bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of whole blood copper, magnesium and zinc levels with metabolic syndrome components in 6–12-year-old rural Chinese children: 2010–2012 China National Nutrition and Health Survey
Authors: Zhang Huidi , Man Qingqing , Song Pengkun , Li Siran , Liu Xiaobing , Wang Lijuan , Li Yuqian , Hu Yichun , Yang Lichen
Published: June 2021

Background

Metabolic syndrome (MetS) is significantly associated with the risk of cardiovascular disease and its prevalence is showing a trend of getting younger. Previous studies on the relationship between elements and MetS were mostly reported in adults with single element analysis, while reports in children with combined effects of multiple elements were very limited. The aim of this study is to investigate the association between whole blood Cu, Mg and Zn in both single and combined effects and MetS components in rural Chinese children aged 6–12 years based on the data from 2010–2012 China National Nutrition and Health Survey.

Methods

A total of 911 children (51.2% male, 48.7% female) aged 6–12 years were included. Basic characteristics and MetS component parameters were collected and determined by trained stuffs. Elements were detected by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Multivariate logistic regression analysis was performed to examine the independent relationship between elements and MetS components.

Results

In single metal analysis, copper was positively associated with elevated waist (OR = 2.00, 1.18–3.28) and all of the metals were associated with elevated TG. And the comprehensive analysis of multiple elements were mostly consistent with the results of single element analysis (low Cu + high Zn with elevated TG (OR = 2.21, 1.18–4.13), high Cu + low Mg with elevated TG (OR = 0.40, 0.16–0.95), high Cu + high Mg with elevated waist (OR = 2.03, 1.26–3.27)), except the combination of Zn and Mg (high Zn + low Mg with reduced HDL-C (OR = 0.47, 0.28–0.77)).

Conclusions

Our study suggested Cu, Zn and Mg in children are indeed associated with metabolic syndrome components, whether in single element or multi-element combined analysis. The results will be confirmed through additional cohort research.
The Danish sports chiropractic landscape: an exploration of practice characteristics and salient developmental issues
Authors: Myburgh Corrie , Andersen Julie , Bakkely Nicklas , Hermannsen Jakob , Zuschlag Marcus , Damgaard Philip , Boyle Eleanor
Published: June 2021

Background

As is the case around the globe, the Danish chiropractic community appears to be an active service provider for the athletic sub-population. However, a paucity of evidence elucidating the experiences, perceptions, and practices of individuals who identify as ‘sports chiropractors’ complicates strategic development efforts.

Methods

A sequential mixed-methods study was conceptualized in which interview responses from seven purposefully selected stakeholders provided context and informed a national descriptive survey exploring practice characteristics and opinions regarding sports chiropractic among Danish chiropractors.

Results

Thematic highlights included divided opinions on the criteria that define a sports chiropractor, the role of a chiropractor functioning beyond the clinic setting, and the need for a structured approach to developing sports chiropractic as a legitimate sub-specialty.

The survey response rate was 34.9% (227 of 651), with 27% of responders identifying as a ‘sports chiropractor’. Compared to non-sports chiropractors, sports chiropractors engaged in a significantly higher level of interprofessional practice (3.8 versus 2.7 partners), in particular medical doctors (p = 0.016) and personal trainers (p <  0.001). Whether participants identified as a sports chiropractor or not, there was consensus that a high-quality post-graduate qualification and continued education was important. Generally speaking, the framing of sports chiropractic into a protected title was not a priority.

Conclusion

The Danish sports chiropractor tends to be male, has a specialist education and engages other chiropractors, medical practitioners and professional trainers more often as practice partners than generalist chiropractors. The position of the sports chiropractor as a ‘knowledgeable expert’ was seen as more important than establishing a protected title. Experiential training appears to be an untapped resource for developing real-world competency and gaining greater professional exposure. Given the potential for development across Europe, more focus is required on a strategic plan for embedding chiropractic professionals in inter-professional athletic health and performance practice settings.
Detailed analysis of recovery process of cranial nerve palsy after IMRT-based comprehensive treatment in nasopharyngeal carcinoma
Authors: Zang Jian , Li Yan , Luo Shanquan , Wang Jianhua , Hou Bingxin , Yao Min , Zhao Lina , Shi Mei
Published: June 2021

Background

Cranial nerve (CN) palsy due to cancer involvement has been considered as an unfavorable prognostic factor for patients with nasopharyngeal carcinoma (NPC). We assessed the role of IMRT based treatment on the recovery of CN palsy and investigated the prognostic value of complete recovery of CN palsy.

Methods

A total of 115 NPC patients with cancer-related CN palsy were included in the study. We referred CTCAE version 5.0 to evaluate the grade of CN palsy.

Results

All patients with grade 1 CN palsy recovered completely during the 2 years of follow-up after definite treatment. Most grade 2 palsy could change gradually to grade 1 palsy or complete recovery during 2 years of follow-up. Patients with more than 2 symptoms of CN palsy had poor 3-year disease-free survival (DFS) than these with 1 or 2 symptoms (60.3% vs. 84.9%, HR 0.25, 95% CI 0.07–0.89, P = 0.001). There were no significant differences for PFS, OS, DMFS and LRFS between patients with complete recovery and non-complete recovery from CN palsy after receiving IMRT based comprehensive treatment.

Conclusions

IMRT based comprehensive treatment could effectively promote the recovery of tumor-related CN palsy for NPC patient. More than 2 symptoms of CN palsy was a poor prognostic factor for DFS of NPC patients. The prognostic role of complete recovery of CN palsy was not identified in our study.
Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review
Authors: Jørgensen Rasmus , Laursen Christian B. , Konge Lars , Pietersen Pia Iben
Published: June 2021

Background

Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education.

Methods

In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale.

Results

Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective.

Conclusion

Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.
Engineering of Yarrowia lipolytica transporters for high-efficient production of biobased succinic acid from glucose
Authors: Jiang Zhennan , Cui Zhiyong , Zhu Ziwei , Liu Yinghang , Tang Ya-jie , Hou Jin , Qi Qingsheng
Published: June 2021

Background

Succinic acid (SA) is a crucial metabolic intermediate and platform chemical. Development of biobased processes to achieve sustainable SA production has attracted more and more attention in biotechnology industry. Yarrowia lipolytica has a strong tricarboxylic acid cycle and tolerates low pH conditions, thus making it a potential platform for SA production. However, its SA titers in glucose media remain low.

Results

In this study, we screened mitochondrial carriers and C4-dicarboxylic acid transporters to enhance SA secretion in Y. lipolytica. PGC62-SYF-Mae strain with efficient growth and SA production was constructed by optimizing SA biosynthetic pathways and expressing the transporter SpMae1. In fed-batch fermentation, this strain produced 101.4 g/L SA with a productivity of 0.70 g/L/h and a yield of 0.37 g/g glucose, which is the highest SA titer achieved using yeast, with glucose as the sole carbon resource.

Conclusion

Our results indicated that transporter engineering is a powerful strategy to achieve the efficient secretion of SA in Y. lipolytica, which will promote the industrial production of bio-based SA.
Harmful mutation load in the mitochondrial genomes of cattle breeds
Authors: Subramanian Sankar
Published: June 2021

Objective

Domestication of wild animals results in a reduction in the effective population size, and this could affect the deleterious mutation load of domesticated breeds. Furthermore, artificial selection will also contribute to the accumulation of deleterious mutations due to the increased rate of inbreeding among these animals. The process of domestication, founder population size, and artificial selection differ between cattle breeds, which could lead to a variation in their deleterious mutation loads. We investigated this using mitochondrial genome data from 364 animals belonging to 18 cattle breeds of the world.

Results

Our analysis revealed more than a fivefold difference in the deleterious mutation load among cattle breeds. We also observed a negative correlation between the breed age and the proportion of deleterious amino acid-changing polymorphisms. This suggests a proportionally higher deleterious SNPs in young breeds compared to older breeds. Our results highlight the magnitude of difference in the deleterious mutations present in the mitochondrial genomes of various breeds. The results of this study could be useful in predicting the rate of incidence of genetic diseases in different breeds.
Letting the patients speak: an in-depth, qualitative research-based investigation of factors relevant to health-related quality of life in real-world patients with hereditary angioedema using subcutaneous C1 inhibitor replacement therapy
Authors: Anderson John , Levy Donald S. , Lumry William , Koochaki Patricia , Lanar Sally , Henry Li H.
Published: June 2021

Background

While many studies of effective hereditary angioedema (HAE) therapy have demonstrated improved health-related quality of life (HRQoL) using validated instruments, specific reasons behind the improved scores have never been investigated using qualitative methods. A non-interventional, qualitative research study was designed to investigate the reasons for improvements in HRQoL while using effective prophylaxis, in this case subcutaneous C1INH (C1INH[SC]) replacement therapy.

Methods

Adult patients with HAE-C1INH type 1 or 2 who had been using C1INH(SC) for ≥ 3 consecutive months were recruited through four HAE specialty practices in the US to participate in a 60-min phone interview performed by a trained qualitative research specialist (ICON plc) using a semi-structured interview guide with open-ended questions developed with the Angioedema Quality of Life (AE-QoL) items in mind. Interview transcripts were analyzed using thematic analysis methods to identify concepts (specific symptoms/impacts) and themes (higher-level categories grouping related concepts). A cross-mapping exercise was performed between interview-identified concepts and items included in the AE-QoL.

Results

Fourteen patients were interviewed and included in the analysis (age range, 28–82 years [mean 47.5 years]; 64% female; 93% white). In 10 interviews, patients mentioned having no or nearly no HAE attacks, no longer feeling limited by HAE, less HAE-related anxiety/worry and depression, an improved ability to travel, fewer emergency room/hospital visits, and ease of administration of C1INH(SC), including not requiring assistance from others. Other commonly expressed concepts included: increased feelings of confidence, independence, optimism, and normalcy; less absence from work/school; better productivity; improved sleep and energy; healthier family relationships; and improved cognition. While all AE-QoL items emerged from patient interviews, a number of identified concepts were not addressed by the AE-QoL, including sensitivity to various potential attack-triggers (e.g., stress/anxiety, sports), attack frequency, not having to cancel social plans, improvements in ability to perform day-to-day tasks, and a lower burden from medical visits.

Conclusions

From these interviews, a large number of common themes and concepts emerged: a greater sense of freedom and normalcy, increased productivity, and improved interpersonal relationships while using convenient and effective prophylaxis. These findings provide insights into real-world experiences and the many facets of HRQoL that are important to patients with HAE-C1INH.
A young girl with chronic isolated cervical lymphadenopathy found to have lupus lymphadenopathy, progressing to develop lupus nephritis: a case report
Authors: Jayawickreme K. P. , Subasinghe S. , Weerasinghe S. , Perera L. , Dissanayaka P.
Published: June 2021

Background

Systemic lupus erythematosus is a rare autoimmune disorder, with the prevalence in Asia ranging from 30 to 50/100,000. The diagnosis of systemic lupus erythematosus is made according to the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria, and it does not contain lymphadenopathy as diagnostic criteria. However, lupus lymphadenopathy has an estimated prevalence of 5–7% at the onset of disease, and 12–15% at any stage of the disease.

Case presentation

A 19-year-old Sinhalese girl had neck nodules since the age of 5 years, which increased in size and became tender since 1 year. She had alopecia and joint stiffness for 6 months. She presented with a 5-day history of worsening joint pain, fever, and painful, enlarging cervical nodules. She had tender cervical lymphadenopathy, and a vasculitic rash on both lower limbs. She had pancytopenia, an erythrocyte sedimentation rate of 92, positive antinuclear antibody titer, and high anti-double-stranded deoxyribonucleic acid (DNA), with low C3 and C4 complements. She had a high reticulocyte count of 5%, with direct and indirect antiglobulin tests being positive, indicating autoimmune hemolytic anemia. Lymph node biopsy showed moderate reactive follicular hyperplasia, with scattered plasma cells and immunoblasts, with varying degree of coagulative necrosis, suggestive of lupus lymphadenopathy. On immunohistochemistry of the lymph node biopsy, Bcl2 was negative, excluding lymphoma. Contrast-enhanced computed tomography of abdomen and chest was normal with no hepatosplenomegaly or lymphadenopathy. Skin biopsy showed leukocytoclastic vasculitis. Later, with development of generalized edema, she was found to have impaired renal function, and renal biopsy showed lupus nephritis. She was started on hydroxychloroquine, prednisolone, and mycophenolate mofetil, and her symptoms improved and lymphadenopathy regressed.

Conclusion

In the case of cervical lymphadenopathy in a patient with systemic lupus erythematosus, the possibilities of lupus lymphadenopathy, Kikuchi–Fujimoto disease, and lymphoma should all be considered, after excluding secondary infection due to immunosuppression. Histology confirms the differentiation of these pathologies. It is important to differentiate the cause for lymphadenopathy in systemic lupus erythematosus as the outcome and treatment varies. Lupus lymphadenopathy is usually generalized, but isolated cervical lymphadenopathy could also rarely be the first presentation of systemic lupus erythematosus. Lupus lymphadenopathy can be the only presenting feature, and needs a high index in suspecting systemic lupus erythematosus, though it is not included in the diagnostic criteria.
Involvement of catalase and superoxide dismutase in hydrophobic organic solvent tolerance of Escherichia coli
Authors: Doukyu Noriyuki , Taguchi Katsuya
Published: June 2021

Escherichia coli strains are generally sensitive to hydrophobic organic solvents such as n-hexane and cyclohexane. Oxidative stress in E. coli by exposure to these hydrophobic organic solvents has been poorly understood. In the present study, we examined organic solvent tolerance and oxygen radical generation in E. coli mutants deficient in reactive oxygen species (ROS)-scavenging enzymes. The organic solvent tolerances in single gene mutants lacking genes encoding superoxide dismutase (sodA, sodB, and sodC), catalase (katE and katG), and alkyl hydroperoxide reductase (ahpCF) were similar to that of parent strain BW25113. We constructed a BW25113-based katE katG double mutant (BW25113∆katE∆katG) and sodA sodB double mutant (BW25113sodA∆sodB). These double-gene mutants were more sensitive to hydrophobic organic solvents than BW25113. In addition, the intracellular ROS levels in E. coli strains increased by the addition of n-hexane or cyclohexane. The ROS levels in BW25113∆katE∆katG and BW25113∆sodA∆sodB induced by exposure to the solvents were higher than that in BW25113. These results suggested that ROS-scavenging enzymes contribute to the maintenance of organic solvent tolerance in E. coli. In addition, the promoter activities of sodA and sodB were significantly increased by exposure to n-hexane.
ADP-ribosyltransferase PARP11 suppresses Zika virus in synergy with PARP12
Authors: Li Lili , Shi Yueyue , Li Sirui , Liu Junxiao , Zu Shulong , Xu Xin , Gao Meiling , Sun Nina , Pan Chaohu , Peng Linan , Yang Heng , Cheng Genhong
Published: June 2021

Background

Zika virus (ZIKV) infection and ZIKV epidemic have been continuously spreading silently throughout the world and its associated microcephaly and other serious congenital neurological complications poses a significant global threat to public health. Type I interferon response to ZIKV infection in host cells suppresses viral replication by inducing the expression of interferon-stimulated genes (ISGs).

Methods

The study aims to demonstrate the anti-ZIKV mechanism of PARP11. PARP11 knock out and overexpressing A549 cell lines were constructed to evaluate the anti-ZIKV function of PARP11. PARP11−/−, PARP12−/− and PARP11−/−PARP12−/− HEK293T cell lines were constructed to explain the synergistic effect of PARP11 and PARP12 on NS1 and NS3 protein degradation. Western blotting, immunofluorescence and immunoprecipitation assay were performed to illustrate the interaction between PARP11 and PARP12.

Results

Both mRNA and protein levels of PARP11 were induced in WT but not IFNAR1−/− cells in response to IFNα or IFNβ stimulation and ZIKV infection. ZIKV replication was suppressed in cells expressed PARP11 but was enhanced in PARP11−/− cells. PARP11 suppressed ZIKV independently on itself PARP enzyme activity. PARP11 interacted with PARP12 and promoted PARP12-mediated ZIKV NS1 and NS3 protein degradation.

Conclusion

We identified ADP-ribosyltransferase PARP11 as an anti-ZIKV ISG and found that it cooperated with PARP12 to enhance ZIKV NS1 and NS3 protein degradation. Our findings have broadened the understanding of the anti-viral function of ADP-ribosyltransferase family members, and provided potential therapeutic targets against viral ZIKV infection.
Existence of a unique weak solution to a non-autonomous time-fractional diffusion equation with space-dependent variable order
Authors: Van Bockstal Karel
Published: June 2021

In this contribution, we investigate an initial-boundary value problem for a fractional diffusion equation with Caputo fractional derivative of space-dependent variable order where the coefficients are dependent on spatial and time variables. We consider a bounded Lipschitz domain and a homogeneous Dirichlet boundary condition. Variable-order fractional differential operators originate in anomalous diffusion modelling. Using the strongly positive definiteness of the governing kernel, we establish the existence of a unique weak solution in$u\in \operatorname{L}^{\infty } ((0,T),\operatorname{H}^{1}_{0}( \Omega ) )$u∈L∞((0,T),H01(Ω))to the problem if the initial data belongs to$\operatorname{H}^{1}_{0}(\Omega )$H01(Ω). We show that the solution belongs to$\operatorname{C} ([0,T],{\operatorname{H}^{1}_{0}(\Omega )}^{*} )$C([0,T],H01(Ω)∗)in the case of a Caputo fractional derivative of constant order. We generalise a fundamental identity for integro-differential operators of the form$\frac{\mathrm{d}}{\mathrm{d}t} (k\ast v)(t)$ddt(k∗v)(t)to a convolution kernel that is also space-dependent and employ this result when searching for more regular solutions. We also discuss the situation that the domain consists of separated subdomains.
Remodeling of the maternal gut microbiome during pregnancy is shaped by parity
Authors: Berry Alexander S. F. , Pierdon Meghann K. , Misic Ana M. , Sullivan Megan C. , O’Brien Kevin , Chen Ying , Murray Samuel J. , Ramharack Lydia A. , Baldassano Robert N. , Parsons Thomas D. , Beiting Daniel P.
Published: June 2021

Background

The maternal microbiome has emerged as an important factor in gestational health and outcome and is associated with risk of preterm birth and offspring morbidity. Epidemiological evidence also points to successive pregnancies—referred to as maternal parity—as a risk factor for preterm birth, infant mortality, and impaired neonatal growth. Despite the fact that both the maternal microbiome and parity are linked to maternal-infant health, the impact of parity on the microbiome remains largely unexplored, in part due to the challenges of studying parity in humans.

Results

Using synchronized pregnancies and dense longitudinal monitoring of the microbiome in pigs, we describe a microbiome trajectory during pregnancy and determine the extent to which parity modulates this trajectory. We show that the microbiome changes reproducibly during gestation and that this remodeling occurs more rapidly as parity increases. At the time of parturition, parity was linked to the relative abundance of several bacterial species, including Treponema bryantii, Lactobacillus amylovorus, and Lactobacillus reuteri. Strain tracking carried out in 18 maternal-offspring “quadrads”—each consisting of one mother sow and three piglets—linked maternal parity to altered levels of Akkermansia muciniphila, Prevotella stercorea, and Campylobacter coli in the infant gut 10 days after birth.

Conclusions

Collectively, these results identify parity as an important environmental factor that modulates the gut microbiome during pregnancy and highlight the utility of a swine model for investigating the microbiome in maternal-infant health. In addition, our data show that the impact of parity extends beyond the mother and is associated with alterations in the community of bacteria that colonize the offspring gut early in life. The bacterial species we identified as parity-associated in the mother and offspring have been shown to influence host metabolism in other systems, raising the possibility that such changes may influence host nutrient acquisition or utilization. These findings, taken together with our observation that even subtle differences in parity are associated with microbiome changes, underscore the importance of considering parity in the design and analysis of human microbiome studies during pregnancy and in infants.
Identification of the high-risk area for schistosomiasis transmission in China based on information value and machine learning: a newly data-driven modeling attempt
Authors: Gong Yan-Feng , Zhu Ling-Qian , Li Yin-Long , Zhang Li-Juan , Xue Jing-Bo , Xia Shang , Lv Shan , Xu Jing , Li Shi-Zhu
Published: June 2021

Background

Schistosomiasis control is striving forward to transmission interruption and even elimination, evidence-lead control is of vital importance to eliminate the hidden dangers of schistosomiasis. This study attempts to identify high risk areas of schistosomiasis in China by using information value and machine learning.

Methods

The local case distribution from schistosomiasis surveillance data in China between 2005 and 2019 was assessed based on 19 variables including climate, geography, and social economy. Seven models were built in three categories including information value (IV), three machine learning models [logistic regression (LR), random forest (RF), generalized boosted model (GBM)], and three coupled models (IV + LR, IV + RF, IV + GBM). Accuracy, area under the curve (AUC), and F1-score were used to evaluate the prediction performance of the models. The optimal model was selected to predict the risk distribution for schistosomiasis.

Results

There is a more prone to schistosomiasis epidemic provided that paddy fields, grasslands, less than 2.5 km from the waterway, annual average temperature of 11.5–19.0 °C, annual average rainfall of 1000–1550 mm. IV + GBM had the highest prediction effect (accuracy = 0.878, AUC = 0.902, F1 = 0.920) compared with the other six models. The results of IV + GBM showed that the risk areas are mainly distributed in the coastal regions of the middle and lower reaches of the Yangtze River, the Poyang Lake region, and the Dongting Lake region. High-risk areas are primarily distributed in eastern Changde, western Yueyang, northeastern Yiyang, middle Changsha of Hunan province; southern Jiujiang, northern Nanchang, northeastern Shangrao, eastern Yichun in Jiangxi province; southern Jingzhou, southern Xiantao, middle Wuhan in Hubei province; southern Anqing, northwestern Guichi, eastern Wuhu in Anhui province; middle Meishan, northern Leshan, and the middle of Liangshan in Sichuan province.

Conclusions

The risk of schistosomiasis transmission in China still exists, with high-risk areas relatively concentrated in the coastal regions of the middle and lower reaches of the Yangtze River. Coupled models of IV and machine learning provide for effective analysis and prediction, forming a scientific basis for evidence-lead surveillance and control.

Graphic Abstract
Adult support during childhood: a retrospective study of trusted adult relationships, sources of personal adult support and their association with childhood resilience resources
Authors: Ashton Kathryn , Davies Alisha R. , Hughes Karen , Ford Kat , Cotter-Roberts Andrew , Bellis Mark A.
Published: June 2021

Background

Adverse childhood experiences (ACEs) can affect health and well-being across the life course. Resilience is an individual characteristic that is known to help negate the effect of adversities and potentially transform toxic stress into tolerable stress. Having access to a trusted adult during childhood is critical to helping children build resiliency. Here, we aim to understand the relationship between always having access to trusted adult support and childhood resilience resources, and examine which sources of personal adult support and the number of sources of adult support, best foster childhood resilience.

Methods

A Welsh national cross-sectional retrospective survey (n = 2497), using a stratified random probability sample. Data were collected via face-to-face interviews at participants’ places of residence by trained interviewers. Analyses use chi-square and binary logistic regression methods. Outcome measures were childhood resilience resources, access to an always-available trusted adult, and sources of personal adult support.

Results

Prevalence of access to an always-available trusted adult decreased with increasing number of ACEs from 86.6% of individuals with no ACEs, to 44.4% of those with four or more ACEs (≥ 4). In addition, for those experiencing ≥ 4 ACEs, individuals with no access to a trusted adult were substantially less likely than those with access, to report childhood resilience resources. For example, for individuals with ≥ 4 ACEs, those with access to an always-available trusted adult were 5.6 times more likely to have had supportive friends and 5.7 times more likely to have been given opportunities to develop skills to succeed in life, compared to those with no access to a trusted adult. When looking at sources of personal adult support, resilience levels increased dramatically for those individuals who had either one parent only or two parents as sources of support, in comparison to those without parental support.

Conclusions

Analyses here suggest strong relationships between elements of childhood resilience, constant access to trusted adults and different sources of personal adult support. While the eradication of ACEs remains unlikely, actions to strengthen childhood access to trusted adults may partially ease immediate harms and protect future generations.
The contribution of single-cell analysis of acute leukemia in the therapeutic strategy
Authors: Madaci Lamia , Colle Julien , Venton Geoffroy , Farnault Laure , Loriod Béatrice , Costello Régis
Published: June 2021

After decades during which the treatment of acute myeloblastic leukemia was limited to variations around a skeleton of cytarabine/anthracycline, targeted therapies appeared. These therapies, first based on monoclonal antibodies, also rely on specific inhibitors of various molecular abnormalities. A significant but modest prognosis improvement has been observed thanks to these new treatments that are limited by a high rate of relapse, due to the intrinsic chemo and immune-resistance of leukemia stem cell, together with the acquisition of these resistances by clonal evolution. Relapses are also influenced by the equilibrium between the pro or anti-tumor signals from the bone marrow stromal microenvironment and immune effectors. What should be the place of the targeted therapeutic options in light of the tumor heterogeneity inherent to leukemia and the clonal drift of which this type of tumor is capable? Novel approaches by single cell analysis and next generation sequencing precisely define clonal heterogeneity and evolution, leading to a personalized and time variable adapted treatment. Indeed, the evolution of leukemia, either spontaneous or under therapy selection pressure, is a very complex phenomenon. The model of linear evolution is to be forgotten because single cell analysis of samples at diagnosis and at relapse show that tumor escape to therapy occurs from ancestral as well as terminal clones. The determination by the single cell technique of the trajectories of the different tumor sub-populations allows the identification of clones that accumulate factors of resistance to chemo/immunotherapy (“pan-resistant clones”), making possible to choose the combinatorial agents most likely to eradicate these cells. In addition, the single cell technique identifies the nature of each cell and can analyze, on the same sample, both the tumor cells and their environment. It is thus possible to evaluate the populations of immune effectors (T-lymphocytes, natural killer cells) for the leukemia stress-induced alteration of their functions. Finally, the single cells techniques are an invaluable tool for evaluation of the measurable residual disease since not only able to quantify but also to determine the most appropriate treatment according to the sensitivity profile to immuno-chemotherapy of remaining leukemic cells.
Facile distribution of an alkaline microenvironment improves human bone marrow mesenchymal stem cell osteogenesis on a titanium surface through the ITG/FAK/ALP pathway
Authors: Wang Chen-Xi , Ma Ting , Wang Ming-Yue , Guo Hou-Zuo , Ge Xi-Yuan , Zhang Yu , Lin Ye
Published: June 2021

Purpose

Osseointegration at the titanium surface-bone interface is one of the key factors affecting the success rate of dental implants. However, the titanium surface always forms a passive oxide layer and impacts bone marrow–derived mesenchymal stem cell (BMSC) osteogenic differentiation after exposure to the atmosphere, which further leads to poor osseointegration. Given that wet storage helps prevent titanium aging and that weakly alkaline conditions stimulate BMSC osteogenic differentiation, the aim of the present study was to explore whether sodium bicarbonate, a well-known hydrogen ion (pH) buffer, forms an alkaline microenvironment on titanium surfaces to promote BMSC osteogenic differentiation.

Material and methods

In this work, sand-blasted and acid-etched (SLA) titanium discs were soaked in 20 mM, 50 mM, 100 mM, and 200 mM sodium bicarbonate at room temperature for 5 min without rinsing. The influence of this surface modification on BMSC adhesion, proliferation, and osteogenic differentiation was measured. Additionally, cellular osteogenic differentiation–associated signaling pathways were evaluated.

Results

We showed that titanium discs treated with sodium bicarbonate created an extracellular environment with a higher pH for BMSCs than the normal physiological value for 5 days, strongly promoting BMSC osteogenic differentiation via the activation of integrin-focal adhesion kinase-alkaline phosphatase (Itg-FAK-ALP). In addition, the proliferation and adhesion of BMSCs were increased after alkaline treatment. These cellular effects were most significant with 100 mM sodium bicarbonate.

Conclusion

The results indicated that the titanium surface treated with sodium bicarbonate improved BMSC osteogenic differentiation mainly by creating an alkaline microenvironment, which further activated the Itg-FAK-ALP signaling pathway.

Clinical relevance

Surfaces modified with 100 mM sodium bicarbonate had the highest initial pH value and thus showed the greatest potential to improve BMSC performance on titanium surfaces, identifying a novel conservation method for dental implants.
Accuracy and dimensional reproducibility by model scanning, intraoral scanning, and CBCT imaging for digital implant dentistry
Authors: Komuro Akira , Yamada Yoichi , Uesugi Satoshi , Terashima Hiroaki , Kimura Masashi , Kishimoto Hiroto , Iida Tsutomu , Sakamoto Katsuya , Okuda Kenichi , Kusano Kaoru , Baba Shunsuke , Sakamoto Takashi
Published: June 2021

Background

Recently, it has become possible to analyze implant placement position using the digital matching data of optical impression data of the oral cavity or plaster models with cone beam computed tomography (CBCT) data, and create a highly accurate surgical guide. It has been reported that CBCT measurements were smaller than the actual values, termed shrinkage. Matching of digital data is reliable when the plaster model or intraoral impression values show shrinkage at the same rate as the CBCT data. However, if the shrinkage rate is significantly different, the obtained digital data become unreliable. To clarify digital matching reliability, we examined dimensional reproducibility and shrinkage in measurements obtained with a model scanner, intra-oral scanner (iOS), and CBCT.

Materials and methods

Three implants that were arranged in a triangle were fixed in an acrylic plate. The distance between each implants were measured using model scanner, iOS, and CBCT. The actual size measured by electronic caliper was regarded as control.

Results

All values measured with CBCT were significantly smaller than that of model scanner, iOS, and control (p<0.001). The model scanner shrinkage was 0.37-0.39%, iOS shrinkage was 0.9-1.4%, and CBCT shrinkage was 1.8-6.9%. There were statistically significant differences among the shrinkage with iOS, CBCT, and model scanner (p<0.001).

Conclusion

Our findings showed that all measurements obtained with those modalities showed shrinkage as compared to the actual values. In addition, CBCT shrinkage was largest among three different measuring methods. They indicated that data matching between CBCT and scanner measurements requires attention in regard to the reliability of values obtained with those devices.
Pancreatic enzymatic mediastinitis followed by total gastrectomy with splenectomy: report of two cases
Authors: Zaitsu Yoko , Nishizaki Takashi , Izumi Takuma , Taniguchi Daisuke , Kajiwara Yuichiro , Oshiro Yumi , Minami Kazuhito
Published: June 2021

Background

Acute mediastinitis is a rare disease that rapidly progresses with a high mortality rate. Its most common cause is direct injury of the mediastinum, including iatrogenic causes such as cardiac surgery or upper endoscopy. Enzymatic mediastinitis is a rare complication of a pancreatic fistula caused by the inflammatory digestion of the parietal peritoneum spreading to the mediastinum. Here, we present two cases of enzymatic mediastinitis caused by total gastrectomy with splenectomy. One of them was successfully treated and cured after early diagnosis and transabdominal drainage.

Case presentation

Case 1 was that of a 60-year-old man (body mass index [BMI] 27) with a medical history of diabetes and hypertension who was diagnosed with advanced gastric cancer in the upper body of the stomach. A total gastrectomy with splenectomy was performed. The patient experienced acute respiratory failure 24 h after surgery. Pulmonary embolism was suspected, so a computed tomography (CT) scan was performed; however, no relevant causes were found. Although he was immediately intubated and treated with catecholamine, he died in the intensive care unit (ICU) 40 h after surgery. Post-mortem findings revealed retroperitonitis caused by a pancreatic fistula spreading towards the mediastinum, causing severe mediastinitis; a review of the CT scan revealed pneumomediastinum. We concluded that the cause of death was enzymatic mediastinitis due to post-gastrectomy pancreatic fistula. Case 2 involved a 61-year-old man (BMI 25) with a medical history of appendicitis who was diagnosed with advanced gastric cancer at the gastric angle between the lesser curvature and the pylorus, spreading to the upper body of the stomach. A total gastrectomy with splenectomy was also performed. The patient had a high fever 3 days after the surgery, and a CT scan revealed pneumomediastinum, indicating mediastinitis. As the inflammation was below the bronchial bifurcation, we chose a transabdominal approach for drainage. The patient was successfully treated and discharged.

Conclusion

Acute mediastinitis caused by gastrectomy is rare. The acknowledgment of abdominal surgery as a cause of mediastinitis is important. In treating mediastinitis caused by abdominal surgery, transabdominal drainage may be a minimally invasive yet effective method if the inflammation is mainly located below the bifurcation of the trachea.
Forming a Parent And Clinician Team (PACT) in a cohort of healthy children
Authors: Vanderhout Shelley M. , Birken Catherine S. , Zaccaria Cho Maria , Maguire Jonathon L.
Published: June 2021

Background

Engaging parents in child health research can facilitate choosing relevant research questions, recruiting participants who reflect the diversity of large communities, and disseminating study results to communities in accessible ways.

Main body

Primary care well-child visit systems present a foundation for trusting relationships between families and clinicians, lending itself well to a system where health research is embedded into the delivery of health care. We provide an example of a practice-based research network called TARGet Kids!, which is a longitudinal cohort study of children from birth to adolescence. Researchers and clinicians have partnered with parents of children participating in TARGet Kids! to ensure child health research is centred on family values and preferences. A Parent And Clinician Team (PACT) was formed to set research priorities, co-design research protocols, troubleshoot issues, and communicate research to knowledge users.

Conclusion

This partnership will facilitate child health research which is feasible, relevant and inclusive for improving children’s health care and public health policy.
Chatbot to improve learning punctuation in Spanish and to enhance open and flexible learning environments
Authors: Vázquez-Cano Esteban , Mengual-Andrés Santiago , López-Meneses Eloy
Published: June 2021

The objective of this article is to analyze the didactic functionality of a chatbot to improve the results of the students of the National University of Distance Education (UNED / Spain) in accessing the university in the subject of Spanish Language. For this, a quasi-experimental experiment was designed, and a quantitative methodology was used through pretest and posttest in a control and experimental group in which the effectiveness of two teaching models was compared, one more traditional based on exercises written on paper and another based on interaction with a chatbot. Subsequently, the perception of the experimental group in an academic forum about the educational use of the chatbot was analyzed through text mining with tests of Latent Dirichlet Allocation (LDA), pairwise distance matrix and bigrams. The quantitative results showed that the students in the experimental group substantially improved the results compared to the students with a more traditional methodology (experimental group / mean: 32.1346 / control group / mean: 28.4706). Punctuation correctness has been improved mainly in the usage of comma, colon and periods in different syntactic patterns. Furthermore, the perception of the students in the experimental group showed that they positively value chatbots in their teaching–learning process in three dimensions: greater “support” and companionship in the learning process, as they perceive greater interactivity due to their conversational nature; greater “feedback” and interaction compared to the more traditional methodology and, lastly, they especially value the ease of use and the possibility of interacting and learning anywhere and anytime.
Cutting efficiency of two heat-treated files in rotation and reciprocation motions
Authors: Kataia Engy M. , Nagy Mohamed Mokhtar , Kataia Mohamed M. , Khalil Hala Fayek
Published: June 2021

Background

This study aimed at assessing the effect of different kinematics as well as different instrument designs on efficiency of cutting of two heat-treated nickel–titanium systems. Forty resin canals with 30°-angle of curvature and a length of 16 mm were utilized in this research. They were divided into four groups depending on the instrument and the operating kinematic, group I; Azure rotary system in rotation motion, group II; Azure rotary system in Reciprocation motion, group III; Fanta AF One rotary system in rotation motion and group IV; Fanta AF One rotary system in reciprocation motion. Blocks were labeled and then weighed pre- and post-preparation with delta weight (Δ wt = wt pre − wt post) and data were documented for statistics evaluation.

Results

Resin canals prepared using Fanta AF One rotary system showed significantly higher weight loss than Azure rotary system in both rotation and reciprocation (P < 0.001). Insignificant difference was reported for rotation and reciprocation movements in both file systems.

Conclusion

The instrument’s cross section revealed a more significant impact on cutting efficiency than the motion used.
Assessment of Adult Women With Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource-Stratified Guideline
Authors: Vanderpuye Verna D. , Clemenceau Jean Rene V. , Temin Sarah , Aziz Zeba , Burke William M. , Cevallos Nixon Leonardo , Chuang Linus T. , Colgan Terence J. , del Carmen Marcela G. , Fujiwara Keiichi , Kohn Elise C. , Gonzáles Nogales Jose Enrique , Konney Thomas Okpoti , Mukhopadhyay Asima , Paudel Bishnu D. , Tóth Icó , Wilailak Sarikapan , Ghebre Rahel G.
Published: June 2021

PURPOSE

To provide expert guidance to clinicians and policymakers in three resource-constrained settings on diagnosis and staging of adult women with ovarian masses and treatment of patients with epithelial ovarian (including fallopian tube and primary peritoneal) cancer.

METHODS

A multidisciplinary, multinational ASCO Expert Panel reviewed existing guidelines, conducted a modified ADAPTE process, and conducted a formal consensus process with additional experts.

RESULTS

Existing sets of guidelines from eight guideline developers were found and reviewed for resource-constrained settings; adapted recommendations from nine guidelines form the evidence base, informing two rounds of formal consensus; and all recommendations received ≥ 75% agreement.

RECOMMENDATIONS

Evaluation of adult symptomatic women in all settings includes symptom assessment, family history, and ultrasound and cancer antigen 125 serum tumor marker levels where feasible. In limited and enhanced settings, additional imaging may be requested. Diagnosis, staging, and/or treatment involves surgery. Presurgical workup of every suspected ovarian cancer requires a metastatic workup. Only trained clinicians with logistical support should perform surgical staging; treatment requires histologic confirmation; surgical goal is staging disease and performing complete cytoreduction to no gross residual disease. In first-line therapy, platinum-based chemotherapy is recommended; in advanced stages, patients may receive neoadjuvant chemotherapy. After neoadjuvant chemotherapy, all patients should be evaluated for interval debulking surgery. Targeted therapy is not recommended in basic or limited settings. Specialized interventions are resource-dependent, for example, laparoscopy, fertility-sparing surgery, genetic testing, and targeted therapy. Multidisciplinary cancer care and palliative care should be offered. Additional information can be found at www.asco.org/resource-stratified-guidelines . It is ASCO's view that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

[Media: see text]
Effects of Local Anesthetic Volume (Standard Versus Low) on Incidence of Hemidiaphragmatic Paralysis and Analgesic Quality for Ultrasound-Guided Superior Trunk Block After Arthroscopic Shoulder Surgery
Authors: Kim Hyunzu , Han Jeong Uk , Lee Woojoo , Jeon Yoon Sang , Jeong Jimyeong , Yang Chunwoo , Uhm Jae Woung , Kim Youngjun
Published: June 2021

BACKGROUND:

Relative to interscalene block, superior trunk block (STB) provides comparable analgesia and a reduced risk of hemidiaphragmatic paralysis. However, the incidence of hemidiaphragmatic paralysis remains high when a standard volume (15 mL) of local anesthetic is used. This study aimed to evaluate the effects of local anesthetic volume of STB on the incidence of phrenic nerve palsy, as well as its analgesic efficacy following arthroscopic shoulder surgery.

METHODS:

Patients scheduled for elective arthroscopic shoulder surgery were randomized to receive ultrasound-guided STB using either 5- or 15-mL 0.5% ropivacaine before general anesthesia. The primary outcome was the incidence of hemidiaphragmatic paralysis at 30 minutes after block. The secondary outcomes were pulmonary function, grade of sensory and motor blockade, pain score, opioid consumption, adverse effects, and satisfaction.

RESULTS:

Relative to standard-volume STB, low-volume STB was associated with a lower incidence of hemidiaphragmatic paralysis after block (14.3 [4.8%–30.3%] vs 65.7 [46.8%–80.9%]; difference 51.4% [95% confidence intervals {CIs}, 29.0%–67.1%]; P < .0001) and at the postanesthesia care unit (9.4% vs 50.0%; difference 40.6 [95% CI, 18.9%–57.7%]; P = .0004). Pulmonary function was also better preserved in the low-volume group than in the standard-volume group. The extent of the sensory and motor blocks was significantly different between the groups. Pain-related outcomes, satisfaction, and any adverse events were not significantly different between the groups.

CONCLUSIONS:

Low-volume STB provided a lower incidence of hemidiaphragmatic paralysis with no significant difference in analgesic efficacy relative to standard-volume STB for arthroscopic shoulder surgery.