bluuebunny/crossref_metadata_2025 huggingface dataset:
Marketing strategies for the tourism industry in the United Arab Emirates after the COVID-19 era
Authors: Seshadri Usha , Kumar Pranav , Vij Anu , Ndlovu Tabani
Published: January 2023

Purpose

This paper reviews the challenging trends in the tourism sector of the UAE brought about by the Covid-19 pandemic. In so doing, it highlights a radical shift in the consumption of travel products and the related marketing strategies that tourism enterprises could adopt.

Design/methodology/approach

The study aims to discern the ramifications of the Covid-19 pandemic for the tourism sector of the UAE by conducting a thematic review of the contextual literature. It highlights how tourism businesses can employ transformative strategies to revive the sector.

Findings

The outcomes reveal that tourism businesses are finding it difficult to respond to the needs of customers in settings where physical distance is a reality. Given this, the study reveals the importance of digital technology in building a relationship between the supplier and the customer. Businesses can leverage virtual reality to provide enriching experiences to prospective customers and in so doing, influence their tourism product choices. Further, there is a need to co-create values wherein the final tourism product is beneficial to both the supplier in terms of profit margin and within the scope of the customer's willingness to pay.

Originality/value

This review highlights that there are both demand and supply-side shocks in delivering tourism products in the post Covid-19 era. It also considers the key socio-economic factors that need to be accounted for when designing tourism products.
Sequential treatment of rituximab and belimumab in thrombotic thrombocytopenia purpura associated with systemic lupus erythematous: A respective case series and literature review
Authors: Liu Jun , Yan Mingming , Wen Rui , Li Jiali
Published: January 2023

Introduction

Thrombotic thrombocytopenia purpura (TTP) associated with systemic lupus erythematous (SLE), features the appearance of inhibitory autoantibodies against ADAMTS13. Rituximab and belimumab (BEL), as both targeting B cells, seem to be an optimal therapy to induce clinical remission, prevent relapse of disease and contribute to glucocorticoid induction. However, the clinical outcome of SLE‐TTP treated with sequential therapy between rituximab and BEL remain elusive.

Case Series

We reported the clinical outcomes of 4 patients diagnosed with SLE‐TTP who were administrated a combination of corticosteroids, plasma exchange, and rituximab at stage of induction. BEL was utilized to rapidly reduce the reliance on these agents and prevent relapse of TTP at maintenance stage. Ultimately, 4 patients fully recovered with a SLE Disease Activity Index score of 0 and reached the goal at dose of prednisolone <7.5 mg/d without relapse.

Conclusion

Sequential treatment of rituximab and BEL could be an encouraging approach in treatment of SLE‐TTP and rapid glucocorticoid reduction.
Long‐term collar deployment leads to bias in soil respiration measurements
Authors: Ma Xiaoliang , Jiang Shengjing , Zhang Zhiqi , Wang Hao , Song Chao , He Jin‐Sheng
Published: January 2023

Accurate measurements of soil respiration (Rs) are critical for understanding how soil carbon will respond to environmental changes. However, a commonly used method for Rs measurements, the collar deployment method, may introduce artefacts that cause bias in Rs measurements. Our objective was to quantify the effect of long‐term collar deployment on Rs and to unravel potential causes due to changes in the soil environment.

A field experiment (2017–2019) including short‐term (2–3 days before the measurement) and long‐term collar deployment (lasting three consecutive growing seasons) was conducted to assess the methodological effect on Rs in an alpine grassland of the northeastern Tibetan Plateau. Soil incubation was used to further explore the mechanisms underlying the effects of collar deployment.

The effect of long‐term collar deployment on Rs varied over time. In the first one and a half growing seasons, no significant difference in Rs was noted under short‐ and long‐term collar deployment. This may be attributed to the negative effects of lower root biomass inside long‐term collars and the positive effects of higher temperature and pulse input of dead roots following collar deployment. Under the long‐term collar, Rs decreased rapidly in the middle of the second growing season and remained low until the end of the experiment, resulting in an 18.2% decrease relative to short‐term collar deployment in the third growing season. Higher soil bulk density and lower root and microbial biomass inside long‐term collars may explain the decrease in Rs and temperature sensitivity (Q10). Soil incubation experiments revealed that the soil organic carbon (SOC) decomposition rate and Q10 were significantly reduced after long‐term collar deployment.

Long‐term collars led to substantial underestimates of Rs after more than 2 years. Our findings suggest that such potential artefacts should be considered when interpreting Rs data based on long‐term collar deployment. Long‐term collars should be relocated every 1–2 years to avoid artefacts if feasible. Alternatively, periodic measurements using short‐term collars are recommended to quantify the magnitude of collar artefacts.
A criminal justice response to address the illegal trade of wildlife in Indonesia
Authors: Adhiasto Dwi N. , Exploitasia Indra , Giyanto ‐ , Fahlapie Patih , Johnsen Pekki , Andriansyah M. Irfan , Hafizoh Nur , Setyorini Yunita D. , Mardiah Sofi , Mardhiah Ulfah , Linkie Matthew
Published: January 2023

The global illegal wildlife trade (IWT) is a multibillion dollar annual trade that threatens numerous species. Understanding ways to improve the law enforcement response is an essential component in addressing this trade. Yet, quantifying the impacts of such conservation measures is often hindered by a lack of long‐term and reliable datasets. Here, we evaluate a 15‐year multistakeholder collaboration that aimed to detect, report, and robustly respond to IWT across the vast Indonesian archipelago. Our results demonstrate the performance of site‐based monitoring networks in reliably reporting a widespread IWT of hundreds of nationally protected species. It revealed highly responsive government law enforcement agencies, high prosecution and conviction rates, and increasing penal sanctions over time, which significantly differed by province, year of arrest, and the number of unique protected species seized in a case. From these results, we formulate management recommendations for key agencies working in the criminal justice system.
Antigen‐specific TCR‐T cells from Rag2 gene‐deleted pluripotent stem cells impede solid tumour growth in a mouse model
Authors: Wu Bingyan , Zhang Qi , Hong Pingshan , Liu Lijuan , Peng Huan , Xia Chengxiang , Wang Tongjie , Wang Yao , Weng Qitong , Liu Xiaofei , Geng Yang , Wang Jinyong , Wu Hongling
Published: January 2023

The technology of adoptive transfer of T‐cell receptor (TCR) engineered T cells is wildly investigated as it has the potential to treat solid cancers. However, the therapeutic application of TCR‐T cells is hampered by the poor quality derived mainly from patients' peripheral blood, as well as heterogeneous TCRs caused by the mismatch between transgenic and endogenous TCRs. To improve the homogeneity, antigen‐specificity and reduce possible autoreactivity, here we developed a technique to generate antigen‐specific T cells from Rag2 gene‐deleted pluripotent stem cells (PSCs) and further measured their anti‐tumour efficacy. PSCs were first targeted with OT1 TCR into the Rag2 locus to prevent TCR rearrangement during T‐cell development. The engineered PSCs were then differentiated through a two‐step strategy, in vitro generation of haematopoietic progenitor cells, and in vivo development and maturation of TCR‐T cells. Finally, the response to tumour cells was assessed in vitro and in vivo. The regenerated OT1‐iT displayed monoclonal antigen‐specific TCR expression, and phonotypic normalities in the spleen and lymph node tissues. Importantly, the OT1‐iT cells eliminated tumour cells while releasing specific cytokines in vitro. Furthermore, adoptive transfer of OT1‐iT cells suppresses solid tumour growth in tumour‐bearing animals. Our study presents a novel and straightforward strategy for producing antigen‐specific TCR‐T cells in vivo from PSCs, allowing for allogeneic transplantation and therapy of solid tumours.
Comprehensive review: Frailty in pancreas transplant candidates and recipients
Authors: Parsons Ronald F. , Tantisattamo Ekamol , Cheungpasitporn Wisit , Basu Arpita , Lu Yee , Lentine Krista L. , Woodside Kenneth J. , Singh Neeraj , Scalea Joseph , Alhamad Tarek , Dunn Ty B. , Rivera Franco H. Cabeza , Parajuli Sandesh , Pavlakis Martha , Cooper Matthew
Published: January 2023

Well‐selected patients with kidney disease and diabetes mellitus who undergo simultaneous kidney‐pancreas transplantation often experience dramatic improvements in quality of life and long‐term survival compared to those who remain on medical therapy. Over the past several years the importance of frailty in the pancreas transplant candidate and recipient populations has grown. More patients with advanced age have entered the waitlist, and complications from prolonged diabetes, even in younger patients, have created increased evidence of risk for frailty. Given these concerns, and the broad challenges facing pancreas transplantation volumes overall, we generated this review to help establish the impact and implications. We summarize the interplay of immunological factors, aging, environmental factors, diabetes mellitus, and chronic kidney disease that put these patients at risk for frailty. We discuss its measurement and recommend a combination of two instruments (both well‐validated and one entirely objective). We describe the outcomes for patients before and after pancreas transplantation who may have frailty, and what interventions can be taken to mitigate its effects. Broader investigation into frailty in the pancreas transplant population is needed to better understand how to select patients for pancreas transplantation and to how manage its consequences thereafter.
Single‐center experience of ex vivo lung perfusion and subsequent lung transplantation
Authors: Noda Kentaro , Chan Ernest G. , Furukawa Masashi , Ryan John P. , Clifford Sarah , Luketich James D. , Sanchez Pablo G. ,   UPMC EVLP Group
Published: January 2023

Background

The safety of lung transplantation using ex vivo lung perfusion (EVLP) has been confirmed in multiple clinical studies; however, limited evidence is currently available regarding the potential effects of EVLP on posttransplant graft complications and survival with mid‐ to long‐term follow‐up. In this study, we reviewed our institutional data to better understand the impact of EVLP.

Methods

Lungs placed on EVLP from 2014 through 2020 and transplant outcomes were retrospectively analyzed. Data were compared between lungs transplanted and declined after EVLP, between patients with severe primary graft dysfunction (PGD3) and no PGD3 after EVLP, and between matched patients with lungs transplanted with and without EVLP.

Results

In total, 98 EVLP cases were performed. Changes in metabolic indicators during EVLP were correlated with graft quality and transplantability, but not changes in physiological parameters. Among 58 transplanted lungs after EVLP, PGD3 at 72 h occurred in 36.9% and was associated with preservation time, mechanical support prior to transplant, and intraoperative transfusion volume. Compared with patients without EVLP, patients who received lungs screened with EVLP had a higher incidence of PGD3 and longer ICU and hospital stays. Lung grafts placed on EVLP exhibited a significantly higher chance of developing airway anastomotic ischemic injury by 30 days posttransplant. Acute and chronic graft rejection, pulmonary function, and posttransplant survival were not different between patients with lungs screened on EVLP versus lungs with no EVLP.

Conclusion

EVLP use is associated with an increase of early posttransplant adverse events, but graft functional outcomes and patient survival are preserved.
Building representations of the social world: Children extract patterns from social choices to reason about multi‐group hierarchies
Authors: Heck Isobel A. , Kushnir Tamar , Kinzler Katherine D.
Published: January 2023

How do children learn about the structure of the social world? We tested whether children would extract patterns from an agent's social choices to make inferences about multiple groups’ relative social standing. In Experiment 1, 4‐ to 6‐year‐old children (N = 36; tested in Central New York) saw an agent and three groups (Group‐A, Group‐B, and Group‐C) and observed the agent choose between pairs of individuals from different groups. Across pairwise selections, a pattern emerged: The agent chose individuals from Group‐A > Group‐B > Group‐C. Children tracked the agent's choices to predict that Group‐A was “most‐preferred” and the “leader” and that Group‐C was “least‐preferred” and the “helper.” In Experiments 2 and 3, we examined children's reasoning about a more complex pattern involving four groups and tested a wider age range. In Experiment 2, 5‐ to 10‐year‐old children (N = 98; tested in Central New York) used the agent's pattern of pairwise choices to infer that the agent liked Group‐A > Group‐B > Group‐C > Group‐D and to make predictions about which groups were likely to be “leaders” and “helpers.” In Experiment 3, we found evidence for social specificity in children's reasoning: 5‐ to 10‐year‐old children (N = 96; from 26 US States) made inferences about groups’ relative social but not physical power from the agent's pattern of affiliative choices across the four groups. These findings showcase a mechanism through which children may learn about societal‐level hierarchies through the patterns they observe over time in people's group‐based social choices.

Research Highlights

Children in our sample extracted patterns from an agent's positive social choices between multiple groups to reason about groups’ relative social standing.

Children used the pattern of an agent's positive social choices to guide their reasoning about which groups were likely to be “leaders” and “helpers” in a fictional town.

The pattern that emerged in an agent's choices of friends shaped children's thinking about groups’ relative social but not physical power.

Children tracked social choices to reason about group‐based hierarchies at the individual level (which groups an agent prefers) and societal level (which groups are privileged).
Civil melancholia: Yemenite Jews’ responses to the kidnapping of their children
Authors: Gamliel Tova , Hazan Haim
Published: January 2023

During Yemenite Jews’ stay in Israeli transit camps during 1948–1950, many of their children disappeared in the so‐called “Yemenite Children Affair,” undermining the immigrants’ faith in the redemptive ethos of Zionism. To better understand this collective trauma, we return to the original Freudian conceptualization of melancholia as “failed mourning,” locating it within the ethnographic context of the Yemenite Children Affair and integrating its private/individual and public/collective aspects. Moreover, we provide a novel historical reading that integrates the individual loss of children and the collective lack of civic recognition. We use the term “civil melancholia” to reflect on the lingering, hurtful group experience of being overlooked (as refugees and parents) and the continuing collective predicament as “second‐rate citizens.” By conceptualizing this civil melancholia and its cultural nuances, the analysis enhances the discussion of cultural traumas and their intergenerational transmission among contemporary ethnic immigrant groups.
The link between reversible cerebral vasoconstriction syndrome and transient global amnesia
Authors: Chandra Rahul , Saini Harneel Singh , Palmer Kaitlyn N. , Cerejo Russell
Published: January 2023

Reversible cerebral vasoconstriction syndrome (RCVS) and transient global amnesia (TGA) are acute and self‐limiting intra‐cerebral conditions. Although previously studied as independent phenomena, there are increasing reports of co‐occurrence of these two pathologies. We report a 55‐year‐old male who presented to the hospital with recurrent thunderclap headaches over the course of 1 week with sudden onset of anterograde memory loss. His medications included a selective serotonin reuptake inhibitor and intermittent use of pseudoephedrine. On examination he was amnestic to recent events and notably perseverating. Magnetic resonance imaging of the brain without contrast showed a small, punctate focus of restricted diffusion in the left hippocampus. He was diagnosed with TGA based on his clinical presentation. His headaches and amnesia resolved over the next 12 h throughout the course of his stay with acetaminophen and oral verapamil and he was discharged. Repeat computed tomography angiogram at 2 weeks revealed diffuse and segmental narrowing of the anterior and posterior intracranial circulation, which resolved on follow‐up imaging at 3 months, confirming RCVS. The acute and reversible nature of these conditions and increasing reports of co‐occurrence suggests a common pathophysiologic link. We review the literature highlighting similar cases and the presumed pathophysiology.
Hypertriglyceridemic waist phenotype is associated with left ventricular hypertrophy in Chinese hypertension patients
Authors: Bao Qiligeer , Li Yun , Ma Shouyuan , Qiu Jiaojiao , Sun Jin , Su Yongkang , Zhang Anhang , Cai Shuang , Cheng Bokai , Li Man , Zhang Yan , Wang Shuxia , Zhu Ping
Published: January 2023

Left ventricular hypertrophy (LVH), the most common target organ damage in patients with hypertension, is closely related to excessive visceral adipose tissue (VAT) accumulation in the body. The hypertriglyceridemic waist (HTHW) phenotype can act as a surrogate marker of excessive VAT. However, the relationship between the HTHW phenotype and LVH in patients with hypertension remains unknown. The present study aimed to investigate whether the HTHW phenotype is associated with LVH, using echocardiography in a cross‐sectional study involving 4470 middle‐aged and older Chinese patients with hypertension. Logistic regression analysis revealed that patients with the HTHW phenotype were 1.52‐fold more likely to experience LVH than those with normal triglyceride levels and normal waist circumference. This association was independent of age, sex, and other potentially confounding factors. In the stratified analysis, a stronger correlation was found among women, people of at least 70 years of age, and people with hyperuricemia. These results suggest that distinguishing the HTHW phenotype in patients with hypertension could serve as a simple and effective screening strategy for identifying people with a higher risk of developing LVH.
Development and application of a sensitive droplet digital PCR‐based method to detect tilapia parvovirus
Authors: Zhao Haikuo , Zhou Yong , Fan Yuding , Jiang Nan , Meng Yan , Li Yiqun , Xue Mingyang , Xu Chen , Guo Weiliang , Liu Wenzhi
Published: January 2023

Tilapia parvovirus (TiPV) causes severe mortality rates in cultured tilapia, resulting in substantial losses to the fish industry. Droplet digital PCR (ddPCR) is a sensitive, accurate, and absolute quantitation method, plus it does not require a standard curve. Herein we report the development and application of a sensitive ddPCR‐based method to rapidly detect and quantify TiPV. Optimal annealing temperature was determined to be 59.3°C, and optimal primer and probe concentrations were 900 nmol/L and 250 nmol/L, respectively. Our ddPCR method was highly specific to TiPV and showed no cross‐reactivity with other viruses. Further, the detection limit of ddPCR was 0.07 copies/μl, being lower than that of real‐time PCR (qPCR, 4.63 copies/μl). We also investigated the ability of ddPCR to detect TiPV in 50 samples and compared the outcome with qPCR data in terms of sensitivity and accuracy. The results showed that the positive detection rate of ddPCR (32%) was higher than that of qPCR (18%). To conclude, our ddPCR method was effective at detecting TiPV in samples with low viral loads. We believe that its application can facilitate the surveillance of sources and transmission routes of TiPV.
Influence of biosafety protocols adopted for the prevention of SARS‐CoV‐2 in slaughterhouses and a positive effect on the reduction of Staphylococcus aureus presence in beef cuts
Authors: Costa Ana K. L. , Castro Vinicius S. , Cunha‐Neto Adelino , Figueiredo Eduardo Eustáquio de Souza
Published: January 2023

Staphylococcus aureus is a food quality indicator microorganism commonly found in human mucous membranes. With the emergence of the virus related to SARS‐CoV‐2, several prevention protocols were established. Therefore, this study assessed whether the adoption of SARS‐CoV‐2 protocols influenced the presence of S. aureus in beef samples. We analyzed the S. aureus results of 3654 beef samples between April and September 2019 and 2020. Mean percentages of the population of S. aureus were different between years (2.63%—2019; 1.13%—2020), revealing that after the adoption of the SARS‐CoV‐2 protocols there was a decrease in the presence of S. aureus. Concomitantly, a significant difference was also presented in the annual means of S. aureus load counts (2.30 log of CFU/g in 2019, and 1.60 log of CFU/g in 2020), of the sets of beef samples analyzed. Therefore, we suggest that the measures used to prevent SARS‐CoV‐2 can continue to be applied even after the pandemic, especially in the stages that involve beef handling in slaughterhouses.
Deferoxamine mesylate enhances mandibular advancement‐induced condylar osteogenesis by promoting H‐type angiogenesis
Authors: Hu Yun , Li Hegang
Published: January 2023

Background

The effect of functional orthopaedic treatment for mandibular deficiency relies on mandibular advancement (MA)‐induced condylar new bone formation. However, this is not easy to achieve, especially in non‐growing patients. Therefore, how to obtain reliable MA‐induced condylar osteogenesis is a subject much worthy of study.

Objective

To investigate whether deferoxamine mesylate (DFM) enhances MA‐induced condylar osteogenesis in middle‐aged mice.

Methods

Forty 30‐week‐old male C57BL/6J mice were randomly divided into 4 groups: the control (Ctrl), DFM, MA + Ctrl and MA + DFM groups. After a 4‐week experimental period, femurs, tibias and condyles were collected for morphological, micro‐computed tomography and histological evaluation.

Results

For long bones, DFM reversed osteoporosis in middle‐aged mice by promoting H‐type angiogenesis. For mandibular condyles, MA promoted condylar osteogenesis in middle‐aged mice, thereby allowing the mandible to achieve a stable protruding position. In addition, DFM enhanced the volume and quality of MA‐induced condylar new bone formation. Furthermore, histological analysis revealed that DFM enhanced MA‐induced condylar subchondral ossification. Mechanistically, it was confirmed that DFM increased the number of H‐type vessels and their coupled Osterix+ osteoprogenitors by upregulating the hypoxia‐inducible factor (HIF)‐1α signalling pathway, thereby enhancing MA‐induced condylar osteogenesis.

Conclusion

Applying DFM to enhance MA‐induced condylar osteogenesis through H‐type angiogenesis is expected to be an effective strategy to achieve favourable functional orthopaedic treatment effectiveness in non‐growing patients.
Obesity‐induced changes in gene expression in feline adipose and skeletal muscle tissue
Authors: Stenberg Kathrine , Novotny Guy W. , Lutz Thomas A. , Mandrup‐Poulsen Thomas , Bjørnvad Charlotte Reinhard
Published: January 2023

Indoor‐confined cats are prone to developing obesity due to a sedentary life and an energy intake exceeding energy requirements. As in humans, feline obesity decreases insulin sensitivity and increases the risk of developing feline diabetes mellitus, but the pathophysiological mechanisms are currently poorly understood. Human obesity‐related metabolic alterations seem to relate to changes in the expression of genes involved in glucose metabolism, insulin action and inflammation. The objective of the current study was to investigate changes in the expression of genes relating to obesity, glucose metabolism and inflammation in cats with non‐experimentally induced obesity. Biopsies from the sartorius muscle and subcutaneous adipose tissue were obtained from 73 healthy, neutered, indoor‐confined domestic shorthaired cats ranging from lean to obese. Quantification of obesity‐related gene expression levels relative to glyceraldehyde‐3‐phosphate dehydrogenase was performed by quantitative real‐time polymerase chain reaction. A negative association between obesity and adiponectin expression was observed in the adipose tissue (mean ± SD; normal weight, 27.30 × 10−3 ± 77.14 × 10−3; overweight, 2.89 × 10−3 ± 0.38 × 10−3 and obese, 2.93 × 10−3 ± 4.20 × 10−3, p < 0.05). In muscle, the expression of peroxisome proliferative activated receptor‐γ2 and plasminogen activator inhibitor‐1 was increased in the obese compared to the normal‐weight cats, and resistin was increased in the normal‐weight compared to the overweight cats. There were no detectable obesity‐related changes in the messenger RNA levels of inflammatory cytokines. In conclusion, a possible obesity‐related low‐grade inflammation caused by increased expression of key proinflammatory regulators was not observed. This could imply that the development of feline obesity and ensuing insulin resistance may not be based on tissue‐derived inflammation, but caused by several determining factors, many of which still need further investigation.
Diurnal changes and topographical distribution of ocular surface epithelial dendritic cells in humans, and repeatability of density and morphology assessment
Authors: Tajbakhsh Zahra , Jalbert Isabelle , Stapleton Fiona , Briggs Nancy , Golebiowski Blanka
Published: January 2023

Purpose

Dendritic cells (DC) play a crucial role in ocular surface defence. DC can be visualised in vivo by confocal microscopy but have not yet been fully characterised in humans. This study investigated the diurnal variation, topographical distribution and repeatability of DC density and morphology measurements.

Methods

In vivo confocal microscopy (IVCM) was conducted on 20 healthy participants (mean age 32.7 ± 6.4 years, 50% female) at baseline and repeated after 30 minutes, 2, 6 and 24 h. Images were captured at the corneal centre, inferior whorl, corneal periphery, limbus and bulbar conjunctiva. DC were counted manually, and their morphology was assessed for cell body size, presence of dendrites, and presence of long and thick dendrites. Mixed‐model analysis, non‐parametric analyses, Bland and Altman plots, coefficient of repeatability (CoR) and kappa were used.

Results

There were no significant changes in DC density (p ≥ 0.74) or morphology (p > 0.07) at any location over the 24‐h period. The highest DC density was observed at the corneal limbus followed by the peripheral cornea (p < 0.001), with the lowest density at the corneal centre, inferior whorl and bulbar conjunctiva. Most DC at the corneal periphery, limbus and bulbar conjunctiva had larger cell bodies compared with the corneal centre (p ≤ 0.01), and the presence of long dendrites was observed mostly at non‐central locations. Day‐to‐day CoR for DC density ranged from ±28.1 cells/mm2 at the corneal centre to ±56.4 cells/mm2 at the limbus. Day‐to‐day agreement of DC morphology determined by kappa ranged from 0.5 to 0.95 for cell body size, 0.60 to 0.95 for presence of dendrites, and 0.55 to 0.80 for the presence of long dendrites at various locations.

Conclusions

No diurnal changes are apparent in corneal or conjunctival DC. Substantial topographical differences exist in DC density and morphology. IVCM provides good repeatability of DC density and acceptable agreement of DC morphology.
Complications and treatment errors in nonsurgical periodontal therapy
Authors: Graziani Filippo , Tinto Manuel , Orsolini Chiara , Izzetti Rossana , Tomasi Cristiano
Published: January 2023

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator‐dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra‐oral and extraoral level. Soft‐tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.
Adenosine deaminase from the cerebrospinal fluid for the diagnosis of tuberculous meningitis: A meta‐analysis
Authors: Ye Qin , Yan Wang
Published: January 2023

Objective

To comprehensively evaluate the diagnostic efficacy of adenosine deaminase in cerebrospinal fluid (CSF) for tuberculous meningitis (TBM), and the potential influence of patients' age groups and cutoffs of measured adenosine deaminase.

Methods

Systematic review and meta‐analysis of relevant studies retrieved from PubMed, Embase, and Web of Science databases. Pooled sensitivity and specificity were calculated with a random‐effect model.

Results

Overall, 43 studies with 1653 patients with TBM and 3417 controls without were included. Pooled results showed that adenosine deaminase in CSF is associated with satisfactory diagnostic efficacy for TBM, with a pooled sensitivity of 0.86 (95% confidence interval [CI]: 0.82–0.90), specificity of 0.89 (95% CI: 0.86–0.91), positive likelihood ratio of 7.70 (95% CI: 6.16–9.63), and negative likelihood ratio of 0.15 (95% CI: 0.12–0.20). The pooled receiver operating characteristic (AUC) was 0.94 (95% CI: 0.91–0.96), suggesting good performance. Subgroup analyses showed good diagnostic efficacies of adenosine deaminase in CSF for both adults (AUC 0.95) and children (AUC 0.96) with TBM. AUCs indicating the diagnostic accuracies of adenosine deaminase in CSF for TBM were 0.93 for studies with cutoffs <10 U/L and and 0.94 for a cutoff =10 U/L, but only 0.90 for studies with cutoffs >10 U/L.

Conclusions

Measuring adenosine deaminase of CSF shows satisfactory diagnostic efficacy for TBM in children and adults, particularly if using a cutoff ≤10 U/L.
Peace Education in the Absence of Violence as a Foundation of Learning: The Case of Cameroon
Authors: Tangwe Abraham Tamukum
Published: January 2023

The study looks at how schools can serve as environments for peace in the absence of violence. It sought to encapsulate students' learning and how well they learn in hazardous environments that are fraught with violence. It was therefore aimed at investigating the effects of violence and the absence of peace on their educational and social needs and how this can affect students' education and learning, compounding global values. The research question was pegged on how violence influences the learner’s motivation in learning. It was conceived as a cross-sectional design with a quantitative approach. The study used structured questionnaires having defined and recorded operations in accepted conditions. These defined operations were assured through two pre-tests to ascertain their reliability. 924 students were randomly selected and used as the primary sample, and the structured questionnaires were used to elicit data. The collected data was analysed using JAMOVI and SPSS. The analysis was interpreted using descriptive statistics and ANOVA. The study's findings show high physical and structural violence, poor school quality, and a very compromised socioeconomic background of the learners. This situation reduces schools away from peaceful learning settings and social justice for the students. In perspective, such findings are a trouble spot for global values and more research needs to be carried out to understand how student learning can effectively take place in such precarious conditions.
Effect of systemic hydrocortisone in ventilated preterm infants on parent-reported behavioural outcomes at 2 years’ corrected age: follow-up of a randomised clinical trial
Authors: Halbmeijer Nienke Marjolein , Onland Wes , Cools Filip , Swarte Renate M , van der Heide-Jalving Marja , Dijk Peter , Mulder-de Tollenaer Susanne , Tan Ratna N G B , Mohns Thilo , Bruneel Els , van Heijst Arno F J , Kramer Boris , Debeer Anne , van Weissenbruch Mirjam M , Marechal Yoann , Blom Henry , Plaskie Katleen , Offringa Martin , van Wassenaer-Leemhuis Aleid G , van Kaam Anton H , Aarnoudse-Moens Cornelieke S H
Published: January 2023

Objective

To report the parent-reported behavioural outcomes of infants included in the Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants study at 2 years’ corrected age (CA).

Design

Randomised placebo-controlled trial.

Setting

Dutch and Belgian neonatal intensive care units.

Patients

Infants born <30 weeks’ gestation and/or birth weight <1250 g, and ventilator dependent in the second week of life.

Intervention

Infants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72.5 mg/kg; n=182) or placebo (n=190).

Main outcome measures

Parent-reported behavioural outcomes at 2 years’ CA assessed with the Child Behavior Checklist (CBCL 1½−5).

Results

Parents completed the CBCL of 183 (70% (183/262)) infants (hydrocortisone group, n=96; placebo group, n=87). Multiple imputation was used to account for missing data. Infants with critically elevated T-scores (>55) were found in 22.9%, 19.1% and 29.4% of infants for total, internalising and externalising problems, respectively; these scores were not significantly different between groups (mean difference −1.52 (95% CI −4.00 to 0.96), −2.40 (95% CI −4.99 to 0.20) and −0.81 (95% CI −3.40 to 1.77), respectively). In the subscales, we found a significantly lower T-score for anxiety problems in the hydrocortisone group (mean difference −1.26, 95% CI −2.41 to –0.12).

Conclusion

This study found high rates of behaviour problems at 2 years’ CA following very preterm birth, but these problems were not associated with hydrocortisone treatment initiated between 7 and 14 days after birth in ventilated preterm infants.

Trial registration number

NTR2768; EudraCT 2010-023777-19.
Birth anthropometry among three Asian racial groups in Singapore: proposed new growth charts
Authors: Sonoko Sensaki , Mao Yinan , Biswas Agnihotri , Amutha Chinnadurai , Amin Zubair , Cook Alex R , Lee Jiun
Published: January 2023

Objective

We analysed birth anthropometry of babies of Chinese, Malay and Indian ancestry living in Singapore with an aim to develop gestational age (GA) and gender-specific birth anthropometry charts and compare these with the widely used Fenton charts.

Design

Retrospective observational study.

Setting

Department of Neonatology, National University Hospital, Singapore.

Population

We report data from 52 220 infants, born between 1991–1997 and 2010–2017 in Singapore.

Methods

Anthropometry charts were built using smoothened centile curves and compared with Fenton’s using binomial test. Birth weight (BW), crown-heel length and head circumference (HC) were each modelled with maternal exposures using general additive model.

Main outcome measures

BW, crown-heel length and HC.

Results

There were 22 248 Chinese (43%), 16 006 Malay (31%) and 8543 Indian (16%) babies. Mean BW was 3103 g (95% CI 3096 to 3109), 3075 g (95% CI 3067 to 3083) and 3052 g (95% CI 3041 to 3062) for Chinese, Malays and Indians, respectively. When exposed to a uniform socioeconomic environment, intrauterine growth and birth anthropometry of studied races were almost identical. From our GA-specific anthropometric charts until about late prematurity, Asian growth curves mirrored that of Fenton’s; thereafter, Asian babies showed a reduction in growth velocity.

Conclusions

These findings suggest that Asian babies living in relatively uniform socioeconomic strata exhibit similar growth patterns. There is a slowing of growth among Asian babies towards term, prompting review of existing birth anthropometry charts. The proposed charts will increase accuracy of identification of true fetal growth restriction as well as true postnatal growth failure in preterm infants when applied to the appropriate population.
Variation in hospital morbidities in an Australian neonatal intensive care unit network
Authors: Abdel-Latif Mohamed E , Adegboye Oyelola , Nowak Gen , Elfaki Faiz , Bajuk Barbara , Glass Kathryn , Harley David
Published: January 2023

Objective

There is an expectation among the public and within the profession that the performance and outcome of neonatal intensive care units (NICUs) should be comparable between centres with a similar setting. This study aims to benchmark and audit performance variation in a regional Australian network of eight NICUs.

Design

Cohort study using prospectively collected data.

Setting

All eight perinatal centres in New South Wales and the Australian Capital Territory, Australia.

Patients

All live-born infants born between 23+0and 31+6weeks gestation admitted to one of the tertiary perinatal centres from 2007 to 2020 (n=12 608).

Main outcome measures

Early and late confirmed sepsis, intraventricular haemorrhage, medically and surgically treated patent ductus arteriosus, chronic lung disease (CLD), postnatal steroid for CLD, necrotising enterocolitis, retinopathy of prematurity (ROP), surgery for ROP, hospital mortality and home oxygen.

Results

NICUs showed variations in maternal and neonatal characteristics and resources. The unadjusted funnel plots for neonatal outcomes showed apparent variation with multiple centres outside the 99.8% control limits of the network values. The hierarchical model-based risk-adjustment accounting for differences in patient characteristics showed that discharged home with oxygen is the only outcome above the 99.8% control limits.

Conclusions

Hierarchical model-based risk-adjusted estimates of morbidity rates plotted on funnel plots provide a robust and straightforward visual graphical tool for presenting variations in outcome performance to detect aberrations in healthcare delivery and guide timely intervention. We propose using hierarchical model-based risk adjustment and funnel plots in real or near real-time to detect aberrations and start timely intervention.
Cariprazine for treating coprophagia and organic psychosis in a young woman with acquired brain injury
Authors: Collison-Ani Emma , Faher Anissa , Au Marcus , Burrah Gayathri
Published: January 2023

Coprophagia or the ingestion of faeces has been associated with medical conditions (seizure disorders, cerebral atrophy and tumours) and psychiatric disorders (intellectual disability, alcoholism, depression, obsessive compulsive disorder, schizophrenia, fetishes, delirium and dementia). The case of a woman in her 30s presenting with coprophagia and psychotic symptoms following hypoxic brain injury is reported. The case is discussed and literature is reviewed. We investigate cariprazine, a relatively new atypical antipsychotic for treating coprophagia, associated with psychotic symptoms. Psychiatric evaluation revealed cognitive dysfunction and psychotic symptoms. Physical examination and laboratory evaluation were unremarkable. She was treated with haloperidol resulting in resolution of coprophagia. Attempts at switching to alternative antipsychotics, due to side effects, resulted in recurrence of coprophagia. Subsequent relapses required higher doses of haloperidol for remission of coprophagia and psychotic symptoms. She finally responded to cariprazine. While firm conclusions are not possible from the experience of a single case, we suggest cariprazine may also be a treatment option for coprophagia, particularly in patients with psychotic symptoms.
Xanthogranulomatous inflammation and spindle cell proliferation in response to silicone breast implant leakage
Authors: Lee Kyra Ji-Young , Seah Jue Li , O’Toole Sandra , Warrier Sanjay
Published: January 2023

This case study highlights the rare complications of silicone breast implants, as well as the diagnostic limitations of imaging. The patient initially presented with leakage of bilateral breast implants as discovered by a positron emission tomography (PET)-computerized tomography (CT) scan performed as part of a workup for small bowel Langerhans cell sarcoma metastases. The imaging results of the PET-CT scan revealed increased activity bilaterally with an enhancing, irregular, heterogeneously enhancing mass in the right breast. Given the clinical suspicion for breast implant-associated anaplastic large cell lymphoma, further investigation including surgical excision was undertaken. What initially was a concern for a serious complication of long-standing breast implants, fortuitously turned out to be a benign but exuberant xanthogranulomatous inflammatory reactive process. We hope that our report will add to the literature of this rare phenomenon and highlight it as a differential diagnosis of a mass in association with breast implants.
MicroRNA-223 attenuates hepatocarcinogenesis by blocking hypoxia-driven angiogenesis and immunosuppression
Authors: Fu Yaojie , Mackowiak Bryan , Feng Dechun , Lu Hongkun , Guan Yukun , Lehner Taylor , Pan Hongna , Wang Xin Wei , He Yong , Gao Bin
Published: January 2023

Objective

The current treatment for hepatocellular carcinoma (HCC) to block angiogenesis and immunosuppression provides some benefits only for a subset of patients with HCC, thus optimised therapeutic regimens are unmet needs, which require a thorough understanding of the underlying mechanisms by which tumour cells orchestrate an inflamed tumour microenvironment with significant myeloid cell infiltration. MicroRNA-223 (miR-223) is highly expressed in myeloid cells but its role in regulating tumour microenvironment remains unknown.

Design

Wild-type and miR-223 knockout mice were subjected to two mouse models of inflammation-associated HCC induced by injection of diethylnitrosamine (DEN) or orthotopic HCC cell implantation in chronic carbon tetrachloride (CCl4)-treated mice.

Results

Genetic deletion of miR-223 markedly exacerbated tumourigenesis in inflammation-associated HCC. Compared with wild-type mice, miR-223 knockout mice had more infiltrated programmed cell death 1 (PD-1+) T cells and programmed cell death ligand 1 (PD-L1+) macrophages after DEN+CCl4administration. Bioinformatic analyses of RNA sequencing data revealed a strong correlation between miR-223 levels and tumour hypoxia, a condition that is well-documented to regulate PD-1/PD-L1. In vivo and in vitro mechanistic studies demonstrated that miR-223 did not directly target PD-1 and PD-L1 in immune cells rather than indirectly downregulated them by modulating tumour microenvironment via the suppression of hypoxia-inducible factor 1α-driven CD39/CD73-adenosine pathway in HCC. Moreover, gene delivery of miR-223 via adenovirus inhibited angiogenesis and hypoxia-mediated PD-1/PD-L1 activation in both HCC models, thereby hindering HCC progression.

Conclusion

The miR-223 plays a critical role in modulating hypoxia-induced tumour immunosuppression and angiogenesis, which may serve as a novel therapeutic target for HCC.
CD4 CAR-T cells targeting CD19 play a key role in exacerbating cytokine release syndrome, while maintaining long-term responses
Authors: Bove Camilla , Arcangeli Silvia , Falcone Laura , Camisa Barbara , El Khoury Rita , Greco Beatrice , De Lucia Anna , Bergamini Alice , Bondanza Attilio , Ciceri Fabio , Bonini Chiara , Casucci Monica
Published: January 2023

Background

To date, T cells redirected with CD19-specific chimeric antigen receptors (CAR) have gained impressive success in B-cell malignancies. However, treatment failures are common and the occurrence of severe toxicities, such as cytokine release syndrome (CRS), still limits the full exploitation of this approach. Therefore, the development of cell products with improved therapeutic indexes is highly demanded.

Methods

In this project, we investigated how CD4 and CD8 populations cooperate during CD19 CAR-T cell responses and what is their specific role in CRS development. To this aim, we took advantage of immunodeficient mice reconstituted with a human immune system (HuSGM3) and engrafted with the B-cell acute lymphoblastic leukemia cell line NALM-6, a model that allows to thoroughly study efficacy and toxicity profiles of CD19 CAR-T cell products.

Results

CD4 CAR-T cells showed superior proliferation and activation potential, which translated into stronger stimulation of myeloid cells, the main triggers of adverse events. Accordingly, toxicity assessment in HuSGM3 mice identified CD4 CAR-T cells as key contributors to CRS development, revealing a safer profile when they harbor CARs embedded with 4-1BB, rather than CD28. By comparing differentially co-stimulated CD4:CD8 1:1 CAR-T cell formulations, we observed that CD4 cells shape the overall expansion kinetics of the infused product and are crucial for maintaining long-term responses. Interestingly, the combination of CD4.BBz with CD8.28z CAR-T cells resulted in the lowest toxicity, without impacting antitumor efficacy.

Conclusions

Taken together, these data point out that the rational design of improved adoptive T-cell therapies should consider the biological features of CD4 CAR-T cells, which emerged as crucial for maintaining long-term responses but also endowed by a higher toxic potential.