousand kernel weight along with lower kernel width. A polymerase chain reaction with confronting two–pair primers marker was developed for economic and efficient screening of G3935‐to‐T. This study provides the basis for cultivar improvement of waxy barley then fully developing its potential value and utility in food processing.
Treatment of benign cephalic histiocytosis with topical 1% rapamycin ointment
Authors: Habeshian Kaiane , Silverman Robert A. , DeKlotz Cynthia M. C.
Published: March 2019

We report a pediatric case of extensive, progressive benign cephalic histiocytosis (BCH) involving the face, trunk, and extremities with response of facial lesions to treatment with topical 1% rapamycin. A split‐face model was used to demonstrate improvement on the treated side versus the untreated side. After physician and parental perception of effectiveness, based in part on photodocumentation, subsequently both cheeks were treated with continued improvement.
Reconciling opposing perceptions of access to physical activity in a gentrifying urban neighborhood
Authors: Schroeder Krista , Klusaritz Heather , Dupuis Roxanne , Bolick Ansley , Graves Amy , Lipman Terri H. , Cannuscio Carolyn
Published: March 2019

Objective

We sought to understand perspectives on access to physical activity in a gentrifying neighborhood.

Design

This qualitative descriptive study used street intercept interviews and photo documentation.

Sample

Participants included members (n = 19) of a gentrifying neighborhood in a northeastern city.

Results

Participants held markedly different perceptions of opportunities for physical activity. Some participants, particularly area university students or those who are identified as White, perceived the neighborhood as favorable to physical activity, with high walkability and abundant resources. Other participants, particularly those who identified as Black or African‐American, felt it was difficult to be physically active because neighborhood recreation facilities are scarce or unaffordable and parks are poorly maintained or unsafe. Multiple participants noted strategies to overcome neighborhood barriers to physical activity. Regardless of neighborhood perceptions, family and friends played an important role in influencing physical activity.

Conclusions

Nurses must consider how disparities in actual and perceived access to neighborhood resources influence participation in physical activity, particularly in gentrifying neighborhood. Public health nurses are embedded in the neighborhoods that they serve, providing a unique opportunity to understand and address the impact of neighborhood on health.
Assessment of sun‐related behaviour, knowledge and attitudes among nursing students
Authors: Iglesias‐Puzas Álvaro , Méndez Iglesias Miguel , Diéguez Montes Mª Paz , Flórez Ángeles
Published: March 2019

Background

As future healthcare professionals, nursing students will play an important role in social training and promoting healthy behaviours including protection against sunlight. However, few studies to date have focused on their knowledge and attitudes regarding sun‐related behaviour.

Objective

To evaluate the level of knowledge, attitudes and practices about sun protection and skin cancer among nursing students.

Methods

This cross‐sectional study included 200 all year nursing students from University of Vigo, located in the Vigo, Ourense and Pontevedra campus. Participants completed a validated, self‐reported questionnaire with 38 questions regarding their demographic characteristics, sun‐related behaviour, knowledge and attitudes.

Results

Approximately 87% of students reported experiencing sunburn last summer and 57% stated that they had sunbathed more than 15 days. Participants showed low level of sun protection behaviours, with the exception of using sunscreen (86%) and wearing sunglasses (72.5%). Knowledge about skin cancer and sun protection was considered high (rate of correct responses 87.7%, 6.14 out of 7). Moreover, positive tanning attitudes were high in the sample overall. Nursing students awarded a high value to tanned skin and showed misconceptions about sun exposure.

Conclusion

Although most of the students were aware of the side effects of sun exposure, their behaviours and attitudes were unsatisfactory. A high level of knowledge may not be predictive of positive practices and adequate attitudes, even among future healthcare professionals. Further guidance and educational campaigns are utmost important, particularly in a group that will be directly involved in prevention and early diagnosis of skin cancer.
Host range and molecular analysis of Beet leaf yellowing virus, Beet western yellows virus‐JP and Brassica yellows virus in Japan
Authors: Yoshida N. , Tamada T.
Published: March 2019

Beet western yellows virus (BWYV; genus Polerovirus, family Luteoviridae) is one of the most important viruses causing yellowing disease of many field and vegetable crops. This study isolated different poleroviruses from sugar beet, spinach, radish and brassica in Japan, and identified them as BWYV‐JP, Beet leaf yellowing virus (BLYV), Brassica yellows virus (BrYV) and BrYV‐R (radish strain) based on host range and molecular analysis. Among over 100 plant species from 19 families inoculated with the vector Myzus persicae, about half of the species in 13 families were infected with some of these viruses. BLYV shared a similar host range to Beet mild yellowing virus (BMYV). These had a much more limited host range than BWYV‐JP, which resembled BWYV‐USA. The host range of BrYV was similar to that of Turnip yellows virus (TuYV). Phylogenetic analyses at the 5′ portion (replication‐related gene) of the genome showed that BLYV, BMYV, BWYV (‐JP and ‐USA) and Cucurbit aphid‐borne yellows virus (CABYV) formed one large group, whereas BrYV and TuYV were grouped together. BLYV and BWYV were most closely related to each other, and were more closely related to CABYV than to BMYV. However, at the 3′ end (coat protein gene), BLYV and BWYV‐JP formed a distinct group, separated from the BrYV group, which in turn was more closely related to BWYV‐USA, BMYV, TuYV and Beet chlorosis virus, a group originating from outside Asia. Thus, this study presents host range differences and phylogeographical relationships of BWYV‐like poleroviruses that are distributed worldwide.
Advocacy Coalitions in Low Salience Policy Subsystems: Struggles Under a Smooth Surface
Authors: Giordono Leanne S.
Published: March 2019

The Advocacy Coalition Framework (ACF), a well‐known framework used to understand policy changes at the subsystem level, is predicated on the idea that coalitions with distinct beliefs compete to influence policy subsystem decisions. The ACF is noted as being most appropriate for, and is typically applied to, high salience policy areas. However, scholars have noted the need to also apply the ACF to less typical application settings in the interest of theoretical refinement. This paper thus explores the applicability of the ACF to Day Habilitation and Employment services systems for working‐age adults with intellectual and developmental disabilities in two U.S. states, Washington and Pennsylvania, both of which have experienced distinct state‐level policy changes during the last two decades despite low levels of public attention and conflict. Using a mixed‐methods approach, the paper identifies the presence of two advocacy coalitions (Employment First and Choice) in both states. The study concludes that there is sufficient evidence to apply the ACF to these low salience subsystems, noting theoretical and practical implications for scholars and policymakers interested in applying the ACF to similar settings.