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Many medical schools are instituting gender equity initiatives to address long-standing inequities (e.g., salary, leadership positions, resource distribution) between women and men in academic medicine. However, few theory-driven models exist with built-in metrics to assess the impact of gender equity initiatives. The authors describe the theory- and metric-driven process utilized to create the Center for Women in Medicine and Science (CWIMS) at the University of Minnesota Medical School (UMN). An innovative theory-driven approach using community-based participatory research (CBPR) was used to create and organize CWIMS. CBPR acknowledges community members (e.g., faculty members, staff), academic organizational representatives (e.g., department heads, center directors), and administrative leaders (e.g., deans) as equal contributors in carrying out all aspects of gender equity work. CBPR values collaborative approaches that empower faculty, promote co-learning and co-creation of initiatives among all university partners, and build upon already-existing community strengths and resources. Four CWIMS action groups were created utilizing CBPR principles. The action groups are retention and recruitment; mentoring; salary, resource, and leadership equity; and strategic communications and collaborations. Faculty members across all medical school departments joined these 4 action groups to co-create and carry out all CWIMS gender equity initiatives. The process of developing the CWIMS center and action groups, the CBPR theoretical model guiding the approach, the initiatives developed by the action groups and metrics created, and the outcomes achieved to date are described. In addition, 4 lessons learned from the development of the CWIMS-use of theoretically driven and evidence-based models is key to building a sustainable organization; bottom-up and top-down engagement of partners is crucial for sustainability; passion and innovation are critical for long-term momentum; and not all faculty members and leaders will be enthusiastic about gender equity issues-are shared for the benefit of other medical schools wanting to develop similar centers.

Objectives To explore the relationship between biomarkers of oxidative stress and inflmmation in cerebrospinal fluid (CSF) and cognitive function in children receiving maintenance therapy for acute lymphocytic leukemia (ALL). Sample & setting 30 participants aged 4-17 years receiving ALL maintenance therapy at two pediatric cancer centers in the United States. Methods & variables F2-isoprostane (F2-ISoP) and interleukin-8 (IL-8) were evaluated in CSF samples, and cognitive function measures were completed during the first and last cycles of ALL maintenance. The Flanker Inhibitory Control and Attention Test (Flanker) and Dimensional Change Card Sort were completed during the last cycle. Results During maintenance therapy, IL-8 decreased, and parent reports of children's cognitive function improved. Higher IL-8 was associated with better parent reports of children's cognitive function at each timepoint. Higher F2-ISoP levels were associated with lower Flanker scores. Implications for nursing F2-ISoP may be a useful biomarker in evaluating cognitive dysfunction in children with ALL and merits further investigation.

Background State-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningful weight loss, but only 30–60% achieve this goal. Developing adaptive interventions that change based on individual progress could increase the number of people who benefit. Purpose Conduct a Sequential Multiple Assignment Randomized Trial (SMART) to determine the optimal time to identify SBT suboptimal responders and whether it is better to switch to portion-controlled meals (PCM) or acceptance-based treatment (ABT). Method The BestFIT trial enrolled 468 adults with obesity who started SBT and were randomized to treatment response assessment at Session 3 (Early TRA) or 7 (Late TRA). Suboptimal responders were re-randomized to PCM or ABT. Responders continued SBT. Primary outcomes were weight change at 6 and 18 months. Results PCM participants lost more weight at 6 months (−18.4 lbs, 95% CI −20.5, −16.2) than ABT participants (−15.7 lbs, 95% CI: −18.0, −13.4), but this difference was not statistically significant (−2.7 lbs, 95% CI: −5.8, 0.5, p = .09). PCM and ABT participant 18 month weight loss did not differ. Early and Late TRA participants had similar weight losses (p = .96), however, Early TRA PCM participants lost more weight than Late TRA PCM participants (p = .03). Conclusions Results suggest adaptive intervention sequences that warrant further research (e.g., identify suboptimal responders at Session 3, use PCMs as second-stage treatment). Utilizing the SMART methodology to develop an adaptive weight loss intervention that would outperform gold standard SBT in a randomized controlled trial is an important next step, but may require additional optimization work. Clinical Trial information ClinicalTrials.gov identifier; NCT02368002

Background. The violation of the marginal tightness of composite restorations and the recurrence of the carious process remains relevant to this day, especially in persons with a decompensated form of caries activity. In this regard, of undoubted interest is the possibility of a wide preventive effect of individual oral hygiene products with a remineralizing effect, particularly those containing brushite crystals. Brushite crystals have unique adhesive properties and tropism to hydroxyapatite crystals on the enamel surface. The principal mechanism of action of the RemarsGel system is a chemical reaction that occurs when calcium nitrate from tube # 1 is mixed with ammonium hydrogen phosphate from tube # 2, as a result of which a brushite crystal is formed on the surface of the teeth. Material and methods. From a clinical point of view, this study compared the clinical efficacies of a standard prophylaxis program (using traditional fluoride-containing personal oral hygiene products) of carious recurrence in patients with a high degree of caries activity and a developed program for using a natural two-component complex to strengthen and remineralize RemarsGel enamel. The effectiveness of the applied technique was monitored using clinical research methods immediately after sanitation and 1, 12, and 36 months after it. Results. The high efficiency of brushite crystals was established in terms of preventing violations of the integrity of the enamelcomposite joint, which has a direct and immediate effect on the recurrence of the carious process. A statistically significant difference in the Ryge criteria was found between group Nos. 1 and 2. These results were confirmed by scanning electron microscopy and statistical processing of the research results. Conclusion. A scientifically based indication of the intended use of the system must be added to the list of main indications for use in the presence of a significant amount of adhesive restorations in the oral cavity, made using direct and indirect methods, especially with decompensate caries.

Survivors of childhood cancer may be at risk of experiencing pain, and a systematic review would advance our understanding of pain in this population. The objective of this study was to describe: 1) the prevalence of pain in survivors of childhood cancer, 2) methods of pain measurement, 3) associations between pain and biopsychosocial factors, and 4) recommendations for future research. Data sources for the study were articles published from January 1990 to August 2019 identified in the PubMed, PsycINFO, EMBASE, and Web of Science data bases. Eligible studies included: 1) original research, 2) quantitative assessments of pain, 3) articles published in English, 4) cancers diagnosed between birth and age 21 years, 5) survivors at 5 years from diagnosis and/or at 2 years after therapy completion, and 6) a sample size >20. Seventy-three articles were included in the final review. Risk of bias was considered using the Cochrane risk of bias tool. The quality of evidence was evaluated according to Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. Common measures of pain were items created by the authors for the purpose of the study (45.2%) or health-related quality-of-life/health status questionnaires (42.5%). Pain was present in from 4.3% to 75% of survivors across studies. Three studies investigated chronic pain according the definition in the International Classification of Diseases. The findings indicated that survivors of childhood cancer are at higher risk of experiencing pain compared with controls. Fatigue was consistently associated with pain, females reported more pain than males, and other factors related to pain will require stronger evidence. Theoretically grounded, multidimensional measurements of pain are absent from the literature.

We present a very rare case of right aortic arch with an isolated left brachiocephalic artery in a 35-year-old female. This entity is an extremely uncommon aortic arch anomaly which has associated multisystem symptoms. We briefly discuss the hypothetical double aortic arch model originally described by Edwards. The aortic embryology can explain the anatomic findings and imaging manifestations of the isolated left brachiocephalic artery. Multimodality imaging evaluation can be helpful in detection and categorization of aortic arch abnormalities. A diagnostic imaging approach should focus on elucidating the abnormal aortic arch and great vessels arrangement with determination of associated cardiac, vascular or visceral congenital abnormalities.

Background Peritoneal dialysis (PD) is increasingly used for long-term management of refractory congestive heart failure (CHF). Patients with severe CHF and ascites were treated with regular at-home abdominal paracentesis via Tenckhoff catheter. We investigated the outcome of those patients, aiming to identify potential prognostic factors for longer survival. Methods Patients with refractory CHF referred by cardiologists to the PD unit between years 2009 and 2019 and treated with regular at-home abdominal paracentesis via Tenckhoff catheter without peritoneal exchanges, were enrolled into this prospective observational study. Results From the total of 69 refractory CHF patients treated with PD, 18 (26%) were managed with regular at-home abdominal paracentesis via Tenckhoff catheter and improved without the need for peritoneal exchanges for fluid removal (no peripheral edema or pulmonary congestion) or for solutes removal. Median survival of severe CHF patients treated with abdominal paracentesis was 13.5 months (0-34 months). Long-term survivors demonstrated significant improvement in the New York Heart Association (NYHA) functional class, improvement in kidney function and decrease in serum C-reactive protein (CRP) and Brain natriuretic peptide (BNP) compared to their baseline status. A subgroup of patients with shorter survival were more likely to have evidence of liver cirrhosis and significantly lower serum sodium compared to patients with longer survival. Conclusions Refractory CHF patients with massive ascites could be successfully treated with regular at-home abdominal paracentesis via Tenckhoff catheter. This treatment provides a useful alternative to periodical percutaneous paracentesis on as-needed basis.

BACKGROUND Children undergoing treatment for acute lymphocytic leukemia (ALL) report co-occurring symptoms of fatigue, sleep disturbances, and depression as a symptom cluster. Physical activity (PA) may influence symptom severity and quality of life (QOL). OBJECTIVES This study examined changes in symptoms and QOL during ALL maintenance in children categorized by symptom cluster and explored the influence of PA and symptoms on QOL. METHODS Self-report of fatigue, sleep disturbance, and depression; QOL; and PA were measured at the beginning and end of maintenance in 42 children aged 3 to 18 years with ALL. Children were categorized into symptom cluster groups based on measurements at the beginning of maintenance. RESULTS Two latent classes of symptom clusters (low and high) were identified with significant differences between groups in symptoms at both the beginning and end maintenance (P < .01). Each group's symptom levels did not change during maintenance. Quality-of-life was different between groups at both time points (P < .01) and did not improve. Children with low symptoms and high PA at the beginning of maintenance had better QOL as treatment ended compared with the physically active high-symptom group and the inactive high-symptom group (P < .01). CONCLUSIONS Children with higher symptoms did not experience an improvement with time. Symptom and PA levels may influence QOL at the end of treatment. IMPLICATIONS FOR PRACTICE Maintenance therapy is a long time (1.5 years) in a child's life. Symptom assessment is needed early in maintenance; interventions are needed for children with high levels.

An increasing interest in a healthy lifestyle raises questions about optimal body weight. Evidently, it should be clearly discriminated between the standardised “normal” body weight and individually optimal weight. To this end, the basic principle of personalised medicine “one size does not fit all” has to be applied. Contextually, “normal” but e.g. borderline body mass index might be optimal for one person but apparently suboptimal for another one strongly depending on the individual genetic predisposition, geographic origin, cultural and nutritional habits and relevant lifestyle parameters—all included into comprehensive individual patient profile. Even if only slightly deviant, both overweight and underweight are acknowledged risk factors for a shifted metabolism which, if being not optimised, may strongly contribute to the development and progression of severe pathologies. Development of innovative screening programmes is essential to promote population health by application of health risks assessment, individualised patient profiling and multi-parametric analysis, further used for cost-effective targeted prevention and treatments tailored to the person. The following healthcare areas are considered to be potentially strongly benefiting from the above proposed measures: suboptimal health conditions, sports medicine, stress overload and associated complications, planned pregnancies, periodontal health and dentistry, sleep medicine, eye health and disorders, inflammatory disorders, healing and pain management, metabolic disorders, cardiovascular disease, cancers, psychiatric and neurologic disorders, stroke of known and unknown aetiology, improved individual and population outcomes under pandemic conditions such as COVID-19. In a long-term way, a significantly improved healthcare economy is one of benefits of the proposed paradigm shift from reactive to Predictive, Preventive and Personalised Medicine (PPPM/3PM). A tight collaboration between all stakeholders including scientific community, healthcare givers, patient organisations, policy-makers and educators is essential for the smooth implementation of 3PM concepts in daily practice.

To define positron emission tomography/computed tomography (PET/CT) imaging characteristics during follow-up of patients with metastatic breast cancer (MBC) treated with yttrium-90 (Y90) radioembolization (RE). From January 2011 to October 2017, 30 MBC patients underwent 38 Y90 glass or resin RE treatments. Pre-RE PET/CT was performed on average 51 days before RE. There were 68 PET/CTs performed after treatment. Response was assessed using modified PERCIST criteria focusing on the hepatic territory treated with RE, normalizing SUVpeak to the mean SUV of liver uninvolved by tumor. An objective response (OR) was defined as a decrease in SUVpeak by at least 30%. Of the 68 post-RE scans, 6 were performed at 0–30 days, 15 at 31–60 days, 9 at 61–90 days, 13 at 91–120 days, 14 scans at 121–180 days, and 11 scans at > 180 days after RE. Of the 30 patients, 25 (83%) achieved OR on at least one follow-up. Median survival was 15 months after the first RE administration. Highest response rates occurred at 30–90 days, with over 75% of cases demonstrating OR at that time. After 180 days, OR was seen in only 25%. There was a median TTP of 169 days among responders. In MBC, follow-up PET/CT after RE demonstrates optimal response rates at 30–90 days, with progression noted after 180 days. These results help to guide the timing of imaging and also to inform patients of expected outcomes after RE.

PURPOSE: Improved therapies for pediatric central nervous system (CNS) tumors have increased survival rates, however, many survivors experience significant long-term functional limitations. Survivors of pediatric CNS tumors can experience deficits in social attainment. The aim of this review was to systematically amalgamate findings pertaining to social attainment (i.e., educational attainment, marriage, employment outcomes) in survivors of pediatric CNS tumors. METHODS: PubMed(Web-based), PsycINFO(EBSCO), EMBASE(Ovid), and Web of Science(Thomson Reuters) were used to identify articles published between January 2011 and September 2018. Eligible studies reported outcomes for survivors of pediatric CNS tumors diagnosed before age 21 years, and >5 years from diagnosis and/or >2 years off therapy. All data were independently abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0. RESULTS: The search yielded 7,021 unique publications. Forty-six were included in the current review. Meta-analyses revealed survivors of CNS tumors were significantly more likely to have completed compulsory education only (OR = 1.87, 95% CI = 1.66, 2.12, p < 0.00001), less likely to be married (OR = 4.70, 95% CI = 3.89, 5.68, p

Intravital microscopy is widely used for in vivo studies of the mechanisms of carcinogenesis and response to antitumor therapy. For visualization of tumor cells in vivo, cell lines expressing fluorescent proteins are needed. Expression of exogenous proteins can affect cell growth rate and their tumorigenic potential. Therefore, comprehensive analysis of the morphofunctional properties of transduced cells is required for creating appropriate models of tumor microenvironment. In the present study, six lines of mouse tumor cells expressing green and red fluorescent proteins were derived. Analysis of cells morphology, growth kinetics, and response to chemotherapy in vitro revealed no significant differences between wild-type and transduced cell lines. Introduction of fluorescent proteins into the genome of 4T1 (murine breast cancer) and B16-F10 (murine melanoma) cells did not affect tumor growth rate after subcutaneous implantation to mice, while both CT26-GFP and CT26-RFP cells (murine colon cancer) were rejected starting from day 8 after implantation. Elucidation of the mechanisms underlying CT26-GFP/RFP rejection is required to modify transduction technique for creating the models of tumor microenvironment accessible for in vivo visualization. Transduced 4T1 and B16-F10 cell lines can be used for intravital microscopic imaging of tumor cells, neoplastic vasculature, and leukocyte subpopulations.

Biological neurons have adaptive nature and perform complex computations involving the filtering of redundant information. However, most common neural cell models, including biologically plausible, such as Hodgkin-Huxley or Izhikevich, do not possess predictive dynamics on a single-cell level. Moreover, the modern rules of synaptic plasticity or interconnections weights adaptation also do not provide grounding for the ability of neurons to adapt to the ever-changing input signal intensity. While natural neuron synaptic growth is precisely controlled and restricted by protein supply and recycling, weight correction rules such as widely used STDP are efficiently unlimited in change rate and scale. The present article introduces new mechanics of interconnection between neuron firing rate homeostasis and weight change through STDP growth bounded by abstract protein reserve, controlled by the intracellular optimization algorithm. We show how these cellular dynamics help neurons filter out the intense noise signals to help neurons keep a stable firing rate. We also examine that such filtering does not affect the ability of neurons to recognize the correlated inputs in unsupervised mode. Such an approach might be used in the machine learning domain to improve the robustness of AI systems., Comment: 24 pages, 10 figures

Acute pulmonary embolism (PE) is a significant cause of mortality and morbidity across the globe. Over the last few decades, there have been major therapeutic advances in acute PE management, including catheter-based therapy. However, the effectiveness of catheter-based therapy in acute PE is not supported by Level I evidence, making the use of this promising treatment rather controversial and ambiguous. In this paper, we discuss the risk stratification of acute PE and review the medical and endovascular treatment options. We also summarize and review the data supporting the use of endovascular treatment options in acute PE and describe the potential role of the PE response team.

Background Peritoneal dialysis (PD) is increasingly used for the long-term management of hypervolemic refractory congestive heart failure (CHF) patients, in particular when complicated by renal insufficiency. While PD has many advantages over hemodialysis (HD) in those patients, there is a controversy concerning survival superiority of PD compared with HD in this population. The aim of the study was to define typical patient profile and to compare outcomes of patients with CHF and renal failure treated with HD or PD. Methods This retrospective cohort study enrolled CHF patients treated with chronic PD or HD between the years 2009-2018. Information at dialysis initiation included age, gender, body weight, blood pressure, cause of renal disease, comorbidities, hospitalisations, echocardiographic and laboratory parameters. Survival was compared between PD and HD patients using a Kaplan-Meier model and Cox regression analysis. Results CHF patients treated with PD had significantly higher eGFR and lower systolic blood pressure compared with HD treated patients. Median survival time was 13.32 (7.08, 23.28) months in the PD group and 19.68 (9.48, 39.24) months in the HD group, P = .013. After adjustment for confounders the mortality risk amongst PD and HD patients was not significantly different: adjusted HR for death in PD vs HD patients was 1.44, P = .35 for 1- year and 1.69, P = .10 for 2-year mortality. Number of hospitalisations was similar in both groups. Conclusions CHF patient profile was different in PD and HD. Two modalities were equally effective in the treatment of patients with CHF and renal failure considering different patient characteristics.

Older people who live in the community and need assistance with daily activities are a unique group of patients to treat in the primary care (PC) setting. This study aimed to understand access-related PC needs and experiences of community-living people over 65 years of age receiving home-based assistance through the Home and Community Care (HACC) program in Melbourne, Australia. This descriptive qualitative study used thematic analysis of in-depth interviews with HACC program clients and assessment officers. Access-related needs and experiences were examined using the patient-centred access to care framework. Client (n = 11) and assessment officer (n = 4) interviews showed that community-living older people receiving home-based assistance from social services are able to find a GP according to their preferences; however, some challenges in access to comprehensive care exist. These challenges relate to regularity of PC attendance, out-of-pocket fees for specialist care and maintaining an enduring patient–GP relationship. GPs can play an important role in improving PC access for vulnerable older people. In particular, GPs can contribute to improving PC attendance and facilitating more affordable access to specialist care by improving systems to recall patients more regularly and developing explicit systems for linking vulnerable patients to affordable specialist services.

Background Deriving individual tumor genomic characteristics from patient imaging analysis is desirable. We explore the predictive value of 2-[18F]FDG uptake with regard to the KRAS mutational status of colorectal adenocarcinoma liver metastases (CLM). Methods 2-[18F]FDG PET/CT images, surgical pathology and molecular diagnostic reports of 37 patients who underwent PET/CT-guided biopsy of CLM were reviewed under an IRB-approved retrospective research protocol. Sixty CLM in 39 interventional PET scans of the 37 patients were segmented using two different auto-segmentation tools implemented in different commercially available software packages. PET standard uptake values (SUV) were corrected for: (1) partial volume effect (PVE) using cold wall-corrected contrast recovery coefficients derived from phantom spheres with variable diameter and (2) variability of arterial tracer supply and variability of uptake time after injection until start of PET scan derived from the tumor-to-blood standard uptake ratio (SUR) approach. The correlations between the KRAS mutational status and the mean, peak and maximum SUV were investigated using Student’s t test, Wilcoxon rank sum test with continuity correction, logistic regression and receiver operation characteristic (ROC) analysis. These correlation analyses were also performed for the ratios of the mean, peak and maximum tumor uptake to the mean blood activity concentration at the time of scan: SURMEAN, SURPEAK and SURMAX, respectively. Results Fifteen patients harbored KRAS missense mutations (KRAS+), while another 3 harbored KRAS gene amplification. For 31 lesions, the mutational status was derived from the PET/CT-guided biopsy. The Student’s t test p values for separating KRAS mutant cases decreased after applying PVE correction to all uptake metrics of each lesion and when applying correction for uptake time variability to the SUR metrics. The observed correlations were strongest when both corrections were applied to SURMAX and when the patients harboring gene amplification were grouped with the wild type: p ≤ 0.001; ROC area under the curve = 0.77 and 0.75 for the two different segmentations, respectively, with a mean specificity of 0.69 and sensitivity of 0.85. Conclusion The correlations observed after applying the described corrections show potential for assigning probabilities for the KRAS missense mutation status in CLM using 2-[18F]FDG PET images.

Objectives:Nontuberculous mycobacteria (NTM) infections pose a diagnostic challenge in peritoneal dialysis (PD) patients. In this study, we sought to identify findings that are suggestive of NTM infection in PD adult patients.Methods:All patients with NTM exit-site infection (ESI) with/without tunnel infection and peritonitis identified during the last decade in eight medical centers in Israel were included. Clinical, microbiological, and outcome data were collected and analyzed.Results:Thirty patients were identified; 16 had ESI (53%) and 14 had peritonitis (47%). Median age was 65 years (interquartile range 52–76). Abdominal pain and cloudy PD fluid were reported in all patients with peritonitis, whereas exit-site discharge and granulation tissue were common in patients with ESI. Fourteen patients (47%) had negative cultures prior NTM diagnosis, and isolation of diphtheroids or Corynebacterium spp. was reported in 9 of 30 patients (30%). Antimicrobial treatment prior to diagnosis was documented in 13 of 30 patients (43%). Delayed diagnosis was frequent. Treatment regimens and duration of therapy varied widely. In 26 of 30 (87%) patients, catheter was removed and 19 of 30 patients (63%) required permanent transition to hemodialysis. Two patients with peritonitis (2 of 14, 14%) and seven with ESI (7 of 16, 44%) were eligible for continuation of PD.Conclusions:Culture negative peritonitis, isolation of diphtheroids or Corynebacterium spp., previous exposure to antibiotics, and/or a refractory infection should all prompt consideration of PD-related NTM infection and timely workup. Catheter removal is recommended aside prolonged antimicrobial therapy. In select patients with ESI, continuation of PD may be feasible.

COVID-19 (Corona Virus Disease-19) is a zoonotic illness first reported in the city of Wuhan, China in December 2019, and is now officially a global pandemic as declared by the World Health Organization. The infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 infected patients can be asymptomatic carriers or present with mild-to-severe respiratory symptoms. Imaging, including computed tomography is not recommended to screen/diagnose COVID-19 infections, but plays an important role in management of these patients, and to rule out alternative diagnoses or coexistent diseases. In our multicenter case series, we outline the clinical presentations and illustrate the most common imaging manifestations in patients hospitalized with COVID-19.

Verbal communication is one of the most sophisticated human motor skills reflecting both—the mental and physical health of an individual. Voice parameters and quality changes are usually secondary towards functional and/or structural laryngological alterations under specific systemic processes, syndrome and pathologies. These include but are not restricted to dry mouth and Sicca syndromes, body dehydration, hormonal alterations linked to pubertal, menopausal, and andropausal status, respiratory disorders, gastrointestinal reflux, autoimmune diseases, endocrinologic disorders, underweight versus overweight and obesity, and diabetes mellitus. On the other hand, it is well-established that stress overload is a significant risk factor of cascading pathologies, including but not restricted to neurodegenerative and psychiatric disorders, diabetes mellitus, cardiovascular disease, stroke, and cancers. Our current study revealed voice perturbations under the stress overload as a potentially useful biomarker to identify individuals in suboptimal health conditions who might be strongly predisposed to associated pathologies. Contextually, extended surveys applied in the population might be useful to identify, for example, persons at high risk for respiratory complications under pandemic conditions such as COVID-19. Symptoms of dry mouth syndrome, disturbed microcirculation, altered sense regulation, shifted circadian rhythm, and low BMI were positively associated with voice perturbations under the stress overload. Their functional interrelationships and relevance for cascading associated pathologies are presented in the article. Automated analysis of voice recordings via artificial intelligence (AI) has a potential to derive digital biomarkers. Further, predictive machine learning models should be developed that allows for detecting a suboptimal health condition based on voice recordings, ideally in an automated manner using derived digital biomarkers. Follow-up stratification and monitoring of individuals in suboptimal health conditions are recommended using disease-specific cell-free nucleic acids (ccfDNA, ctDNA, mtDNA, miRNA) combined with metabolic patterns detected in body fluids. Application of the cost-effective targeted prevention within the phase of reversible health damage is recommended based on the individualised patient profiling.

Restorative filling materials used for dental caries prevention and treatment consist of various components including monomers or oligomers, which play a significant role in forming the main structure of these materials, as well as in characterising their physical, mechanical and chemical properties. The necessity for the development and improvement of structural characteristics of polymeric dental filling materials intended for caries prevention and their life duration increase served as the initiating factor of our research. According to the research purpose and challenges, we studied the changes in the physical, mechanical and chemical properties of composite filling materials with and without electromagnetic field influence. The investigations in vivo include the study of microstructural features of polymeric filling materials by scanning electron microscopy (SEM) and the investigations in vitro include the study of sealed and extracted human teeth chips by using X-ray spectral analysis. We also evaluated the changes in the strength characteristics of dental filling materials with and without electromagnetic field influence. The analysis of the obtained data indicates the presence of structural changes in polymeric dental filling materials, including the material microstructure condensation confirmed by the SEM results, an increase in the strength and adhesion characteristics and certain regularities of the chemical elemental composition concentration change in the area of hard tooth tissue and dental filling material. These scientific data will provide tooth caries prevention and promote the increase of treatment quality.

An endo-perio lesion is one of the more common tooth-related problems. An association between the presence of apical and marginal periodontitis is known in the literature and has been observed in 5.7% of individuals aged 40–45 years old. The purpose of the present article is to present three case reports describing the successful retreatment of endo-perio lesions. In each of these cases, we used a biologically active bioceramic root canal sealer, GuttaFlow Bioseal, which is a bioactive root canal filling material composed of gutta percha, polydimethylsiloxane, platinum catalyzer, zirconium dioxide, and bioglass. All cases were followed up clinically and radiographically for a period of at least 11 months.

The digitization of radiographic studies along with high-speed transmission of images has formed the basis of teleradiology, which has become an integral component in the workflow of a contemporary radiology practice. It is with this advent and growing utilization of teleradiology that the significance of the source location of images has gained importance. Specifically, the importance of where the patient resides and what endemic fungi occur in that location cannot be underestimated. In the United States, histoplasmosis, coccidioidomycosis, blastomycosis, and cryptococcosis are caused by endemic fungi occurring in the Ohio and Mississippi river valleys, the Southwest, the Upper Midwest, and the Pacific Northwest, respectively. All of these organisms enter the body through the respiratory system and have the potential to cause significant morbidity and mortality. Patients infected with these fungi are often asymptomatic but may present with acute flulike symptoms such as fever, cough, or dyspnea. Patients may also present with vague chronic symptoms including cough, fever, malaise, and weight loss. Thoracic manifestations at radiography and CT include consolidation, nodules, cavities, lymphadenopathy, and pleural disease. PET may show fluorine 18-fluorodeoxyglucose uptake with active acute or chronic infections, and it is difficult to distinguish infections from malignancy. Imaging findings may be nonspecific and can be confused with other disease processes, including malignancy. The patient demographics, clinical history, and location are clues that may lead to a proper diagnosis of endemic fungal disease. The radiologist should be cognizant of the patient location to provide a correct and timely radiologic diagnosis that helps guide the clinician to initiate appropriate therapy. ©RSNA, 2021.

Aim To determine (i) the proportion of different referral sources for new referrals to paediatric specialist outpatient clinics and (ii) any association of referral source with utilisation of additional health services. Methods Survey of parents presenting with their child at five paediatric specialist outpatient clinics at two Melbourne public hospitals. Results Just over half (52%) of the respondents were referred by a general practitioner (GP). The remainder were referred by a paediatrician (27%) at hospital discharge (16%) or from the ED (6%). Most respondents (71%) reported that their child also has a referral to see another specialist for the same health concern but had not yet had the consultation; 44% had consulted another doctor for the same health concern between receiving the referral and the appointment. Paediatrician referrals were more likely to see another specialist for the same health concern compared to other referral sources (P = 0.032). Conclusion Only half of the referrals of new patients to paediatric specialist outpatient clinics come from GPs. Future research should investigate whether multiple referral sources have a negative impact on the co-ordination and cost of paediatric health care.

Aim. To study clinical efficacy of chronic generalized periodontitis treatment in patients with infiltrative pulmonary tuberculosis with the use of α-lipoic acid. Methods. 50 patients with chronic generalized periodontitis and infiltrative pulmonary tuberculosis randomly divided into 2 groups were examined. The study group included 25 patients who had received α-lipoic acid «Octolipen» in complex treatment for 3 months. The comparison group included 25 patients who were administered complex treatment of tuberculosis and periodontitis without α-lipoic acid. All patients on admission and dynamically after 3 months of treatment had routine clinical studies, cytology analysis of capillary gingival blood and gingival fluid and cytokine status testing of oral fluid. Results. Patients with chronic generalized periodontitis combined with infiltrative pulmonary tuberculosis who received «Octopilen» had statistically significant positive dynamics of clinical signs and decrease of basic dental indices after 3 months of treatment compared to baseline data. Dynamics of IL-1β, tumor necrosis factor α and IL-4 revealed significant decrease of these cytokines concentration in gingival fluid in patients from both groups after 3 months of treatment. Conclusion. Inclusion of α-lipoic acid product to complex treatment of patients with chronic generalized periodontitis combined with infiltrative pulmonary tuberculosis leads to faster clinical remission.

Survival rates for children with Down syndrome (DS) and acute myeloid leukemia (AML) are high; however, little is known regarding the health-related quality of life (HR-QOL) of these survivors. Individuals who survived ≥5 years following diagnosis of childhood AML were invited to complete parent or patient-report surveys measuring HR-QOL and chronic health conditions. In total, 26 individuals with DS had a median age at diagnosis of 1.8 years (range, 0.77 to 10.9 y) and median age at interview of 15 years (range, 8.3 to 27.6 y). Participants with DS and AML were compared with AML survivors without DS whose caregiver completed a HR-QOL survey (CHQ-PF50). In total, 77% of survivors with DS reported ≥1 chronic health condition compared with 50% of AML survivors without DS (P=0.07). Mean physical and psychosocial QOL scores for children with DS and AML were statistically lower than the population mean, though not discrepant from AML survivors without DS. Although the overall prevalence of chronic health conditions in survivors with DS is higher than in survivors without DS, prior studies of children with DS have reported similarly high rates of chronic health conditions, suggesting that AML therapy may not substantially increase this risk.

Despite many protocols are proposed for STR analysis of old human remains, the question of preferential DNA source for successful genotyping is still open. Herein we compared STR typing efficiency in DNA samples extracted from different bones: tubular and flat bones, several vertebrae and coccyx from the World War II victim’s burials. Partial STR genotypes were obtained from all examined bones but we’ve got the complete genotypes profile in DNA samples extracted from the specific structure of the 2nd cervical vertebra – odontoid process. Furthermore, a histological analysis of its morphological structure showed some specific features such as distinguishable osteons within Haversian channels and the presence of lamellar structures that can create optimal conditions for DNA preservation in old human remains.

Objective: To compare birth and early developmental screening outcomes for infants with and without in utero cannabis exposures. Study design: Observational cohort of women receiving prenatal care within a large health system, live birth between10/1/15–12/1/17, and at least one infant visit. Cannabis exposure was through routine urine toxicology screen. Preterm birth, small for gestational age (SGA) birth, birth defects, and early developmental screening outcomes were assessed from birth and electronic health record data. Results: Of 3435 women, 283 (8.2%) had a positive urine toxicology screen. In utero cannabis exposure was associated with SGA birth, adjusted rate ratio (aRR) 1.69 (95% confidence interval [CI]: 1.22–2.34). Abnormal 12-month developmental screens occurred in 9.1% of infants with in utero cannabis exposure versus 3.6% of those with negative maternal screens, aRR 1.90 (95% CI: 0.92–3.91). Additional birth outcomes were not associated with in utero cannabis exposure. Conclusion: Exposure to cannabis during pregnancy may adversely impact fetal growth.

Background: Cardiac collagen remodeling is important in the progression of heart failure. Estimation of cardiac collagen turnover by serum levels of serological markers is used for monitoring cardiac tissue repair and fibrosis. Peritoneal dialysis (PD) is used for the long-term management of refractory congestive heart failure (CHF). In this study, we investigated the effect of PD treatment on circulating fibrosis markers levels in patients with refractory CHF and fluid overload. Methods: Twenty-five patients with refractory CHF treated with PD were prospectively enrolled in the study. Circulating fibrosis markers procollagen type III C-peptide (PIIINP), matrix metalloproteinase 2 (MMP-2), and tissue inhibitor of metalloproteinases I (TIMP-1) levels were checked at baseline and after three and six months of treatment. Results: The clinical benefit of PD manifested by improved NYHA functional class and reduced hospitalization rate. Serum brain natriuretic peptide (BNP) levels decreased significantly during the treatment. Serum MMP-2 and TIMP-1 decreased significantly on PD. Circulating PIIINP showed two patterns of change, either decreased or increased following PD treatment. Patients in whom circulating PIIINP decreased had significantly lower baseline serum albumin, lower baseline mean arterial blood pressure, higher serum CRP, and a less significant improvement in hospitalization rate compared to the patients in whom circulating PIIINP increased. Patients in whom all three markers decreased demonstrated a trend to longer survival compared to patients whose markers increased or did not change. Conclusion: In refractory CHF patients PD treatment was associated with a reduction in circulating fibrosis markers.

Background Refugees are one of the most vulnerable groups in our society. They are at risk of poor physical and mental health outcomes, much of this attributed to traumatic events prior to migration and the additional risk factors refugees face in the host nations. However, how migration factors shape the health of resettling refugees is not well understood. This study uses a mixed methods approach to examine how pre- and post-migration factors shape the self-rated health of resettling adult refugees in an effort to address the current knowledge gap. Methods This study will use a sequential explanatory mixed method study design. We begin by analyzing resettlement and health data from the ‘Building a New Life In Australia’ longitudinal study of humanitarian refugees resettled in Australia to identify significant associations between migration factors and refugee health. Then, a series of semi-structured interviews with resettled refugees will further explore the lived experiences of refugees with respect to the relationship between migration and refugee health. Finally, we will integrate both sets of findings to develop a detailed understanding of how and why migratory factors contribute to refugee health during resettlement. Discussion There is a paucity of studies that examine the multidimensional nature of refugee health during resettlement and as a result, little is understood about their resettlement health needs. This information is required to inform existing or new resettlement interventions to help promote or improve refugee health. To overcome these limitations in the research knowledge, this study will use a mixture of study methods to illustrate the complex and multifaceted determinants of refugee health during resettlement in Australia.

Background Refugees are potentially at an increased risk for health problems due to their past and current migration experiences. How migration factors shape refugee health is not well understood. We examined the association between migration factors and the self-rated general health of adult humanitarian refugees living in Australia. Methods We analyzed the first three waves of data from the ‘Building A New Life In Australia’ longitudinal survey of 2399 humanitarian refugees resettled in Australia. The study outcome was self-rated health measured by the 36-Item Short Form Health Survey. Predictors were migration process and resettlement factors. We used generalized linear mixed models to investigate the relationship between predictor and outcome variables. Results Poor general health persisted among this refugee population at high levels throughout the three-year follow-up. At baseline, 35.7% (95% CI: 33.8–37.7%) of the study population reported poorer general health. Female gender, increasing age and post-migration financial stressors were positively associated with poorer general health. Having a university degree and absence of chronic health conditions were seemingly protective against declining general health (OR: 0.50; 95% CI: 0.65–1.81 and OR: 0.15, 95% CI: 0.09–1.04, respectively). Conclusion Our results show that there is persisting high prevalence of poorer general health among adult refugees across the initial years of resettlement in Australia. This finding suggests unmet health needs which may be compounded by the challenges of resettlement in a new society, highlighting the need for increased clinical awareness of this sustained health burden to help inform and prepare refugee health care and settlement service providers. Electronic supplementary material The online version of this article (10.1186/s12939-019-1033-z) contains supplementary material, which is available to authorized users.

“Dry mouth” syndrome (chronic hyposalivation) can be caused by a number of pathophysiological conditions such as acute and chronic stress exposure, abnormal body weight (both – too high and too low), eating disorders (such as Anorexia nervosa), metabolic syndrome(s), Sjogren’s and Sicca syndromes, drugs and head/neck radiotherapy application. In turn, the chronic hyposalivation as a suboptimal health condition significantly reduces quality of life, may indicate a systemic dehydration, provoke and contribute to a number of pathologies such as a strongly compromised protection of the oral cavity, chronic infections and inflammatory processes, periodontitis, voice and digestive disorders, amongst others. Consequently, “dry mouth” syndrome might be extremely useful as an indicator for an in-depth diagnostics of both – co-existing and snowballing health-threating conditions. However, predictive diagnostics, targeted prevention and personalisation of treatments are evidently underdeveloped for individuals at high risk suffering from the “dry mouth” syndrome.

Background: Adult survivors of childhood cancers such as acute lymphoblastic leukemia (ALL) are at risk of overweight and related chronic morbidities. As childhood cancer survival has been improving, long-term quality of life (QOL) among cancer survivors becomes more important. We examined the association of body mass index with physical and psychosocial QOL among childhood ALL survivors who returned for long-term follow-up after end of therapy. Methods: Using a cross-sectional survey (2006-2012), we assessed the association between body mass index and quality of life in 58 long-term survivors of childhood ALL (ages 9 to 43 at the time of survey/measurement) using age-appropriate QOL instruments (Health-Related Quality of Life Short Form – SF-36 or Child Health Questionnaire-PF-50). Results: Half of the participants were overweight or obese at the time of survey. Mean QOL scores were similar to population norms. Compared to underweight/healthy weight status, being overweight/obese was not significantly associated with poorer physical QOL, but with poorer psychosocial QOL (47.1±13.2 vs. 54.0±6.0, P=0.01, effect size Cohen’s d=0.67), which remained statistically significant after adjusting for age and sex. Conclusions: Weight management should be the target of timely interventions among survivors of childhood ALL.

Purpose This study examined (1) the prevalence of anxiety and depressive symptoms among adolescents and young adults (AYA) with epilepsy and (2) demographic and medical characteristics, illness beliefs, and social factors associated with anxiety and depressive symptoms to guide intervention development. Methods A community-based sample of AYA with epilepsy (n = 179, ages 13–24 years, 39% male) completed online questionnaires measuring anxiety symptoms (GAD-7), depressive symptoms (PHQ-9), illness beliefs (helplessness; acceptance; perceived benefits), and social factors (family functioning; social stigma; connectedness). Participants also reported medical information (epilepsy type; years since diagnosis; time since last seizure; current medications). Results Prevalence of clinically significant symptoms of anxiety and depression, 36% and 35%, respectively, was high compared to population prevalence. In multivariable regression models, demographic and medical factors explained only 2% of the variance in depressive symptoms and 6% in anxiety symptoms. Illness beliefs and social factors accounted for a majority of the explanatory power of both models (partial R2 = 0.37 for anxiety; 0.44 for depression). Specifically, acceptance, family functioning, and social stigma accounted for the greatest variance (p’s Conclusions This study found a high prevalence of anxiety and depressive symptoms among AYA with epilepsy. Epilepsy variables (seizure type, medications, and years since diagnosis) were not associated with these psychological symptoms. Rather, the majority of variance in symptoms was accounted for by potentially modifiable beliefs and social factors. Interventions that promote illness acceptance, enhance family functioning, and reduce social stigma may ameliorate psychological distress among AYA with epilepsy.

Objectives To prospectively evaluate parent supportive behaviors (PSB) for child physical activity (PA) and neighborhood environment variables on changes in child PA over 3 years. Study design Secondary data analysis of the Now Everybody Together for Amazing and Healthful Kids-Works study with 534 parent-child (age 2-4 years) dyads randomized to a community-based pediatric obesity prevention intervention for 3 years (92% retention). PSB and neighborhood environmental variables were examined in relation to changes in child moderate-to-vigorous PA (MVPA), light and sedentary activity, and screen time. Child and parent accelerometry data were collected at visit 0, 12, 24, and 36 months. Mixed multivariate models were used to examine independent and interactive effects of parent-level and neighborhood-level variables on changes in child PA outcomes. Results PSB significantly interacted with visit on change in child MVPA (β = 0.12) and sedentary behaviors (β = -0.18). Over 3 years, a 1-unit increase in PSB was associated with an average increase of 4.3 minutes/day of MVPA and an average decrease of 6.5 minutes/day of sedentary time. Significant main effects were observed for PSB and 3-year change in child screen time (β = -0.05). The children of parents with higher PSB at baseline watched an average of 1.8 fewer minutes/day of screen time compared with parents with lower baseline PSB. Neighborhood-level variables were not significantly associated with changes in child PA outcomes. Conclusions Parents who increase their supportive behaviors for their child's PA have children who are more physically active and less sedentary over time. Interventions to increase preschool-age children's PA may enhance their effectiveness by targeting parents' supportive behaviors for their child's PA.