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Electronic cigarettes have increased in popularity globally. Vaping may be associated with oral symptoms and pathologies including dental and periodontal damage, both of which have an underlying microbial etiology. The primary aim of this pilot study, therefore, was to compare the oral microbiome of vapers and non-vapers.This secondary data analysis had a cross-sectional comparative descriptive design and included data for 36 adults. Bacterial 16S rRNA genes were extracted and amplified from soft tissue oral swab specimens and taxonomically classified using the Human Oral Microbiome Database.Data for 18 vapers and 18 non-vapers were included in this study. Almost 56% of the vapers also smoked conventional cigarettes. Beta diversity differences were identified between vapers and non-vapers. Vapers had a significantly higher relative abundance of an unclassified species of Veillonella compared with non-vapers. Dual users had higher alpha diversity compared with exclusive vapers. Beta diversity was also associated with dual use. Multiple OTUs were identified to be associated with dual use of e-cigarettes and conventional cigarettes.Vapers exhibit an altered oral microbiome. Dual use of electronic cigarettes and conventional cigarettes is associated with the presence of several known pathogenic microbes.

Due to lateral ligament laxity, bearing dislocation occurs in 1%–6% of Oxford Domed Lateral replacements. Most dislocations are medial but they do rarely occur anteriorly or posteriorly. The aim was to decrease the risk of dislocation. For a bearing to dislocate the femoral component has to be distracted from the tibial component. A robotic-path-planning-algorithm was used with a computer model of the implant in different configurations to determine the Vertical Distraction needed for Dislocation (VDD). With current components, VDD anteriorly/posteriorly was 5.5 to 6.5 mm and medially was 3.5 to 5.75 mm. A thicker bearing increased VDD medially and decreased VDD anteriorly/posteriorly (0.1 mm/1 mm thickness increase). VDD medially increased with the bearing closer to the tibial wall (0.5 mm/1 mm closer), or by increasing the tibial wall height (1 mm/1 mm height increase). VDD anteriorly/posteriorly was not influenced by bearing position or wall height. To prevent collision between the femoral and tibial components an increase in wall height must be accompanied by a similar increase in minimum bearing thickness. Increasing the wall height and minimum bearing thickness by 2 mm and ensuring the bearing is 4 mm or less from the wall increased the minimum VDD medially to 5.5 mm. The lower VDD medially than anteriorly/posteriorly explains why medial dislocation is more common. If the wall height is increased by 2 mm, the minimum bearing thickness is 5 mm and the surgeon ensured the bearing is 4 mm or less from the wall, the medial dislocation rate should be similar to the anterior/posterior dislocation rate, which should be acceptable.

This study aims to comprehensively review and update the literature concerning the correlates of sleep disturbance among caregivers of persons living with Alzheimer's disease and related dementias to identify gaps in the literature and antecedent targets for interventions.We searched PubMed, CINAHL, PsycINFO, and Embase using terms related to "sleep," "caregiver," and "dementia."Thirty-six articles were included in this review. Based on the antecedents within the 3P model of insomnia, predisposing factors associated with caregiver sleep included caregiver demographics, and physiological factors like genotype and biomarkers. Precipitating factors related to caregiver sleep included caregiving status and responsibilities, and person living with dementia factors.Sleep disturbance is a significant issue for caregivers of persons living with dementia. However, this review has identified multiple precipitating factors that are modifiable targets for interventions to improve or enhance caregiver sleep.Numerous predisposing and precipitating factors contribute to caregivers of persons living with dementia being susceptible to sleep disturbance. Healthcare providers should ask patients about their caregiving status during annual visits. Healthcare providers should also evaluate caregivers' sleep patterns, and the predisposing and precipitating factors of sleep disturbance, with a focus on the modifiable factors, to enable timely intervention.

Background Bearing dislocation is a problem following mobile bearing Oxford lateral Unicompartmental Knee Replacement (UKR). Therefore, the design of the tibial component was changed from a flat tibial surface to a domed tibial surface with a biconcave bearing to increase bearing entrapment. This systematic review compared the dislocation and revision rates of the two designs. Methods Two authors independently searched MEDLINE, EMBASE and ISI Web of Science, reference lists of retrieved articles, and the internet. Randomised, cohort, case-control and case studies of adult patients with lateral knee osteoarthritis treated with flat or domed Oxford lateral UKR and their outcomes were included. The overall dislocation rate and the annual revision rate (per 100 component years) were determined. Results Nine studies (937 knees) met the inclusion criteria (3 flat, 6 domed). Four studies (all domed) had a low risk of bias and five had a high risk (3 flat, 2 domed), so data should be interpreted with caution. The bearing dislocation rate decreased from 17% (flat) to 3.7% (domed). Dislocations occurred on average at 16 months and medial dislocations were most common. The revision rate excluding dislocation decreased from 1.1%pa to 0.7%pa. PROSPERO registration: CRD42019139250. Conclusion Modifying the tibial component from a flat to a domed shape decreased the bearing dislocation rate to 3.7% and increased the 10 year survival rate excluding dislocation to 93%. The dislocation rate is still relatively high so bearing stability should be assessed intra-operatively and if unacceptable, a fixed bearing version of the Oxford lateral tibial component can be inserted.

ObjectiveTo evaluate whether eculizumab helps patients with anti–acetylcholine receptor–positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension.MethodsPatients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study.ResultsA total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1–4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected.ConclusionEculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population.ClinicalTrials.gov IdentifierREGAIN, NCT01997229; REGAIN open-label extension, NCT02301624.Classification of EvidenceThis study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo.

AimsTo report mid- to long-term results of Oxford mobile bearing domed lateral unicompartmental knee arthroplasty (UKA), and determine the effect of potential contraindications on outcome.MethodsA total of 325 consecutive domed lateral UKAs undertaken for the recommended indications were included, and their functional and survival outcomes were assessed. The effects of age, weight, activity, and the presence of full-thickness erosions of cartilage in the patellofemoral joint on outcome were evaluated.ResultsMedian follow-up was seven years (3 to 14), and mean age at surgery was 65 years (39 to 90). Median Oxford Knee Score (OKS) was 43 (interquartile range (IQR) 37 to 47), with 260 (80%) achieving a good or excellent score (OKS > 34). Revisions occurred in 34 (10%); 14 (4%) were for dislocation, of which 12 had no recurrence following insertion of a new bearing, and 12 (4%) were revised for medial osteoarthritis (OA). Ten-year survival was 85% (95% confidence interval (CI) 79 to 90, at risk 72). Age, weight, activity, and patellofemoral erosions did not have a significant effect on the clinical outcome or survival.ConclusionDomed lateral UKA provides a good alternative to total knee arthroplasty (TKA) in the management of lateral compartment OA. Although dislocation is relatively easy to treat successfully, the dislocation rate of 4% is high. It is recommended that the stability of the bearing is assessed intraoperatively. If the bearing can easily be displaced, the fixed rather than the mobile bearing version of the Oxford lateral tibial component should be inserted instead. Younger age, heavier weight, high activity, and patellofemoral erosions did not detrimentally affect outcome, so should not be considered contraindications. Cite this article: Bone Joint J 2020;102-B(8):1033–1040.

Setting the stage for good oral health early in life is critical to long-term oral and overall health. This exploratory study aimed to characterize and compare maternal and newborn oral microbiota among mother-infant pairs. Oral samples were collected from 34 pregnant African American women and their infants at 1 to 3 months of age. Extracted 16SrRNA genes were matched to the Human Oral Microbiome Database. Alpha and beta diversity differed significantly between overall maternal and infant microbiomes. Maternal or infant alpha diversity, however, was not differentiated by maternal gingival status. Several demographic and behavioral variables were associated with, but not predictive of, maternal oral microbiome alpha diversity. There was no association, however, among birth mode, feeding mode, and the infant oral microbiome. Megasphaera micronuciformis was the only periodontal pathogen detected among the infants. Notably, maternal gingival status was not associated with the presence/absence of most periodontal pathogens. This study provides an initial description of the maternal and infant oral microbiomes, laying the groundwork for future studies. The perinatal period presents an important opportunity where perinatal nurses and providers can provide oral assessment, education, and referral to quality dental care.

Sulforaphane (SFN), a potent antioxidant and antiinflammatory agent, has been shown to protect against cancers especially at early stages. However, how SFN affects UVB-mediated epigenome/DNA methylome and transcriptome changes in skin photodamage has not been fully assessed. Herein, we investigated the transcriptomic and DNA methylomic changes during tumor initiation, promotion, and progression and its impact and reversal by SFN using next-generation sequencing (NGS) technology. The results show that SFN reduced tumor incidence and tumor number. SFN's protective effects were more dramatic in the early stages than with later stages. Bioinformatic analysis of RNA sequencing (RNA-seq) data shows differential expressed genes and identifies the top canonical pathways related to SFN treatment of UVB-induced different stages of epidermal carcinogenesis. These pathways include p53 signaling, cell cycle: G2–M DNA damage checkpoint regulation, Th1, and Th2 activation pathway, and PTEN signaling pathways. The top upstream regulators related to UVB and SFN treatment as time progressed include dextran sulfate, TP53, NFE2L2 (Nrf2), IFNB1, and IL10RA. Bioinformatic analysis of Methyl-seq data shows several differential methylation regions induced by UVB were attenuated by SFN. These include Notch1, Smad6, Gnai3, and Apc2. Integrative analysis of RNA-seq and DNA-seq/CpG methylome yields a subgroup of genes associated with ultraviolet B (UVB) and SFN treatment. The changes in gene expression were inversely correlated with promoter CpG methylation status. These genes include Pik3cd, Matk, and Adm2. In conclusion, our study provides novel insights on the impact of SFN on the transcriptomic and DNA methylomic of UVB-induced different stages of skin cancer in mice.

Oral health is an important component of maternal health. Pregnant women face unique oral health challenges. Although there is abundant evidence of the strong association between poor oral health and adverse pregnancy outcomes, oral health assessment is frequently overlooked by prenatal care providers. The purpose of this study was to test the reliability and validity of a brief maternal oral symptom survey for potential use by prenatal care providers to screen pregnant women for oral health concerns.This study provides results of preliminary psychometric testing of a brief maternal oral symptom survey. The survey was administered to 455 pregnant African American women at 2 time points: early pregnancy (8-14 weeks) and late pregnancy (24-30 weeks). Saliva samples were collected on a small subset of the larger sample (n = 34). Cronbach's alpha was used to measure the internal consistency of the survey. Content validity was assessed using an expert panel (n = 32), and criterion validity was assessed by testing the association of survey items with salivary biomarkers.The oral health survey showed moderate overall content validity. Scores on the content validity index identified that 5 out of 10 survey items were relevant, clear, and important. Log-transformed C-reactive protein levels were associated with reported "dry mouth" and education. Cronbach's alpha value was 0.502.Suggested revisions of the oral symptom survey include removing items that performed poorly on the content validity index and additional inclusion of sociodemographic variables. With further testing and validation, this survey has the potential to be an effective screening tool to assess for prenatal oral health concerns that increase risk for poor birth outcomes.

BACKGROUND: When the COVID-19 pandemic hit in 2020, researchers in the P30 Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions at Emory University’s Nell Hodgson Woodruff School of Nursing faced major challenges in recruitment and data collection due to limited access to the clinic and community facilities and the risk of COVID-19 exposure associated with in-person study contact. OBJECTIVES: The purpose of this paper is to (a) describe how a cadre of pilot/supplement principal investigators adapted their studies to allow for safe and trustworthy data collection during the COVID-19 pandemic (March 2020 through date of publication), and (b) discuss steps that facilitated the technical aspects of remote data collection, especially involving biological specimens. RESULTS: Four pilot studies and two administrative supplements within the center—all at different stages of execution—adopted various alternative remote recruitment, enrollment, and data and specimen collection approaches to continue their research endeavors in a way that maximized the safety of both the research participants and the research teams. DISCUSSION: The paper concludes with a discussion on the importance of a participant-centered approach when using remote methods, actions, or steps initiated to facilitate the technical aspects of remote data collection and reflections on the continued use of remote research strategies beyond the COVID-19 pandemic.

Electronic cigarette use is highest among adults of child-bearing age. Many parents that use electronic cigarettes believe that secondhand exposure of electronic cigarette vapors for their children is not dangerous and is less harmful than secondhand exposure to traditional cigarette smoke. These beliefs may prompt excessive secondhand exposure to electronic cigarette vapors for their children. Little research has been done to document exposure in children. The traditional biological method of exposure detection is through a blood draw, which is difficult and undesirable in children. The purpose of this study was to assess the feasibility of using saliva and exhaled breath condensate as non-invasive biomatrices for detecting secondhand electronic cigarette vapor exposure in children. In this cross-sectionally designed study, we recruited 22 children exposed to electronic cigarette vapors and 26 non-exposed between the ages of 4–12 years. We compared metabolic features across three biomatrices, blood, saliva, and exhaled breath condensate. We noted moderate to strong pairwise, sample-specific, and feature-specific adjusted correlations. Annotated features associated with direct and secondhand electronic cigarette exposure were noted. These results demonstrate that less invasive biomatrices may be used to detect features associated with secondhand electronic cigarette vapor exposure in children.

Introduction: Electronic cigarette (e-cigarette) use is becoming more prevalent and is particularly popular among adolescents and conventional smokers. While the oral health sequelae of conventional smoking are well-established, the impact of e-cigarettes on oral health is still unknown. This study aims to systematically review the available research evidence on the oral health impact of e-cigarette use.Methods: This systematic review was conducted according to PRISMA guidelines and used the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence. Three electronic databases (PubMed, Web of Science, and Embase) were systematically searched for studies including case reports. Two independent reviewers extracted data and synthesized the findings.Results: Ninety-nine articles were included in this systematic review. Analyses of the articles yielded seven categories based on symptom similarity and/or focus: mouth effects, throat effects, periodontal effects, dental effects, cytotoxic/genotoxic/oncologic effects, oral microbiome effects, and traumatic/accidental injury. The majority of mouth and throat symptoms experienced by e-cigarette users were relatively minor and temporary, with some evidence that conventional smokers who switched to e-cigarettes experienced mitigation of these symptoms. E-cigarette exposure increased the risk for deteriorating periodontal, dental and gingival health as well as changes to the oral microbiome. Extensive dental damage as a result of e-cigarette explosions were described in case reports. Components of e-cigarette vapor have known cytotoxic, genotoxic, and carcinogenic properties.Conclusions: Although switching to e-cigarettes may mitigate oral symptomatology for conventional smokers, findings from this review suggest that a wide range of oral health sequelae may be associated with e-cigarette use. Well-designed studies to investigate oral health outcomes of e-cigarette use are needed.

Exposure to ultraviolet B (UVB) irradiation results in multitude of cellular responses including generation of reactive oxygen species and DNA damage and is responsible for non-melanoma skin cancers (NMSCs). Although genetic mutation is well documented, the epi-mutation, the alteration in epigenetics, remains elusive. In this study, we utilized CpG Methyl-seq to identify a genome-wide DNA CpG methylation, to profile the DNA methylation in UVB-irradiated SKH-1 mouse skin epidermis and non-melanoma skin papillomas at various stages. Methyl-seq and RNA-seq were performed to examine the methylation and corresponding transcriptome alterations. The methylation profiles in mouse epidermis were altered by UVB-irradiation as time progresses. Ingenuity Pathways Analysis (IPA) identified many cancer related pathways including PTEN, p53, Nrf2 and inflammatory signaling in UVB-irradiation induced carcinogenesis. Additionally, some novel genes involved in skin carcinogenesis that were not previously reported were differentially methylated, including Enf2, Mgst2, Vegfa, and Cdk4. Taken together, the current study provides novel profiles and insights of methylation and transcriptomic changes at different stages of carcinogenesis in UVB-irradiation induced NMSC and offers potential targets for prevention and treatment of NMSC at different stages of human skin cancer.

Although male-female differences in placental structure and function have been observed, little is understood about their molecular underpinnings. Here, we present a mega-analysis of 14 publicly available placenta DNA methylation (DNAm) microarray datasets to identify individual CpGs and regions associated with fetal sex. In the discovery dataset of placentas from full term pregnancies (N = 532 samples), 5,212 CpGs met genome-wide significance (p ZNF300 that showed consistent differential DNAm in samples from earlier timepoints in pregnancy and appeared to be driven predominately by effects in the trophoblast cell type. We describe the largest study of fetal sex differences in placenta DNAm performed to date, revealing genes and pathways characterizing sex-specific placenta function and health outcomes later in life.

IntroductionThe 2019 novel coronavirus disease (COVID-19) pandemic has had devastating consequences in the US, yet clinical research on its natural history and transmission outside hospitalized settings has faced tangible and intangible challenges due to uncertainty in testing, case ascertainment, and appropriate safety measures. To better understand temporal evolution of COVID-19 related serological and other immune responses during a pandemic, we designed and implemented a baseline cross-sectional study of asymptomatic community volunteers and first responders in metro-Atlanta before the predicted infection peak in 2020.MethodsWe recruited healthy community volunteers and first responders for health history, serology, and biobanking. Through an iterative process, we identified one location on our campus and one community location which were accessible, vacant, distant from COVID-19 testing sites, open for social distancing, private for informed consent, and operational for sanitation and ventilation. Research and cleaning supplies were obtained from other researchers and private online vendors due to shortages, and faculty directly participated in consenting and phlebotomy.ResultsA total of 369 participants completed the study visits over six full and three half days. Over half of Phase 1 (174/299, 58.2%) and Phase 2 (45/70, 64.3%) self-reported as healthcare workers, and there was a high percentage of participants reporting exposure to known COVID-19 cases (48.2% and 61.4%).ConclusionsRigorous prospective clinical research with informed consents and is possible during a pandemic. Effective recruitment for moderately large sample size is facilitated by direct faculty involvement, connections with the community, and non-financial support from colleagues and the institution.

This article considers the human microbiome—the collective genetic material of the microbes that live on and in the human body—and its relationships to human health and disease. The article begins by reflecting on the technologies, both hardware and software, that have made possible the explosion of explorations of the human microbiome over the last decade. The article then reflects on the microbiome of four body sites: the skin, the vagina, the oral cavity, and the gut, and the contribution of the microbiome to health and disease in these four areas of the body. Major diseases of these areas in which the microbiome has a major role are discussed, including acne, atopic dermatitis, wound healing, bacterial vaginosis, Alzheimer's disease, preterm birth, periodontal disease, dental caries, metabolic disorders, and obesity. Linkages between the microbiome and inflammatory processes are described throughout these discussions. This article concludes with a short description of possible research avenues for applications of the strategies and systems biology tools to further elucidate the role of the human microbiome in health and disease.

Inflammation and immune mechanisms are believed to play important roles in Alzheimer's disease pathogenesis. Research supports the link between poor oral health and Alzheimer's disease. Periodontal disease and dental caries represent the two most common infections of the oral cavity. This study focused on a precursor to Alzheimer's disease, mild cognitive impairment (MCI). Using 16S rRNA sequencing, we characterized and compared the oral microbiome of 68 older adults who met the criteria for MCI or were cognitively normal, then explored relationships between the oral microbiome, diagnostic markers of MCI, and blood markers of systemic inflammation. Two taxa, Pasteurellacae and Lautropia mirabilis were identified to be differentially abundant in this cohort. Although systemic inflammatory markers did not differentiate the two groups, differences in five cerebrospinal fluid inflammatory mediators were identified and had significant associations with MCI. Because inflammatory markers may reflect CNS changes, pursuing this line of research could provide opportunities for new diagnostic tools and illuminate mechanisms for prevention and mitigation of Alzheimer's disease.

Dislocation of the bearing occurs in 1 - 6% of Oxford Domed Lateral (ODL) mobile bearing unicompartmental knee replacements (UKRs). Dislocations occur in flexion as the lateral ligaments are lax in this position allowing the knee to distract. Anterior and posterior dislocations are rare: clinically, their dislocation rates are acceptable. Most dislocations tend to occur medially, with the bearing sitting on top of the tibial wall. Using robotics path planning algorithms and a modified Open Motion Planning Library (OMPL) Graphical User Interface (GUI), a dislocation analysis tool was developed to assess the minimum amount of vertical distraction of the femoral component relative to the tibial component required for the mobile bearing to dislocate. In the tool, the Rapidly- exploring Random Trees (RRT) algorithm was applied to the mobile bearing, which enabled autonomous movement of the bearing from a non-dislocated to a dislocated position. Testing increased the relative distance between the femoral component and the tibial component: vertically (2-6 mm) and mediolaterally (0-4 mm) in 0.25 mm increments resulting in a total of 289 configurations. For each configuration, the tool assessed whether mobile bearing dislocation was possible (either medially, laterally, anteriorly or posteriorly). For each mediolateral translation distance, the minimum vertical distraction required for dislocation was recorded. To validate the tool, dislocation results were compared to measurements taken using a custom-built mechanical rig. The minimum amount of distraction required for medial dislocation was similar for the dislocation analysis tool (3.75 to 4.75 mm) as compared to a custom-built mechanical rig (2.5 to 4 mm). The amount of distraction for a medial dislocation was much smaller than that for an anterior or posterior dislocation (6 to 6.25 mm). This explains why medial dislocations are more common. Future work will use this tool to inform implant design, with the aim to reduce the risk of medial dislocation to match that of anterior/posterior dislocation, which is clinically acceptable.

To report mid- to long-term results of Oxford mobile bearing domed lateral unicompartmental knee arthroplasty (UKA), and determine the effect of potential contraindications on outcome.A total of 325 consecutive domed lateral UKAs undertaken for the recommended indications were included, and their functional and survival outcomes were assessed. The effects of age, weight, activity, and the presence of full-thickness erosions of cartilage in the patellofemoral joint on outcome were evaluated.Median follow-up was seven years (3 to 14), and mean age at surgery was 65 years (39 to 90). Median Oxford Knee Score (OKS) was 43 (interquartile range (IQR) 37 to 47), with 260 (80%) achieving a good or excellent score (OKS34). Revisions occurred in 34 (10%); 14 (4%) were for dislocation, of which 12 had no recurrence following insertion of a new bearing, and 12 (4%) were revised for medial osteoarthritis (OA). Ten-year survival was 85% (95% confidence interval (CI) 79 to 90, at risk 72). Age, weight, activity, and patellofemoral erosions did not have a significant effect on the clinical outcome or survival.Domed lateral UKA provides a good alternative to total knee arthroplasty (TKA) in the management of lateral compartment OA. Although dislocation is relatively easy to treat successfully, the dislocation rate of 4% is high. It is recommended that the stability of the bearing is assessed intraoperatively. If the bearing can easily be displaced, the fixed rather than the mobile bearing version of the Oxford lateral tibial component should be inserted instead. Younger age, heavier weight, high activity, and patellofemoral erosions did not detrimentally affect outcome, so should not be considered contraindications. Cite this article

Despite advances in modern surgery, congenital heart disease remains a medical challenge and major cause of infant mortality. Valved conduits are routinely used to surgically correct blood flow in hearts with congenital malformations by connecting the right ventricle to the pulmonary artery (RV-PA). This review explores the current range of RV-PA conduits and describes their strengths and disadvantages. Homografts and xenografts are currently the primary treatment modalities, however both graft types have limited biocompatibility and durability, and present a disease transmission risk. Structural deterioration of a replaced valve can lead to pulmonary valve stenosis and/or regurgitation. Moreover, as current RV-PA conduits are of a fixed size, multiple subsequent operations are required to upsize a valved conduit over a patient's lifetime. We assess emerging biomaterials and tissue engineering techniques with a view to replicating the features of native tissues, including matching the durability and elasticity required for normal fluid flow dynamics. The benefits and limitations of incorporating cellular elements within the biomaterial are also discussed. Present review demonstrates that an alignment of medical and engineering disciplines will be ultimately required to produce a biocompatible and high-functioning artificial conduit.

Background Oral factor Xa inhibitors (OFXais) may interfere with the heparin antifactor Xa (antiXa) assay. The best method to measure heparin activity during the transition from an OFXai to intravenous (IV) unfractionated heparin (UFH) remains unknown. This study aimed to assess the safety and effectiveness of transitioning from an OFXai to UFH. Methods A retrospective analysis was conducted of patients with supratherapeutic antiXa levels on UFH who received either apixaban or rivaroxaban within 72 h prior to UFH initiation at NYU Langone Health (NYULH). The primary objective was to identify the incidence of interference on the heparin antiXa assay due to OFXai exposure in the previous 72 h. The secondary outcomes included the indication for transition to UFH and the rate of thromboembolic and bleeding events. Results A total of 93 patients with supratherapeutic antiXa activity levels with prior OFXai use were reviewed. Moderate renal impairment, defined as CrCl less than 49 mL/min, was present in 67 (72%) patients. The primary indication for transition from OFXai to UFH was in anticipation for a procedure, and it occurred in 37 (40%) patients. There were three major bleeding events and three clinically relevant non-major bleeding events. No thromboembolic events occurred. Conclusions This study assessed the prevalence of supratherapeutic antiXa levels and clinical outcomes during the transition from OFXais to UFH. Healthcare systems should develop guidelines to assist clinicians in monitoring antiXa activity in patients undergoing a transition from an OFXai to UFH. It is also important to assess the patient's underlying thromboembolic and bleeding risks.

Background: The maternal microbiome is a key contributor to the development and outcomes of pregnancy and the health status of both mother and infant. Significant advances are occurring in the science of the maternal and child microbiome and hold promise in improving outcomes related to pregnancy complications, child development, and chronic health conditions of mother and child. Objectives: The purpose of this study was to review site-specific considerations in the collection and storage of maternal and child microbiome samples and its implications for nursing research and practice. Approach: Microbiome sampling protocols were reviewed and synthesized. Precautions across sampling protocols were also noted. Results: Oral, vaginal, gut, placental, and breast milk are viable sources for sampling the maternal and/or child microbiome. Prior to sampling, special considerations need to be addressed related to various factors including current medications, health status, and hygiene practices. Proper storage of samples will avoid degradation of cellular and DNA structures vital for analysis. Discussion: Changes in the microbiome throughout the perinatal, postpartum, and childhood periods are dramatic and significant to outcomes of the pregnancy and the long-term health of mother and child. Proper sampling techniques are required to produce reliable results from which evidence-based practice recommendations will be built. Ethical and practical issues surrounding study design and protocol development must also be considered when researching vulnerable groups such as pregnant women and infants. Nurses hold the responsibility to both perform the research and to translate findings from microbiome investigations for clinical use.

The terminal complement inhibitor eculizumab was shown to improve myasthenia gravis-related symptoms in the 26-week, phase 3, randomized, double-blind, placebo-controlled REGAIN study (NCT01997229). In this 52-week sub-analysis of the open-label extension of REGAIN (NCT02301624), eculizumab's efficacy and safety were assessed in 11 Japanese and 88 Caucasian patients with anti-acetylcholine receptor antibody-positive refractory generalized myasthenia gravis. For patients who had received placebo during REGAIN, treatment with open-label eculizumab resulted in generally similar outcomes in the Japanese and Caucasian populations. Rapid improvements were maintained for 52 weeks, assessed by change in score from open-label extension baseline to week 52 (mean [standard error]) using the following scales (in Japanese and Caucasian patients, respectively): Myasthenia Gravis Activities of Daily Living (-2.4 [1.34] and - 3.3 [0.65]); Quantitative Myasthenia Gravis (-2.9 [1.98] and - 4.3 [0.79]); Myasthenia Gravis Composite (-4.5 [2.63] and - 4.9 [1.19]); and Myasthenia Gravis Quality of Life 15-item questionnaire (-8.6 [5.68] and - 6.5 [1.93]). Overall, the safety of eculizumab was consistent with its known safety profile. In this interim sub-analysis, the efficacy and safety of eculizumab in Japanese and Caucasian patients were generally similar, and consistent with the overall REGAIN population. ispartof: JOURNAL OF THE NEUROLOGICAL SCIENCES vol:407 ispartof: location:Netherlands status: published

Introduction Hypoglycemia is a common adverse effect when intravenous (IV) insulin is administered for hyperkalemia. A prolonged infusion of dextrose 10% (D10) may mitigate hypoglycemia compared to dextrose 50% (D50) bolus. Our objective was to evaluate whether D10 infusion is a safe and effective alternative to D50 bolus for hypoglycemia prevention in hyperkalemic patients receiving IV insulin. Methods We conducted a retrospective review of patients ≥ 18 years who presented to the emergency department (ED) with hyperkalemia (K+ > 5.5) and received IV insulin and D10 infusion or D50 bolus within 3 h. The primary endpoint was incidence of hypoglycemia, defined as blood glucose (BG) ≤ 70 mg/dL, in the 24 h following IV insulin administration for hyperkalemia. Results A total of 134 patients were included; 72 in the D50 group and 62 in the D10 group. There was no difference in incidence of hypoglycemia between the D50 and D10 groups (16 [22%] vs. 16 [26%], p = 0.77). Symptomatic hypoglycemia, severe hypoglycemia, and hyperglycemia rates in the D50 and D10 groups were [5 (7%) vs. 2 (3%), p = 0.45], [5 (7%) vs. 1 (2%), p = 0.22], and [34 (47%) vs. 23 (37%), p = 0.31] respectively. Low initial BG was a predictor for developing hypoglycemia. Conclusions In our study, D10 infusions appeared to be at least as effective as D50 bolus in preventing hypoglycemia in hyperkalemic patients receiving IV insulin. In context of ongoing D50 injection shortages, D10 infusions should be a therapeutic strategy in this patient population.

Socioeconomically disadvantaged pregnant women are especially at risk for smoking. To understand better this health behavior disparity, this systematic, integrative, comprehensive review aimed to identify factors related to prenatal smoking among socioeconomically disadvantaged women in the United States. A comprehensive literature search yielded 67 articles published between 2008 and 2016. Associated factors included any study variable related to persistent prenatal smoking. The Social Ecological Model (SEM), a multidimensional ecological framework, was used to organize the findings. Thirty-eight factors were explored in the reviewed studies and categorized according to SEM dimensions: individual, interpersonal, organizational, community, public policies and laws. At the individual level, most studies identified the socioeconomically disadvantaged prenatal smoker as older, US-born, White, unmarried, and multiparous. Other individual-level factors included alcohol abuse, nicotine dependence, and psychosocial factors such as stress and depressive symptoms. For broader levels of the SEM, associated factors included abuse/trauma, secondhand smoke exposure, lack of prenatal care, smoking cessation interventions, neighborhood risk, and state level initiatives such as cigarette taxes. The results of this review suggested multiple directions for future research to move science toward effective, scalable, and sustainable approaches that effectively address prenatal smoking among socioeconomically disadvantaged women.

Background: Low-income, unemployed women with low levels of education are more likely to smoke during pregnancy compared to their higher-income, employed, and well-educated counterparts. The reserve capacity model (RCM) offers a theoretical framework to explain how psychosocial factors may serve as pathways connecting socioeconomic status (SES) to health behaviors. Research supports the link between prenatal smoking and several psychosocial variables such as chronic stressors, depressive symptoms, and social support. How these variables interrelate to explain the predominance of prenatal smoking in lower socioeconomic groups of pregnant women has not been fully elucidated. Objective: The aim of this study was to test the RCM to evaluate the roles of early pregnancy levels of chronic stress, quality of the primary intimate relationship, and depressive symptoms in explaining the relationship between SES and persistent prenatal smoking. Methods: A secondary analysis of data from 370 pregnant nonsmokers, spontaneous quitters, and persistent prenatal smokers was conducted. On the basis of the RCM, chronic stressors, depressive symptoms, and the quality of the primary intimate relationship were evaluated as potential mediating variables linking SES with persistent prenatal smoking using path analysis. Results: Path analyses indicated that a simple model with all three psychosocial variables as mediators of the relationship between SES and persistent prenatal smoking provided the best fit. Discussion: Findings indicated that chronic stressors, depressive symptoms, and the quality of the primary intimate relationship play important roles in the pathway from SES to prenatal smoking status. This knowledge can assist in the development of prevention and intervention strategies to target these variables and ultimately reduce prenatal smoking.

This integrative review provides an overview of nicotine dependence measures used with perinatal women and an evaluation of their psychometric properties. Fifty-five articles that met inclusion and exclusion criteria were identified from five different databases. Most of the studies used the Fagerström Test for Nicotine Dependence (FTND). Other approaches included diagnostic tests, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), the Tobacco Dependence Screener, and single-item measures. This review indicated that the FTND may not be the best option for measuring nicotine dependence in this population. The WISDM is a newer instrument that has excellent psychometric properties and captures nonnicotinic dimensions of nicotine dependence relevant to women. Future research is needed to assess its reliability in the perinatal population. Other recommendations from this review include the use of biomarker validation, thorough psychometric reporting on nicotine dependence instruments, and the use of multiple instruments to maximize comparability between nicotine dependence instruments.

Objective To generate preliminary data about the subgingival microbiome of pregnant African American women to calculate power for a future larger study and to explore associations among the microbiome, periodontal inflammation, and preterm birth. Design Comparative descriptive pilot study design. Setting Urban area in the southeastern United States. Participants Thirty-four African American women in the third trimester of pregnancy. Methods Based on visual assessment, participants were placed in two groups: healthy gingiva and gingivitis. Saliva samples were analyzed for interleukin-1β (IL-1β), matrix metalloproteinase–8 (MMP-8), and C-reactive protein (CRP). DNA was extracted from subgingival plaque samples, and amplicons of the fourth hypervariable region were sequenced. Results We found no differences in overall microbiome diversity between the healthy gingiva (n = 22) and the gingivitis (n = 12) groups although significant differences were found among the bacterial taxa present. The gingivitis group had greater levels of salivary IL-1β and MMP-8, whereas CRP was not different between groups. Overall microbiome diversity was positively associated with the CRP level. We found no significant relationships among the subgingival microbiome, periodontal inflammation, and preterm birth. Conclusion Gingivitis in pregnancy did not appear to shift the overall composition or diversity of the subgingival microbiome although differences in several bacterial taxa suggest that inflamed gingiva in pregnant women are associated with a disruption in the stability of the subgingival microbiome. A correlation between the abundance of bacteria and CRP also suggests an association between the microbiome and systemic inflammation. These findings provide support for future research about how the oral microbiome and progression of periodontal disease in pregnant women link with adverse pregnancy outcomes.

Nuclear factor erythroid-2-related factor-2 (Nrf2 or NFE2L2) is a master regulator of the anti-oxidative stress response, which is involved in the defense against many oxidative stress/inflammation-mediated diseases, including anticancer effects elicited by an increasing number of natural products. Our previous studies showed that the epigenetic modification of the Nrf2 gene plays a key role in restoring the expression of Nrf2. In this study, we aimed to investigate the epigenetic regulation of Nrf2 by astaxanthin (AST) and fucoxanthin (FX), carotenoids which are abundant in microalgae and seaweeds, in mouse skin epidermal JB6 P+ cells. FX induced the anti-oxidant response element (ARE)-luciferase and upregulated the mRNA and protein levels of Nrf2 and Nrf2 downstream genes in HepG2-C8 cells overexpressing the ARE-luciferase reporter. Both FX and AST decreased colony formation in 12-Otetradecanoylphorbol-13-acetate (TPA)-induced transformation of JB6 P+ cells. FX decreased the methylation of the Nrf2 promoter region in the JB6 P+ cells by the bisulfite conversion and pyrosequencing. Both FX and AST significantly reduced DNA methyltransferase (DNMT) activity but did not affect histone deacetylase (HDAC) activity in JB6 P+ cells. In summary, our results show that FX activates the Nrf2 signaling pathway, induces the epigenetic demethylation of CpG sites in Nrf2 and blocks the TPA-induced transformation of JB6 P+ cells, indicating the potential health-promoting effects of FX in skin cancer prevention.

Based on the rapidly growing use of social media and its influence on society an online survey to explore social media use and perceptions of social support was developed. A survey link or QR, quick read code was provided to new mothers in the postpartum setting of an academic medical center, posted on the hospital hosted website for new mothers and shared with Centering Pregnancy groups at the research hospital. The survey link was available for 4 weeks and 117 mothers from 64 different zip codes across the United States completed the survey. The majority of respondents indicated the main source of social support came from their current partner (92%). In addition, 43% used blogs to communicate with other mothers, 99% used the internet for answers to parenting questions, 89% used social media sites for questions and advice related to pregnancy and/or their role as a parent, and 84% considered social media friends a form of social support. These results demonstrate social media plays a substantial role in the lives of mothers today. Providers of healthcare should become familiar and comfortable with social media resources to support mothers of young children.

In this digital age, universities shift their teaching and learning from conventional to blended learning utilizing various state-of-the-art digital technologies. Thus, online video-based teaching and learning have also gained its popularity among educators to facilitate the students’ learning. However, little research has been conducted on learner-produced-videos-based approach. Therefore, this research investigates and designs an innovative student-centered learning approach through collaborative production of mathematics screencast videos. A survey was also conducted to understand the learners’ perceptions in terms of benefits, challenges, motivation, sharing platform, and effectiveness of learning. This paper discusses the design, methodology, evaluation, and findings of the study conducted.

Purpose To compare inpatient postpartum current and former smokers on: need for smoking cessation assistance; cessation interventions received from healthcare providers; cessation methods used; perceived barriers of cessation; exposure to second hand smoke (SHS); interest in postdischarge interventions; and smoking abstinence self-efficacy (SASE). Study design and methods A descriptive comparative study was conducted using a cross-sectional survey of 24 postpartum women in the inpatient setting. Surveys were administered by face-to-face interview, with a paper-and-pencil option, and included questions from the Pregnancy Risk Assessment Monitoring System and the SASE Scale. Results Women were predominantly low-income, unemployed, and Medicaid insured. Two-thirds of current smokers indicated that they needed help with smoking cessation. Most women in both groups received advice to quit smoking. Fewer, however, received specific types of assistance to stop smoking. The predominant smoking cessation method attempted in both groups was the "cold turkey" method. More former smokers than current smokers maintained a nonsmoking home environment. More current smokers than former smokers were interested in postdischarge interventions. Clinical implications Current smokers need help quitting smoking and former smokers need postpartum relapse interventions. Providers should be intentional about offering existing interventions to help women quit smoking. Affordable and accessible interventions are needed that address unique stressors experienced by women, which include screening for depression and anxiety, and that incorporate smoking cessation interventions for spouses and partners who smoke. Cessation and relapse prevention interventions for postpartum women should start in the postpartum inpatient period and continue after discharge.