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The article discusses a case of successful hemoperfusion treatment in a 28-year-old female patient who intentionally ingested a lethal dose of phenobarbitone. Phenobarbitone overdosage can lead to severe symptoms, including respiratory and cardiovascular depression. Hemoperfusion was used to aid in the rapid clearance of the drug, resulting in the patient's substantial recovery. The article highlights the importance of considering hemoperfusion as a first-line therapy in patients with phenobarbitone poisoning who are in a comatose state. [Extracted from the article]

Aim: The PelvEx Collaborative collates global data on outcomes following exenterative surgery for locally advanced and locally recurrent rectal cancer (LARC and LRRC, respectively). The aim of this study is to report contemporary data from within the collaborative and benchmark it against previous PelvEx publications. Method: Anonymized data from 45 units that performed pelvic exenteration for LARC or LRRC between 2017 and 2021 were reviewed. The primary endpoints were surgical outcomes, including resection margin status, radicality of surgery, rates of reconstruction and associated morbidity and/or mortality. Results: Of 2186 patients who underwent an exenteration for either LARC or LRRC, 1386 (63.4%) had LARC and 800 (36.6%) had LRRC. The proportion of males to females was 1232:954. Median age was 62 years (interquartile range 52–71 years) compared with a median age of 63 in both historical LARC and LRRC cohorts. Compared with the original reported PelvEx data (2004–2014), there has been an increase in negative margin (R0) rates from 79.8% to 84.8% and from 55.4% to 71.7% in the LARC and LRRC cohorts, respectively. Bone resection and flap reconstruction rates have increased accordingly in both cohorts (8.2%–19.6% and 22.6%–32% for LARC and 20.3%–41.9% and 17.4%–32.1% in LRRC, respectively). Despite this, major morbidity has not increased. Conclusion: In the modern era, patients undergoing pelvic exenteration for advanced rectal cancer are undergoing more radical surgery and are more likely to achieve a negative resection margin (R0) with no increase in major morbidity. [ABSTRACT FROM AUTHOR]

Background and Aim: Serrated polyps have been recognized as a premalignant lesion accounting for a significant proportion of colorectal cancer. Limited data are available regarding the risk factors for colorectal sessile serrated lesions (SSLs). We aimed to investigate clinical risk factors of SSLs and compared them with colorectal adenomas in a study population of Chinese individuals. Methods: A retrospective case–control study was performed in an academic tertiary‐referral center in Hong Kong. Subjects with SSLs and adenomas were identified from the hospital pathology database from January 2010 to December 2020, and additional clinical data were retrieved from the electronic patient record system. We compared clinical features and risk factors of SSL patients with those without these lesions. Results: A total of 2295 subjects were included in the study, including 459 subjects with SSLs, 918 subjects with adenomas, and 918 subjects with normal colonoscopy. By multivariable logistic regression, compared with normal subjects, patients with SSLs only were significantly more likely to have dyslipidemia (adjusted OR: 1.431, 95% CI 1.008–2.030) and diabetes mellitus (adjusted OR: 2.119, 95% CI 1.439–3.122). Conclusions: Dyslipidemia and diabetes were independent risk factors for SSLs. Our findings suggest these metabolic factors may be important for the risk of SSLs. The findings may improve our understanding of SSLs and shed light on patient selection for screening and risk stratification. [ABSTRACT FROM AUTHOR]

Objective: To characterise paediatric poisoning presentations to EDs and determine if the advent of the COVID‐19 pandemic was associated with increased intentional paediatric poisoning presentations. Methods: We performed a retrospective analysis of paediatric poisoning presentations to three EDs (two regional and one metropolitan). Simple and multiple logistic regression analysis were performed to determine the association between COVID‐19 and intentional poisoning events. In addition, we calculated the frequency with which patients reported various psychosocial risk factors as being an implicating factor in engaging in an intentional poisoning event. Results: A total of 860 poisoning events met inclusion criteria during the study period (January 2018–October 2021), with 501 being intentional, and 359 unintentional. There was an increased proportion of intentional poisoning presentations during the COVID‐19 pandemic (261 intentional and 218 unintentional in the pre‐COVID‐19 period vs 241 intentional and 140 unintentional during the COVID‐19 period). In addition, we found a statistically significant association between intentional poisoning presentations and an initial COVID‐19 lockdown (adjusted odds ratio 26.32, P < 0.05). 'The COVID‐19 lockdown' or 'COVID‐19' was reported to be implicating factor for psychological stress in patients who presented with intentional poisonings during the COVID‐19 pandemic. Conclusions: Intentional paediatric poisoning presentations increased during the COVID‐19 pandemic in our study population. These results may support an emerging body of evidence that the psychological strain of COVID‐19 disproportionately impacts adolescent females. [ABSTRACT FROM AUTHOR]

Homeobox genes include HOX and non‐HOX genes. HOX proteins play fundamental roles during ontogenesis by interacting with other non‐HOX gene‐encoded partners and performing transcriptional functions, whereas aberrant activation of HOX family members drives tumorigenesis. In this study, gastric cancer (GC) expression microarray data indicated that HOXB9 is a prominent upregulated HOX member in GC samples significantly associated with clinical outcomes and advanced TNM stages. However, the functional role of HOXB9 in GC remains contradictory in previous reports, and the regulatory mechanisms are elusive. By in silico and experimental analyses, we found that HOXB9 was upregulated by a vital cell cycle‐related transcription factor, E2F1. Depleting HOXB9 causes G1‐phase cell cycle arrest by downregulating CDK6 and a subset of cell cycle‐related genes. Meanwhile, HOXB9 contributes to cell division and maintains the cytoskeleton in GC cells. We verified that HOXB9 interacts with PBX2 to form a heterodimer, which transcriptionally upregulates CDK6. Knocking down CDK6 can phenocopy the tumor‐suppressive effects caused by HOXB9 depletion. Blocking HOXB9 can enhance the anti‐tumor effect of CDK6 inhibitors. In conclusion, we elucidate the oncogenic role of HOXB9 in GC and reveal CDK6 as its potent downstream effector. The E2F1–HOXB9/PBX2–CDK6 axis represents a novel mechanism driving gastric carcinogenesis and conveys prognostic and therapeutic implications. © 2023 The Pathological Society of Great Britain and Ireland. [ABSTRACT FROM AUTHOR]

Introduction: Fetal growth restriction (FGR) fetuses develop cardiovascular remodeling and dysfunction and, in this process, heart first compensates by changing its shape from ellipsoid to spherical and then cardiac dysfunction follows. Our aim was to evaluate global sphericity index (GSI) after 32 weeks of gestation to evaluate this change in cardiac shape and correlate GSI changes associated with fetal growth abnormalities. Materials and Methods: This was a prospective study conducted at 32–38 weeks of gestation. Women were classified into three groups—Appropriate for gestational age (AGA), small for gestational age (SGA), late onset FGR (LO FGR) and GSI was measured and perinatal outcome studied. Results: Out of 217 women, 131 were of AGA, 31 were SGA, 55 were of late onset FGR. SGA and late onset FGR groups had low GSI compared to AGA group. There was no significant difference in mean GSI between late onset FGR and SGA groups. Neonatal morbidity, adverse perinatal outcomes did not significantly differ with GSI in SGA and late onset FGR groups. Conclusion: This study showed that late gestation small fetuses develop early stages of cardiovascular remodeling as shown by GSI changes. These changes were independent of Doppler changes. This supports the concept that atleast a proportion of them are not constitutionally small but are true forms of FGR. [ABSTRACT FROM AUTHOR]

Aim: Actinomycosis is a rare subacute to chronic granulomatous infection which can mimic other infectious or malignant diseases. This study examined the epidemiology and treatment outcome of actinomycosis in children. Methods: A retrospective study on children admitted for actinomycosis in a tertiary paediatric hospital in Singapore, from January 2004 to December 2020. Clinical profile, therapeutic interventions and outcomes were examined. Results: A total of 10 patients were identified; 7 were female. The median age at first presentation was 9.8 years (range 4.7–15.7). The most common presenting symptom was fever (n = 6, 60%), followed by facial or neck swelling (n = 3, 30%) and ear pain (n = 3, 30%). Actinomycosis occurred predominantly in the orocervicofacial region (n = 6, 60%). Four patients (40%) had preceding dental infections in the form of dental caries or gingivitis. One patient had poorly controlled insulin‐dependent diabetes mellitus. Actinomycosis was confirmed via culture in four patients, histopathology in four patients and both methods in two patients. All except one patient (n = 9, 90%) underwent surgical procedures. All patients received ampicillin or amoxicillin/clavulanate or other beta‐lactams, for a median duration of 6.5 months (range 1.5–14). Complications included osteomyelitis (n = 4, 40%), mastoiditis (n = 2, 20%), brain abscess (n = 1, 10%) and recurrent neck abscess (n = 1, 10%). There was no mortality and all patients achieved complete resolution. Conclusions: Paediatric actinomycosis was rare in our 16‐year review, but had a high complication rate. It can occur in immunocompetent patients, and dental infection was the predominant risk factor identified. Prognosis was excellent after surgical intervention and appropriate antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Background: Although there is a growing body of literature on cognitive and language processing in bilingual children with developmental language disorder (DLD), there is a major gap in the evidence for language intervention. Critically, speech–language therapists are often required to make clinical decisions for language intervention on specific domains, such as phonology, vocabulary, morphosyntax and literacy. Aims: To examine evidence for language intervention and cross‐language transfer effects in bilingual children with DLD. Specifically, the study aimed to review intervention evidence targeting non‐linguistic cognitive skills and six areas of language: phonology, vocabulary, morphosyntax, pragmatics, narrative skills and literacy. Methods & Procedures: We carried out searches in five electronic databases: CINAHL, Scopus, Psychinfo, Proquest and Sciencedirect. Data from selected papers were extracted and organized into the three following categories: study information, participant information and intervention information. Critical appraisal for selected papers was conducted using a quality assessment tool (QAT). Outcomes & Results: We included 14 papers in the review. The majority indicated evidence for vocabulary intervention. There was limited evidence for intervention targeting phonology or morphosyntax. Cross‐language generalization effects were evident for vocabulary, but in some instances also reported for morphosyntax and literacy. Conclusions & Implications: The present review indicates that there is a significant gap in the literature regarding language intervention for several key language areas such as morphosyntax, narrative skills and literacy. There are only limited data for the effects of cross‐language generalization indicating that more research is needed in this area specifically for skills beyond vocabulary. What this paper adds: What is already known on the subject: Previous studies have examined the effects of bi‐ and monolingual intervention in bilingual children with DLD. Although the results indicated superior effects for bilingual compared with monolingual intervention, language intervention evidence in specific language domains (e.g., vocabulary, literacy) has not been investigated. What this paper adds to existing knowledge: This study will add intervention evidence specific to language domains such as phonology, vocabulary, morphosyntax, pragmatics, narrative skills and literacy. Additionally, we have synthesized intervention evidence on non‐linguistic cognition given that these skills are often impaired in bilingual children with DLD. The review has also demonstrated evidence for the effects of cross‐language transfer beyond vocabulary skills, especially when the intervention was provided in the home language. What are the potential or actual clinical implications of this work?: Although there was a lack of intervention evidence in language domains such as pragmatics, the results indicated some evidence for intervention targeting vocabulary. However, positive effects of cross‐language generalization were not constrained to vocabulary but were also reported for intervention targeting mean length of utterance and literacy in the home language. This result indicates an interactive nature of the two languages, as well as provides further evidence for supporting home language(s) in intervention. Finally, intervention targeting non‐linguistic cognition may yield additional cross‐domain generalization to language skills specifically for bilingual children with DLD. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of the most common cancers worldwide. The tumor microenvironment exerts crucial effects in driving CRC progression. Cancer‐associated fibroblasts (CAFs) serve as one of the most important tumor microenvironment components promoting CRC progression. This study aimed to elucidate the novel molecular mechanisms of CAF‐secreted insulin‐like growth factor (IGF) 2 in colorectal carcinogenesis. Our results indicated that IGF2 was a prominent factor upregulated in CAFs compared with normal fibroblasts. CAF‐derived conditioned media (CM) promoted tumor growth, migration, and invasion of HCT 116 and DLD‐1 cells. IGF1R expression is significantly increased in CRC, serving as a potent receptor in response to IGF2 stimulation and predicting unfavorable outcomes for CRC patients. Apart from the PI3K–AKT pathway, RNA‐seq analysis revealed that the YAP1‐target signature serves as a prominent downstream effector to mediate the oncogenic signaling of IGF2–IGF1R. By single‐cell RNA sequencing (scRNA‐seq) and immunohistochemical validation, IGF2 was found to be predominantly secreted by CAFs, whereas IGF1R was expressed mainly by cancer cells. IGF2 triggers the nuclear accumulation of YAP1 and upregulates YAP1 target signatures; however, these effects were abolished by either IGF1R knockdown or inhibition with picropodophyllin (PPP), an IGF1R inhibitor. Using CRC organoid and in vivo studies, we found that cotargeting IGF1R and YAP1 with PPP and verteporfin (VP), a YAP1 inhibitor, enhanced antitumor effects compared with PPP treatment alone. In conclusion, this study revealed a novel molecular mechanism by which CAFs promote CRC progression. The findings highlight the translational potential of the IGF2–IGF1R–YAP1 axis as a prognostic biomarker and therapeutic target for CRC. © 2022 The Pathological Society of Great Britain and Ireland. [ABSTRACT FROM AUTHOR]

Lysosome integrity is essential for cell viability, and lesions in lysosome membranes are repaired by the ESCRT machinery. Here, we describe an additional mechanism for lysosome repair that is activated independently of ESCRT recruitment. Lipidomic analyses showed increases in lysosomal phosphatidylserine and cholesterol after damage. Electron microscopy demonstrated that lysosomal membrane damage is rapidly followed by the formation of contacts with the endoplasmic reticulum (ER), which depends on the ER proteins VAPA/B. The cholesterol‐binding protein ORP1L was recruited to damaged lysosomes, accompanied by cholesterol accumulation by a mechanism that required VAP–ORP1L interactions. The PtdIns 4‐kinase PI4K2A rapidly produced PtdIns4P on lysosomes upon damage, and knockout of PI4K2A inhibited damage‐induced accumulation of ORP1L and cholesterol and led to the failure of lysosomal membrane repair. The cholesterol–PtdIns4P transporter OSBP was also recruited upon damage, and its depletion caused lysosomal accumulation of PtdIns4P and resulted in cell death. We conclude that ER contacts are activated on damaged lysosomes in parallel to ESCRTs to provide lipids for membrane repair, and that PtdIns4P generation and removal are central in this response. Synopsis: Lysosome integrity is essential for cell survival, and ruptures in lysosome membranes are repaired by the ESCRT machinery. This study identifies an additional, ESCRT‐independent repair mechanism that involves cholesterol transfer mediated by contact sites between lysosomes and the endoplasmic reticulum (ER). Upon lysosome damage, the ER proteins VAPA/B form contacts between ER and lysosomes and recruit the cholesterol‐binding protein ORP1L.PI4K2A‐dependent accumulation of PtdIns4P on the damaged lysosomes is essential for ORP1L recruitment and lysosome repair.ORP1L induces cholesterol accumulation on damaged lysosomes.Depletion of the cholesterol–PtdIns4P transporter OSBP causes PtdIns4P hyperaccumulation on damaged lysosomes and impairs cell viability. [ABSTRACT FROM AUTHOR]

A defining characteristic of mammalian prions is their capacity for self‐sustained propagation. Theoretical considerations and experimental evidence suggest that prion propagation is modulated by cell‐autonomous and non‐autonomous modifiers. Using a novel quantitative phospholipase protection assay (QUIPPER) for high‐throughput prion measurements, we performed an arrayed genome‐wide RNA interference (RNAi) screen aimed at detecting cellular host‐factors that can modify prion propagation. We exposed prion‐infected cells in high‐density microplates to 35,364 ternary pools of 52,746 siRNAs targeting 17,582 genes representing the majority of the mouse protein‐coding transcriptome. We identified 1,191 modulators of prion propagation. While 1,151 modified the expression of both the pathological prion protein, PrPSc, and its cellular counterpart, PrPC, 40 genes selectively affected PrPSc. Of the latter 40 genes, 20 augmented prion production when suppressed. A prominent limiter of prion propagation was the heterogeneous nuclear ribonucleoprotein Hnrnpk. Psammaplysene A (PSA), which binds Hnrnpk, reduced prion levels in cultured cells and protected them from cytotoxicity. PSA also reduced prion levels in infected cerebellar organotypic slices and alleviated locomotor deficits in prion‐infected Drosophila melanogaster expressing ovine PrPC. Hence, genome‐wide QUIPPER‐based perturbations can discover actionable cellular pathways involved in prion propagation. Further, the unexpected identification of a prion‐controlling ribonucleoprotein suggests a role for RNA in the generation of infectious prions. Synopsis: A systematic analysis for cellular host‐factors involved in prion propagation has been missing due to the lack of a compatible high‐throughput detection method. This study describes the development and application of a novel prion detection assay and identifies new host‐factors involved in prion propagation. The QUantItative Prion PhospholipasE pRotection assay (QUIPPER) allows for prion detection in cultured cells in a high‐throughput format.A genome‐wide screen in prion infected mouse cells identifies new host factors for prion propagation.Hnrnpk/HNRNPK limits prion formation in mouse and human cells.The compound Psammaplysene A can reduce prion formation in vitro and in vivo. [ABSTRACT FROM AUTHOR]

Optical nanoantennas provide control of light at the nanoscale, which makes them important for diverse areas ranging from photocatalysis and flat metaoptics to sensors and biomolecular tweezing. They have traditionally been limited to metallic and dielectric nanostructures that sustain plasmonic and Mie resonances, respectively. More recently, nanostructures of organic J‐aggregate excitonic materials have been proposed capable of also supporting nanooptical resonances, although their advance has been hampered from difficulty in nanostructuring. Here, the authors present the realization of organic J‐aggregate excitonic nanostructures, using nanocylinder arrays as model system. Extinction spectra show that they can sustain both plasmon‐like resonances and dielectric resonances, owing to the material providing negative and large positive permittivity regions at the different sides of its exciton resonance. Furthermore, it is found that the material is highly anisotropic, leading to hyperbolic and elliptic permittivity regions. Nearfield analysis using optical simulation reveals that the nanostructures therefore support hyperbolic localized surface exciton resonances and elliptic Mie resonances, neither of which has been previously demonstrated for this type of material. The anisotropic nanostructures form a new type of optical nanoantennas, which combined with the presented fabrication process opens up for applications such as fully organic excitonic metasurfaces. [ABSTRACT FROM AUTHOR]

Objective: To define patterns of prescription and factors associated with choice of pharmacotherapy for gestational diabetes mellitus (GDM), namely metformin, glyburide and insulin, during a period of evolving professional guidelines. Desing: Cross‐sectional study. Setting: US commercial insurance beneficiaries from Market‐Scan (late 2015 to 2018). Study design: We included women with GDM, singleton gestations, 15–51 years of age on pharmacotherapy. The exposure was pharmacy claims for metformin, glyburide and insulin. Main outcomes: Pharmacotherapy for GDM with either oral agent, metformin or glyburide, compared with insulin as the reference, and secondarily, consequent treatment modification (addition and/or change) to metformin, glyburide or insulin. Results: Among 37 762 women with GDM, we analysed data from 10 407 (28%) with pharmacotherapy, 21% with metformin (n = 2147), 48% with glyburide (n = 4984) and 31% with insulin (n = 3276). From late 2015 to 2018, metformin use increased from 17 to 29%, as did insulin use from 26 to 44%, whereas glyburide use decreased from 58 to 27%. By 2018, insulin was the most common pharmacotherapy for GDM; metformin was more likely to be prescribed by 9% compared with late 2015/16, but glyburide was less likely by 45%. Treatment modification occurred in 20% of women prescribed metformin compared with 2% with insulin and 8% with glyburide. Conclusions: Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for GDM among a privately insured US population during a time of evolving professional guidelines. Further evaluation of the relative effectiveness and safety of metformin compared with insulin is needed. Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for gestational diabetes mellitus in the USA. Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for gestational diabetes mellitus in the USA. Linked article This article is commented on by AB Caughey, p. 484 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16961. [ABSTRACT FROM AUTHOR]

Background: Numerous studies related to Helicobacter pylori (H. pylori) eradication have been published since the discovery of H. pylori. This study aimed to use a quantitative method to assess the development of this field. Materials and Methods: We performed a search of related articles from Web of Science published in 1983–2020 using a combination of the search terms "H. pylori" and "eradication". Eligible studies were included after a two‐stage screening process, and the following data were extracted: title, author, institution, country, study type, sample size, eradication regimen, publication year, number of citations, journal, and H‐index. Results: A total of 1402 studies were finally identified. The results showed that the period from 1994–2003 was the most influential period in this field. Italy and the USA were dominant countries in this field, while China's publication number increased sharply in the last ten years. Baylor College of Medicine was the most influential institution. Alimentary Pharmacology Therapeutics was the most productive journal. The effects of H. pylori eradication on peptic ulcers and gastric cancer and H. pylori eradication therapy were the most cited topics in this field. After the publish of Maastricht/Florence Ⅳ guideline, the research of quadruple therapy was more than triple therapy. Bismuth‐containing quadruple therapy became the most focused regimen after Maastricht/Florence Ⅴ guideline. Conclusions: In this study, we summarized the characteristics of the publications; identified the most influential countries, institutions, journals; identified the popular research topics and eradication regimen of clinical H. pylori eradication. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm (<28 weeks of gestation). Design: The Extremely Low Gestational Age Newborn (ELGAN) Study, a prospective cohort. Setting: Ten‐year follow‐up of extremely preterm infants born at 14 US hospitals between 2002 and 2004. Methods: Prenatal tobacco smoke exposure was defined as a mother's report at enrolment of active (i.e. maternal) and passive smoking during pregnancy. Poisson regression with generalized estimating equations was used. Models adjusted for mother's age, race/ethnicity, education, insurance, pre‐pregnancy body mass index, US region, multiple gestation and infant's sex; and in sensitivity analysis, gestational age at delivery and clinical subtype of preterm birth, given their classification as intermediate and non‐confounding variables. Main outcomes: Neurological impairment at 10 years, epilepsy, cerebral palsy and cognitive impairment. Results: Of 1200 ELGAN study survivors, 856 were assessed at 10 years of age with neurological outcomes, of whom 14% (118/856) had active tobacco exposure during pregnancy and 24% (207/852) had passive tobacco exposure. Compared with children who were not exposed prenatally to tobacco, children exposed to active tobacco use during pregnancy had a higher risk of epilepsy (14% versus 5%; adjusted relative risk: 1.68, 95% CI 1.45–1.92). This risk remained after adjustment for gestational age at delivery and clinical subtype of preterm birth. Prenatal tobacco smoke exposure was not associated with other assessed neurological outcomes, including cerebral palsy and multiple measures of cognitive impairment. Conclusions: Among children born extremely preterm, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life. Among infants born before 28 weeks of gestation, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life. Among infants born before 28 weeks of gestation, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life. [ABSTRACT FROM AUTHOR]

Since its invention 25 years ago, atom transfer radical polymerization has become one of the most dominant methods in controlled radical polymerization. This rise in importance is due in large part to increases in scope, reduced catalyst loading and improved oxygen tolerance. These developments have been in turn underpinned by an improved understanding of the mechanism, kinetics and structure–reactivity trends. This mini‐review outlines these mechanistic developments with a particular emphasis on the relationship between structure and activity in both the catalyst and alkyl halide substrate, and their implications for future catalyst design. © 2020 Society of Industrial Chemistry [ABSTRACT FROM AUTHOR]

BACKGROUND: Brewers spent grains (BSG) represents ≤85% of a brewery's solid waste and common disposal to landfill is increasingly more difficult. Yet BSG is a food‐grade by‐product with potential economic valorization that can significantly improve resource efficiency and reduction in carbon emissions. This study investigated valorization of BSG through the application of novel high solids hydrothermal processing technology in a small‐scale biorefinery, annexed to a brewery. It focused on three scenarios for the production of: (A) the sugar replacement xylitol; (B) prebiotic xylo‐oligosaccharide (XOS); and (C) co‐production of xylitol and XOS. Economic assessment was conducted by comparing the capital and operating expenditure from process simulations created in Aspen Plus®. The process models developed were supplemented with experimental data to improve accuracy. RESULTS: Internal rate of return (IRR) values obtained were greater than the hurdle rate of 9.7% for all scenarios when considering a conservative market price for xylitol and XOS as US$4500 t–1, yet dedicated production of XOS was economically more favourable with a minimum required selling price (MRSP) of US$2509 t–1 compared to US$4153 t–1 for xylitol. Additionally, the scenario for co‐production of xylitol and XOS achieved the lowest MRSP of US$2182 t–1. By‐products significantly contributed to 32.7%, 14.2% and 27.5% of the revenue generated in scenarios A, B and C, respectively. CONCLUSION: These results provide a good platform from which to develop the cost‐effective commercial production of XOS and xylitol from BSG. © 2021 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to investigate the hearing outcomes of cochlear implantation (CI) in patients with hearing loss who had received radiotherapy for nasopharyngeal cancer (NPC). The study compared speech perception in patients who had prior radiotherapy with those who did not receive radiotherapy. Methods: Eighty‐eight Cantonese speaking adult patients who had profound sensorineural hearing loss and received CI from 1995 to 2015 at the Chinese University of Hong Kong CI‐center were studied. Twenty‐five patients had history of NPC and radiotherapy were determined as the exposed group, while 63 patients of mixed etiologies but with no history of radiotherapy were included in the control group. The Hong Kong Speech Perception Test Manual (HKSPTM) scores preoperatively, at 6, 12, and 24 months postoperatively were used to assess hearing performance. The HKSPTM consisted categories of speech recognition, word recognition, and tone perception. Results: No statistical significance differences were found at the four time‐points in the three categories of HKSPTM between the two groups. Conclusion: CI is a clinically effective intervention and good rehabilitative option for hearing restoration in NPC patients with hearing impairment. Further studies with greater sample size and additional pathological studies on the pathophysiology of hearing loss in this subgroup of patients may provide supplementary information for clinicians when counseling for CI. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Aim: A total of 15–20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise. Method: Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved. Results: A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first‐line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one‐quarter of the panellists would consider simultaneous pelvic exenteration and liver resection. Conclusion: This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach. [ABSTRACT FROM AUTHOR]

Objective: To identify factors influencing the survival of confirmed gastric dilatation volvulus (GDV) cases presented to a specialist referral and emergency hospital. Methods: Clinical records of confirmed GDV cases admitted to two specialist referral and emergency centres in Sydney (Animal Referral Hospital (ARH) Homebush and ARH Baulkham Hills) between July 1999 and July 2019 were searched. Results: A total of 736 GDV cases were reviewed, of which 460 dogs were surgically treated and 276 dogs were humanely killed. The survival rates of patients operated on by general surgeons and specialists were 81.7% and 88.7%, respectively. Both incisional gastropexy and belt‐loop gastropexy were clinically effective in treating GDV, with no significant difference in survival rates. Intraoperative mortality rates for general surgeons and specialists were 7.0% and 2.9%, respectively. The odds of mortality in dogs operated on by general surgeons were 2.03 times those operated on by specialist surgeons. The odds of mortality in dogs presented between 3:00 and 9:00 am were 3.57 times those of dogs presented between 9:00 am and 9:00 pm. The odds of mortality in dogs where the duration from presentation to completion of surgery was more than 3 h were 2.53 times those of dogs where time lapsed was equal or less than 3 h. Conclusion: The results suggested that admission time was statistically significantly related to the survival rate. Dogs operated on by specialist surgeons had a significantly higher survival rate compared to those operated on by general surgeons. Clinicians should aim to stabilise and complete surgical correction of GDV as soon as possible to decrease the mortality. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non‐surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter‐sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures.A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter‐sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re‐intervention and incontinence rates.Fifteen non‐randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re‐intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long‐term follow up 23 months (range: 5–60 months).Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures. [ABSTRACT FROM AUTHOR]

Objectives: To quantify the health‐related quality of life (HRQoL) of patients with bladder cancer around the time of diagnosis and to test the hypotheses of a two‐factor model for the HRQoL questionnaire QLQ‐C30. Methods: From participants in the Bladder Cancer Prognoses Programme, a multicentre cohort study, sociodemographic data were collected using semi‐structured face‐to‐face interviews. Answers to the QLQ‐C30 were transformed into a scale from 0 to 100. HRQoL data were analysed in multivariate analyses. The hypothesized two‐factor (Physical and Mental Health) domain structure of the QLQ‐C30 was also tested with confirmatory factor analyses (CFA). Results: A total of 1160 participants (78%) completed the questionnaire after initial visual diagnosis and before pathological confirmation. Despite non‐muscle‐invasive bladder cancer (NMIBC) being associated with a higher HRQoL than carcinoma invading bladder muscle, only the domain Role Functioning was clinically significantly better in patients with NMIBC. Age, gender, bladder cancer stage and comorbidity all had a significant influence on QLQ‐C30 scores. The CFA showed an overall good fit of the hypothesized two‐factor model. Conclusion: This study identified a baseline reference value for HRQoL for patients with bladder cancer, which allows better evaluation of any changes in HRQoL as disease progresses or after treatment. In addition, a two‐factor (Physical and Mental Health) model was developed for the QLQ‐C30. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery.Design: A retrospective cohort study.Setting: Data from the Consortium on Safe Labor Study in the USA (2002-2008).Population: Singleton deliveries at ≥23 weeks of gestation (221 274 assessed deliveries, 62 331 by caesarean section).Methods: The association of chorioamnionitis, and secondarily the duration of chorioamnionitis estimated from intrapartum antibiotic use, with adverse maternal outcomes was analysed using logistic regression with generalised estimating equations, adjusting for age, parity, race, pregestational diabetes, chronic hypertension, gestational age at delivery, study site and delivery year. Analyses were stratified by vaginal versus caesarean delivery.Main Outcome Measures: The composite adverse maternal outcome included: postpartum transfusion, endometritis, wound/perineal infection/separation, venous thromboembolism, hysterectomy, admission to intensive care unit and/or death.Results: Chorioamnionitis was associated with higher odds of the composite adverse maternal outcome with caesarean delivery (adjusted odds ratio 2.31; 95% CI 1.97-2.71); and the association persisted regardless of whether a woman had a trial of labour, preterm delivery or maternal group B streptococcus colonisation. The most common adverse outcomes after caesarean section were postpartum transfusion (56.0%) and wound/perineal infection or endometritis (38.6%). Chorioamnionitis was not associated with adverse maternal outcomes after vaginal delivery. The duration of chorioamnionitis as the exposure did not alter the association between chorioamnionitis and adverse maternal outcomes.Conclusions: Chorioamnionitis, but not the estimated duration, was associated with increased odds of adverse maternal outcomes with caesarean delivery. This finding has implications for care programmes to prevent maternal morbidity after a caesarean section complicated by chorioamnionitis.Tweetable Abstract: Chorioamnionitis, but not its duration, increases the risk of adverse maternal outcomes with caesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: Evidence on the impact of leisure time physical activity (LTPA) in pregnancy on birth size is inconsistent. We aimed to examine the association between LTPA during early and late pregnancy and newborn anthropometric outcomes.Design: Individual level meta-analysis, which reduces heterogeneity across studies.Setting: A consortium of eight population-based studies (seven European and one US) comprising 72 694 participants.Methods: Generalised linear models with consistent inclusion of confounders (gestational age, sex, parity, maternal age, education, ethnicity, BMI, smoking, and alcohol intake) were used to test associations between self-reported LTPA at either early (8-18 weeks gestation) or late pregnancy (30+ weeks) and the outcomes. Results were pooled using random effects meta-analyses.Main Outcome Measures: Birth weight, large-for-gestational age (LGA), macrosomia, small-for-gestational age (SGA), % body fat, and ponderal index at birth.Results: Late, but not early, gestation maternal moderate to vigorous physical activity (MVPA), vigorous activity, and LTPA energy expenditure were modestly inversely associated with BW, LGA, macrosomia, and ponderal index, without heterogeneity (all: I2  = 0%). For each extra hour/week of MVPA, RR for LGA and macrosomia were 0.97 (95% CI: 0.96, 0.98) and 0.96 (95% CI: 0.94, 0.98), respectively. Associations were only modestly reduced after additional adjustments for maternal BMI and gestational diabetes. No measure of LTPA was associated with risk for SGA.Conclusions: Physical activity in late, but not early, pregnancy is consistently associated with modestly lower risk of LGA and macrosomia, but not SGA.Tweetable Abstract: In an individual participant meta-analysis, late pregnancy moderate to vigorous physical activity modestly reduced birth size outcomes. [ABSTRACT FROM AUTHOR]

Background: The caries process follows a strong social gradient which can commence in the first years of life. Yet data on young children remain limited. This study reports the potential risk factors and indicators in urban, Aboriginal and Torres Strait Islander children aged less than 5 and estimates the prevalence of caries.Methods: Demographic and risk factor and risk indicator data were collected at baseline in a cohort study of children attending a health clinic in north Brisbane. Dentulous children received a basic oral examination to explore the presence of decayed, missing and filled teeth (dmft). Descriptive analyses were performed. A backwards stepwise logistic regression model was performed to identify potential associations with dmft status.Results: In this study, 180 children enrolled: 111 children received the oral examination, of whom 14 (12.6%) (mean age 35 months) were estimated to have dmft >0. There was a high prevalence of socio-economic, dietary and behavioural risk factors/indicators present for children. Due to the small sample size, planned regression was not performed.Conclusions: Overall, the prevalence of risk factors and risk indicators for caries in the study population is high. More culturally appropriate resources that support preventive care need to be invested before children are school aged. [ABSTRACT FROM AUTHOR]

Objective: To investigate the potential long-term effects of adolescent parenthood on completed education and income.Design: Population-based birth cohort study.Setting: All live births in 1982, whose mothers lived in the urban area of Pelotas, southern Brazil.Sample: A total of 3701 participants: 1914 women and 1787 men at age 30 years.Methods: Questionnaires were completed by the mothers in the early phases of this study, and by the cohort members in adolescence and adulthood. Linear regression models and G-computation were used in the analyses.Main Outcome Measures: Educational attainment and income at age 30 years.Results: In women, adolescent parenthood was associated with lower attained education compared with women without adolescent maternity: by -2.8 years [95% confidence interval (CI) -3.2 to -2.3] if their first birth was at age 16-19, and by -4.4 years (-5.5 to -3.3) at age 11-15. These effects were greater among women who had three or more children. Women with adolescent parenthood also had 49 or 33% lower income at age 30 if their first child was born when aged 16-19 or 11-15, respectively. In men, the adverse effect of adolescent parenthood on education appeared to be mediated by a higher number of children and there was no effect of adolescent paternity on income at age 30 years.Conclusion: These findings suggest lasting socio-economic disadvantages of adolescent parenthood, with larger effects being apparent in women than in men.Tweetable Abstract: Adolescent parenthood has an adverse effect on educational attainment later in life, and on household income among women. [ABSTRACT FROM AUTHOR]

Objective: To study vaginal as opposed to cervical human papillomavirus (HPV) acquisition with regard to true prevalence, HPV types, and the role of co-factors in virgins and after their sexual debut.Design: Prospective epidemiological observational study.Setting: University hospital specialised in genital malformations.Population: Women diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) and undergoing neovaginoplasty between November 2011 and July 2017.Methods: This is a prospective study including 186 women with MRKHS before and after sexual debut.Main Outcome Measures: Conventional vaginal cytology and different HPV tests were performed at surgery and during routine gynaecological follow-up 1, 3, 6 and ≥ 11 months after surgery and risk factors were documented.Results: The mean age of all women at surgery was 20.1 years (SD 5.4), mean body mass index (BMI) was 22.1 kg/m2 (SD 4.6). In 83 vaginal samples from 41 different women at least one of the HPV tests was positive. Thirty-three different HPV types were detected. The prevalence of 41/186 = 22.0% as well as type distribution are comparable with those found in a young German female population. The overall rate of acquisition was clearly associated with sexual activity and smoking habits. Out of 367 Papanicolaou smears only six were abnormal with Pap IIID (MN II) and no obvious vaginal lesion was detected.Conclusions: Vaginal HPV prevalence and HPV types in previously virgin women after creation of a neovagina are not different from the acquisition of cervical infections in the general population and is clearly associated with sexual activity and with smoking habits. However, abnormal Papanicolaou smears are rarely seen.Tweetable Abstract: Vaginal HPV prevalence after creation of a neovagina is similar to that on the cervix in the general population. [ABSTRACT FROM AUTHOR]

Background: Leventhal's commonsense model implies illness perceptions influence illness outcomes. This study examined illness perceptions among head and neck cancer survivors, and whether these predicted subsequent psychological distress. Methods: A total of 124 survivors of head and neck cancer (87% nasopharyngeal carcinoma; NPC) completed measures of psychological distress (Hospital Anxiety and Depression Scale; HADS), illness perceptions (Brief Illness Perception Questionnaire; B‐IPQ), dispositional optimism (revised Chinese version of the Life Orientation Test; C‐LOT‐R), and clinical and demographic data approximately12.9 months after diagnosis (T1). Six months later (T2) psychological distress (HADS) was again measured. Adjusted multivariate analyses tested whether illness perceptions predicted T2 HADS scores. Results: Illness perception dimensions were significantly intercorrelated (0.01‐0.68), explaining 8.0% of anxiety and 4.8% of depression symptom variability at T2. After adjustment for T1 distress, illness identity (β = 0.270, P <.01) and sex identification as a woman (β = 0.275, P <.01) predicted T2 anxiety symptoms while illness identity (β = 0.195, P <.05), unemployment (β = 0.195, P <.05), and pessimism (β = –0.227, P <.01) predicted T2 depression symptoms. Conclusion: Perceived illness identity predicted psychological distress, accounting for modest levels of distress variance. Unresolved symptoms may exacerbate distress. [ABSTRACT FROM AUTHOR]

Contents This study was designed to investigate the relationship of temperament with oestrus, resumption of ovarian cyclicity and milk yield in post-partum buffaloes. For this study, 102 post-partum Murrah buffaloes were observed for temperament in open paddock and during milking. Based on the temperament score (1-5 score), they were classified into docile, slightly restless, restless, aggressive and nervous. Oestrous behaviour was monitored twice daily in all the buffaloes along with milk yield (weekly), body weight (BW) and body condition score (BCS) at day 0, 30, 60 and 90 post-partum. Based on the temperament score, the number of buffaloes classified as docile, slightly restless, restless and aggressive was 37 (36.27%), 28 (27.45%), 30 (29.41%) and 7 (6.86%), respectively, but none under nervous category. Number of buffaloes resuming cyclicity in various temperaments groups were as follows: docile ( n = 35; 94.59%), slightly restless ( n = 22; 78.57%), restless ( n = 20; 66.67%) and aggressive ( n = 7; 85.71%). Temperament was not correlated ( p = .128; r=−.152) with oestrous behaviour. But, temperament was correlated ( p < .0001; r = .384) with the resumption of cyclicity as docile and slightly restless buffaloes resumed cyclicity ( p < .0016) earlier. Temperament of buffaloes was weakly correlated ( p = .0017; r=−.306) with milk production with higher ( p < .0358) total milk yield in docile (1022 ± 23.75 kg) and slightly restless buffaloes (948 ± 35.86 kg) as compared to other temperament groups. In summary, temperament of post-partum buffaloes was related with resumption of ovarian cyclicity and milk yield, but not oestrous behaviour. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to explore oral health experiences from the perspective of older adults' living in community dwellings. The two objectives of this study were to identify facilitators and barriers to oral health care, and to determine how utilization of oral health services compares to utilization of other healthcare services. Methodology An interpretive descriptive methodology was employed with a purposive sample of 12 adults, aged 70 years or older. The inclusion criterion was English-speaking seniors residing in community dwellings. Community dwellings were defined as any housing outside of long-term care or other supportive living facilities. Semi-structured interviews were 30-80 min, audio-recorded and transcribed verbatim. Three researchers participated in the comparative analysis process to develop codes, generate categories, interpret patterns and construct themes. Results Three central themes surfacing from the data were as follows: life course influences on oral health, transparency in delivery of oral health services and interrelationships between oral health and overall health. Conclusions Older adults in this study emphasized the value of establishing collaborative and trusting relationships between oral health practitioners and older adults. Oral health practitioners should be clear and transparent when communicating information about oral health costs and be cognizant of different circumstances from childhood to older adulthood that inhibit or promote routine utilization of oral health services. Including oral health services as part of interdisciplinary care teams could help promote understandings of the reciprocal relationship between oral health and general health and improve oral health status for older adults. [ABSTRACT FROM AUTHOR]

Reduced levonorgestrel concentrations from the levonorgestrel contraceptive implant was previously seen when given concomitantly with efavirenz. We sought to assess whether single nucleotide polymorphisms (SNPs) in genes involved in efavirenz and nevirapine metabolism were linked to these changes in levonorgestrel concentration. SNPs in CYP2B6, CYP2A6, NR1I2, and NR1I3 were analyzed. Associations of participant demographics and genotype with levonorgestrel pharmacokinetics were evaluated in HIV-positive women using the levonorgestrel implant plus efavirenz- or nevirapine-based antiretroviral therapy (ART), in comparison to ART-naïve women using multivariate linear regression. Efavirenz group: CYP2B6 516G>T was associated with lower levonorgestrel log10 Cmax and log10 AUC. CYP2B6 15582C>T was associated with lower log10 AUC. Nevirapine group: CYP2B6 516G>T was associated with higher log10 Cmax and lower log10 Cmin. Pharmacogenetic variations influenced subdermal levonorgestrel pharmacokinetics in HIV-positive women, indicating that the magnitude of the interaction with non-nucleoside reverse transcriptase inhibitors (NNRTIs) is influenced by host genetics. [ABSTRACT FROM AUTHOR]

Contents In this study, we developed an in vitro model for studying sperm-oviduct binding in the buffalo. Oviduct explants were prepared by overnight culture of epithelial cells in TCM-199 medium under 5% CO2 at 38.5 °C. Cryopreserved spermatozoa from buffalo bulls ( n = 4) were incubated with the oviduct explants, and the sperm-oviduct explants complex was stained with JC-1. The effect of sperm concentration (2, 3 and 4 million), size of the oviduct explants (<0.2, 0.2-0.3, 0.3-0.4 and >0.4 mm2) and time of incubation (1 hr and 4 hr) on binding index ( BI-number of sperm bound to unit area of explants) was studied. No significant difference was observed in the BI among <0.2, 0.2-0.3 and 0.3-0.4 mm2 size of explants; however, the BI decreased significantly ( p < .05) when the size of explants exceeded 0.4 mm2. The BI decreased significantly ( p < .05) when the sperm concentration was increased to 4 million, while the duration of incubation did not have any significant effect on the BI. The interaction of bulls with explants size, sperm concentration and incubation time was not significant. The developed assay has the potential to be used as an in vitro model for studying sperm-oviduct binding in the buffalo. [ABSTRACT FROM AUTHOR]

Contents To determine the effects of poor maternal nutrition and litter size on foetal growth during mid-gestation, pregnant ewes ( n = 82) were fed 100%, 60% or 140% of NRC TDN beginning at day 30.2 ± 0.2 of gestation. Transabdominal ultrasound was performed weekly between day 46.0 ± 0.4 and 86.0 ± 0.7 to monitor foetal heart width ( HW), umbilical diameter ( UMB), rib width ( RW) and placentome outer ( OD) and inner diameter ( ID). Data were analysed with repeated-measures using the mixed procedure for effects of maternal diet, litter size and gestation, and equations predictive of gestational age were generated using the regression procedure. To determine the agreement of ultrasound measurement and actual size, ewes ( n = 20-21) were euthanized at day 45 or 90 to obtain corresponding postmortem measurements for Bland-Altman analysis. The HW, UMB and placentome OD and ID increased with gestation ( p < .0001) but were unaffected by maternal diet or litter size ( p ≥ .12). Ultrasound underestimated postmortem measurements of HW (14.8%), UMB (7.3%), placentome OD (4.5%) and ID (37.3%) at day 90 of gestation. Ultrasound underestimated RW at day 45 (7.7%) but overestimated RW (23.8%) at day 90, indicating inconsistent bias when reporting RW by ultrasound. Combining the HW, UMB, RW and placentome OD generated the strongest equation predictive of gestational age ( R2 = .91). These findings indicate that during mid-gestation, maternal diet or litter size did not affect HW, UMB or placentome diameters and these factors can be used to estimate gestational age. [ABSTRACT FROM AUTHOR]

Screening for oral cancer and other mucosal conditions is a knowledge-to-action objective that should be easy: there is supportive evidence, it is fast and non-invasive, and the oral cavity is easy to visualize. However, over 60% of oral cancers are diagnosed late, when treatment is complex and prognosis poor. Adjunctive screening devices (ASDs), e.g. toluidine blue (TB), fluorescence visualization (FV), chemiluminescence (CL) and brush biopsies, were designed to assess risk of oral lesions or aid in identification and localization of oral premalignant and malignant lesions. Little is known on how clinicians feel about using ASDs. Objectives To evaluate use and level of comfort in using ASDs for oral cancer screening among dental hygienists. Methods Online email survey of a stratified random sample of nearly 3000 dental hygienists from four Canadian provinces. Results A total of 369 hygienists responded about ASDs. Ninety-three (25%) had used an ASD. Use was associated with six or more continuing education ( CE) courses per year ( P = 0.030), having a CE course in oral pathology within the last 3 years ( P = 0.003) and having a screening protocol ( P = 0.008). The most commonly used ASD is FV, which was the tool hygienists felt most comfortable using. Few used brush biopsies. Older graduates were more comfortable using TB ( P = 0.014) and CL (0.033). Conclusion Current evidence and education through CE appears to bolster knowledge translation efforts for hygienists to become more comfortable in the use of ASDs. ASDs with minimal supporting evidence and not specifically targeted to hygienists, such as the brush biopsies, are not well utilized. [ABSTRACT FROM AUTHOR]

Objective: The use of lymph node sampling during staging procedures in clinical early-stage mucinous ovarian carcinoma (MOC) is an ongoing matter of debate. Furthermore, the incidence of lymph node metastases (LNM) in MOC in relation to tumour grade (G) is unknown. We aimed to determine the incidence of LNM in clinical early-stage MOC per tumour grade.Design: Retrospective study with data from the Dutch Pathology Registry (PALGA).Setting: The Netherlands, 2002-2012.Population or Sample: Patients with MOC.Methods: Histology reports on patients with MOC diagnosed in the Netherlands between 2002 and 2012 were obtained from PALGA. Reports were reviewed for diagnosis, tumour grade and presence of LNM. Clinical data, surgery reports and radiology reports of patients with LNM were retrieved from hospital files.Main Outcome Measures: Incidence of LNM, disease-free survival (DFS).Results: Of 915 patients with MOC, 426 underwent lymph node sampling. Cytoreductive surgery was performed in 267 patients. The other 222 patients received staging without lymph node sampling. In eight of 426 patients, LNM were discovered by sampling. In four of 190 (2.1%) patients with G1 MOC, LNM were present, compared with one of 115 (0.9%) patients with G2 MOC and three of 22 (13.6%) patients with G3 MOC. Tumour grade was not specified in 99 patients. Patients with clinical early-stage MOC had no DFS benefit from lymph node sampling.Conclusions: LNM are rare in early-stage G1 and G2 MOC without clinical suspicion of LNM. Therefore, lymph node sampling can be omitted in these patients.Tweetable Abstract: Lymph node sampling can be omitted in clinical early-stage G1 and G2 mucinous ovarian cancer. [ABSTRACT FROM AUTHOR]

A class of novel therapies leverages regenerative cell types in disease microenvironments. This complex interplay challenges established good manufacturing practices, as standards and analytical tools to measure regenerative potency are missing. That is, we can build the product right, but we do not know if we are building the right product. Here, we suggest that organ-chips, biomimetic in vitro phenotyping platforms, can serve as key quality assurance systems in regenerative medicine. [ABSTRACT FROM AUTHOR]

The impact of community conservation management on a semi-arid savannah herbaceous vegetation and soil nutrient status was studied in the conservation and grazing zones of two community ranches in Laikipia County, Kenya. Land zoning was carried out in 1999 using participatory approaches to demarcate conservation areas excluded from livestock grazing, buffer areas for grazing and high-intensity use zones for both grazing and settlement. Collected data included cover, grass species composition, standing grass biomass and topsoil chemical characteristics using line transect and quadrant methods. The conservation zones had significantly higher herbaceous diversity, species richness and relative abundance of both annual and perennial grasses, basal cover and herbage and a lower percentage of bare ground compared with the continuously grazed zones. The conservation zones also had higher total organic carbon, organic nitrogen and exchangeable basic cations content, indicating improved soil nutrient status. The grazing zones exhibited loss of vegetation cover and reduction of forage production, with a decline in rangeland condition, whereas the conservation zones showed recovery and improvement of the rangeland condition. Long-term implementation of Natural resource management programme in community wildlife conservancies seems to drive the semi-arid savannahs to exist in two steady states and transitions under the influence of grazing. We recommend long-term monitoring of the impact of the community conservation model on the rangeland and timely incorporation of remedial measures such as shifting bomas (cattle corrals) across the grazing zones, aggressive rangeland rehabilitation of severely degraded areas through reseeding and random grass seed broadcast along stock routes. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose To assess oral cancer prevention and early detection curricula in Illinois associate-degree dental hygiene programmes and highlight global health applications. Methods An email invitation was sent to each Illinois associate-degree granting dental hygiene programme's oral cancer contact to participate in a survey via a Survey Monkey™ link to a 21-item questionnaire. Questions elicited background information on each programme and inquired about curriculum and methods used for teaching oral cancer prevention and early detection. Results Eight of the 12 (67%) programmes responded. Three (37.5%) reported having a specific oral cancer curriculum. Five (62.5%) require students to perform examinations for signs and symptoms of oral cancer at each clinic visit. Variations exist across the programmes in the number of patients each student sees annually and the number of oral cancer examinations each student performs before graduation. Seven programmes (87.5%) conduct early detection screening in community settings. All programmes included risk assessment associated with tobacco. All other risk factors measured were treated inconsistently. Conclusion Significant differences in training and experience were reported across Illinois dental hygiene programmes. Training is neither standardized nor uniformly comprehensive. Students' preparation for delivering prevention and early detection services to their patients could be strengthened to ensure competence including reflection of risk factors and behaviours in a global context. Regular review of curricular guidelines and programme content would help dental hygienists meet the expectations of the Crete Declaration on Oral Cancer Prevention. [ABSTRACT FROM AUTHOR]

Contents Artificial breeding of mithun poses several challenges including lack of standard protocol for cryopreservation of spermatozoa. This is further complicated by harmful effects of hen's egg yolk ( EY) as additive in extender. Purified low-density lipoproteins ( LDL) extracted from EY have been shown as beneficial over EY extender for long-term semen storage in several species. This investigation explored use of LDL versus EY on semen quality and oxidative stress following freezing-thawing of spermatozoa. A total of 25 of 50 ejaculates based on biophysical parameters were selected for the experiment. After diluting with the Tris-citrate-glycerol ( TCG) extender, each sample was split into three equal aliquots: Group I, control, EY; Group II and Group III contained 8% and 10% purified LDL, respectively. Frozen-thawed samples were evaluated for motility parameters (progressive, and in the bovine cervical mucus penetration test [ BCMPT]), viability, sperm and nuclear abnormality, acrosome integrity, and enzymatic (leakage of intracellular contents) and biochemical (oxidative stress) profiles and in vitro fertility ( IVF) assay. Study revealed a significant ( p < .05) improvement in viability, sperm and nuclear abnormality, acrosome integrity, motility (progressive and in cervical mucus), cholesterol content, and reduction in the leakage of intracellular enzymes in Group II. Moreover, intactness of acrosome and biochemical membranes was protected significantly ( p < .05) in addition to significant ( p < .05) improvement in binding per cent and binding index in IVF assay in extender containing 8% LDL. These results demonstrate that although cryopreservation of mithun's spermatozoa in EY was comparable with other species, addition of 8% LDL holds a clear advantage over EY or 10% LDL. [ABSTRACT FROM AUTHOR]

The protein kinase C (PKC) signaling system plays a role in mood disorders and PKC inhibitors such as endoxifen may be an innovative medicine for bipolar disorder (BP) patients. In this study we show for the first time the antimanic properties of endoxifen in patients with bipolar I disorder (BPD I) with current manic or mixed episode. In a double-blind, active-controlled study, 84 subjects with BPD I were randomly assigned to receive endoxifen (4 mg/day or 8 mg/day) or divalproex in a 2:1 ratio. Patients orally administered 4 mg/day or 8 mg/day endoxifen showed significant improvement in mania assessed by the Young Mania Rating Scale as early as 4 days. The effect remained significant throughout the 21-day period. At study end point, response rates were 44.44% and 64.29% at 4 mg/day and 8 mg/day of endoxifen treatment, respectively. Thus, endoxifen has been shown as a promising novel antimanic or mood stabilizing agent. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) is of particular concern during pregnancy when not one, but two lives are at risk. Previous meta-analyses have suggested an association between IPV and adverse birth outcomes; however, many large studies have since been published, illustrating the need for updated pooled effect estimates.Objectives: To evaluate the relationship between IPV during pregnancy and the risk of preterm birth (PTB), low-birthweight (LBW), and small-for-gestational-age (SGA) infants.Search Strategy: We searched PubMed and SCOPUS (from inception until May 2015), and the reference lists of the relevant studies.Selection Criteria: Observational studies comparing the rates of at least one adverse birth outcome (SGA, LBW, or PTB) in women who experienced IPV during pregnancy and those who did not.Data Collection and Analysis: Data extracted from 50 studies were pooled and pooled odds ratios were calculated using random-effects models.Main Results: Intimate partner violence (IPV) was significantly associated with PTB (OR 1.91, 95% CI 1.60-2.29) and LBW (OR 2.11, 95% CI 1.68-2.65), although a large level of heterogeneity was present for both (I(2)  = 84 and 91%, respectively). The association with SGA was less pronounced and marginally significant (OR 1.37, 95% CI 1.02-1.84), although fewer studies were available for meta-analysis (n = 7).Conclusions: Our meta-analysis indicates that women who experienced IPV during pregnancy are at increased risk of having a PTB, and an LBW or an SGA infant. More studies examining the association between IPV and SGA are needed.Tweetable Abstract: Meta-analysis of IPV during pregnancy finds increased risk for preterm birth, LBW and SGA infants. [ABSTRACT FROM AUTHOR]

Epigenetic mechanisms, including DNA methylation, histone modifications, chromatin remodelling and microRNAs, convert environmental signals to transcriptional outputs but are commonly hijacked by pathogenic microorganisms. Recent advances in cancer epigenomics have shed new light on the importance of epigenetic deregulation in Helicobacter pylori- and Epstein-Barr virus ( EBV)-driven gastric tumourigenesis. Moreover, it is becoming apparent that epigenetic mechanisms interact through crosstalk and feedback loops, which modify global gene expression patterns. The SWI/ SNF remodelling complexes are commonly involved in gastric cancers associated with H. pylori or EBV through different mechanisms, including microRNA-mediated deregulation and genetic mutations. While H. pylori causes epigenetic silencing of tumour-suppressor genes to deregulate cellular pathways, EBV-positive tumours exhibit a widespread and distinctive DNA hypermethylation profile. Given the early successes of epigenetic drugs in haematological malignancies, further studies are mandated to enrich and translate our understanding of combinatorial epigenetic deregulation in gastric cancers into interventional strategies in the clinic. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives Review the meaning of 'health need', consider oral health inequalities and oral health promotion among people with HIV and outline methods to enhance coordination, standardization and dissemination of research efforts. Methods This workshop involved a brief introduction of each topic by an invited speaker followed by participant discussion. Participants were dentists and dental students attending the 7th World Workshop on Oral Health & Disease in AIDS Results A health need was regarded as a population's ability to benefit from care. Oral health inequalities called for both downstream and upstream health promotion. A community health programme to reach people with HIV infection in the community was described. Despite deploying community health workers to reduce costs, the programme required additional resources for comprehensive implementation. The Indian National AIDS Control Program exemplified coordinated efforts. Knowledge transfer can be achieved via educational, linkage and exchange and organizational interventions. Stakeholder engagement in a combination of all three types of intervention is the most effective. Conclusions The discussion centred on the difficulties of Indian dentists who felt they did not receive sufficient revenue to treat patients with HIV. An opposing view approach treated all patients using universal standards of infection control. Dental regulatory bodies, professional organizations and governments may need to demonstrate leadership and advocacy for the oral health of people with HIV infection. [ABSTRACT FROM AUTHOR]