Notes

Views of teenage along with young adult most cancers heirs: review of community-based user discussion forums.
While no clear objective function emerges, we find that, as the medium gets richer, the fitness and inferred variability for Escherichia coli populations follow and slowly approach the theoretically optimal bound defined by minimal reduction of variability at given fitness. These results suggest that bacterial metabolism may be crucially shaped by a population-level trade-off between growth and heterogeneity.Fengycins are a class of antifungal lipopeptides synthesized by the bacteria Bacillus subtilis, commercially available as the primary component of the agricultural fungicide Serenade. They are toxic to fungi but far less to mammalian cells. One key difference between mammalian and fungal cell membranes is the presence of cholesterol only in the former; recent experimental work showed that the presence of cholesterol reduces fengycin-induced membrane leakage. Since our previous all-atom and coarse-grained simulations suggested that aggregation of membrane-bound fengycin is central to its ability to disrupt membranes, we hypothesized that cholesterol might reduce fengycin aggregation. Here, we test this hypothesis using coarse-grained molecular dynamics simulations, with sampling enhanced via the weighted ensemble method. The results indicate that cholesterol subtly alters the size distribution for fengycin aggregates, limits the lateral range of their membrane disordering, and reduces the ability of aggregates to bend the membrane. Taken together, these phenomena may account for cholesterol's effects on fengycin activity.In epithelial-mesenchymal transition (EMT), cells organized into sheets break away and become motile mesenchymal cells. EMT plays a crucial role in wound healing, embryonic development, and cancer metastasis. Intracellular signaling in response to mechanical, topographic, or chemical stimuli can promote EMT. We present a multiscale model for EMT downstream of the protein YAP, which suppresses the cell-cell adhesion protein E-cadherin and activates the GTPase Rac1 that enhances cell migration. We first propose an ordinary differential equation (ODE) model for intracellular YAP/Rac1/E-cadherin interactions. The ODE model dynamics are bistable, accounting for both motile loose cells and adherent slower cells. We incorporate this model into a cellular Potts model simulation of two-dimensional wound healing using the open-source platform Morpheus. We show that, under suitable stimuli representing topographic cues, the sheet exhibits finger-like projections and EMT. Morphological differences and quantitative differences in YAP levels as well as variations in cell speed across the sheet are consistent with previous experimental observations of epithelial sheets grown on topographic features in vitro. The simulation is also consistent with experiments that knock down or overexpress YAP, inhibit Rac1, or block E-cadherin.
The presence of 2 or more high-risk cytogenetic abnormalities on FISH characterizes patients as Double/Triple Hit Myeloma (DH/THM). This entity has poorer outcomes, though data from the real-world setting is scarce.

We retrospectively analyzed all MM patients presenting to our hospital over 3 years to study the clinical characteristics and outcomes with DH/THM.

Fifty-five (19.2%) of 285 newly-diagnosed MM patients had DH/THM. The most common cytogenetic abnormality was increased copies of chromosome 1q (53 patients, 96.4%)- 22 patients had 3 copies, and 31 patients had 4 or more copies. The most common cytogenetic combination was IgH-FGFR3 translocation, increasing 1q copy number (28 patients; 50.9%). The disease was characterized by aggressive presentation, with 9 patients (16.4%) dying in the first month after diagnosis, and 7 patients (12.7%) dying in the second month. Only 22 patients (40%) achieved a VGPR or better with therapy. The Median EFS and OS for the cohort were 8 months and thirteen months, respectively. On multi-variate analysis, renal failure and plasma cell leukemia were associated with increased mortality risk, while achievement of VGPR or better was associated with better survival.

Our findings suggest that multiple myeloma patients with double/triple hit cytogenetics on FISH have aggressive presentations, high early mortality, and poor outcomes. These patients may benefit from more aggressive regimens and better supportive care.
Our findings suggest that multiple myeloma patients with double/triple hit cytogenetics on FISH have aggressive presentations, high early mortality, and poor outcomes. These patients may benefit from more aggressive regimens and better supportive care.
The aim of this multicentric study was to assess the diagnostic accuracy of a telediagnosis service for oral mucosal disorders.

This study included 100 patients seen at the oral medicine outpatient clinic of 3 Brazilian Dental Schools (University of Campinas, Federal University of Pernambuco, and Federal University of Santa Catrina) from March 2019 to October 2019. In addition to the face-to-face assistance provided by graduate students and the final diagnosis validated by the professors of these institutions, a remote evaluation was requested for these patients through the EstomatoNet/TelessaúdeRS platform.

The sensitivity and specificity of telediagnosis were compared with those of the face-to-face approach and found to be 100% and 97.4%, respectively. The concordance between the examiners was 95%, and case management was relatively simple in approximately 60% of cases.

Based on the results, telediagnosis for oral diseases can be considered a reliable method, representing a promising alternative for the clinical support of health professionals, particularly in remote locations.
Based on the results, telediagnosis for oral diseases can be considered a reliable method, representing a promising alternative for the clinical support of health professionals, particularly in remote locations.
This study aimed to evaluate the relationship between oral candidiasis with salivary features, neutrophil function, and glycemic control in type 2 diabetes (T2D).

Twenty-nine individuals were included, 16 with T2D and 13 without the disease. The participants underwent clinical examination, neutrophilic function tests, fasting glycemia and glycated hemoglobin (A1c), stimulated and unstimulated saliva collection, and swab and exfoliative cytology. Salivary flow, pH, and total fungi count were evaluated on saliva, and identification of the Candida species was performed in saliva and swab samples.

There was no difference in unstimulated salivary flow and pH of the stimulated and unstimulated saliva for participants with T2D and controls (P > .05). Individuals from both groups presented no candidal lesions. The salivary fungal growth in the T2D group was higher than that in controls (P < .05). Only individuals with T2D presented alterations in the neutrophilic functions (14/16; 87.5%; P < .05). There was no relationship between high A1c values and neutrophil dysfunction with the presence of Candida spp. in both saliva and mucosa (P > .05).

High A1c level, reduction in neutrophil activity, salivary flow and pH, and increase in total salivary Candida spp. counts were not related to oral candidiasis in patients with T2D.
High A1c level, reduction in neutrophil activity, salivary flow and pH, and increase in total salivary Candida spp. counts were not related to oral candidiasis in patients with T2D.
The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises.

To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains choice of birthplace, companionship, and families in vulnerable situations.

A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders.

Both countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers' fear of contracting COalues into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.
Growing concerns about opioid overprescribing, opioid use disorder (OUD), and overdose led to opioid misuse prevention practices that may impact the lives of people with disability (PWD) and chronic pain.

To investigate the experiences of providers and people with arthritis related disability with opioid prescribing and monitoring following release of the Centers for Disease Control and Prevention Guideline for prescribing opioids for chronic pain.

We conducted semi-structured interviews with 24 specialists and primary care providers and 24PWD. Providers were required to prescribe opioids to people with arthritis-disability. PWD were required to have arthritis-disability causing chronic pain and to be on chronic opioid therapy (COT) or have been treated for OUD. We used a deductive and inductive analytic approach to develop themes.

Providers recommended COT when other pain treatment options were exhausted or unaffordable. PWD reported their provider recently reduced their opioid treatment intensity antreatments for chronic pain.The coronavirus 2019 (COVID-19) pandemic is a health and economic crisis. It has also highlighted human relational problems, such as racism and conflicts between nations. Although vaccination programs against the severe respiratory syndrome coronavirus 2 (SARS-CoV-2) have started worldwide, the pandemic is ongoing, and people are struggling. The mechanism of disease severity in COVID-19 is multifactorial, complicated, and affected by viral pathogenesis. For example, monocyte dysfunction due to aging and respiratory and gut dysbiosis influence the host's immunity against SARS-CoV-2 including helper T-cell imbalance and viral clearance reduction, leading to accelerated disease progression in older patients or those with underlying diseases. The different immune responses against SARS-CoV-2 also contribute to various radiological findings, including that of acute respiratory distress syndrome, which is associated with high mortality, especially in patients susceptible to disease progression. We aimed to review the pathophysiological mechanisms involved in COVID-19, with emphasis on the altered microbiome in the lung and gut, and the different radiological findings in different patient groups, such as younger adults and pregnant women.
To automate the segmentation of treatment applicators on computed tomography (CT) images for high-dose-rate (HDR) brachytherapy prostate patients implanted with titanium needles with the goals of improving plan quality and reducing the patient's time under anesthesia.

The investigation was performed using 57 retrospective, interstitial prostate treatments randomly assigned to training (n = 27), validation (n = 10), and testing (n = 20). Unique to this work, the CT image set was reformatted into 2D sagittal slices instead of the default axial orientation. A deep learning-based segmentation was performed using a 2D U-Net architecture followed by a density-based linkage clustering algorithm to classify individual catheters in 3D. Potential confounders, such as gold seeds and conjoined applicators with intersecting needle geometries, were corrected using a customized polynomial fitting algorithm. The geometric agreement of the automated digitization was evaluated against the clinically treated manual digitizaotential to improve quality and consistency while reducing the patient's time under anesthesia.
In the era of image guided radiotherapy and interstitial needle use, radiation dose to ureters can cause toxicity.

A retrospective analysis of 106 patients with cervical cancer was performed to investigate ureter dose in brachytherapy patients. Re-optimization of brachytherapy treatment plans in 20 MRI planned patients was performed to reduce ureter dose whilst maintaining HRCTV D90 and OAR dose constraints.

A total of 212 ureters were contoured and dose recorded. The crude incidence of ureteric stenosis was 6.6%. Ureter dose for all patients was 75.8 Gy and 74.4 Gy on the right and left respectively. A cohort of 20 MRI planned patients were reoptimized to reduce dose to ureters. Ureter dose was reduced from 91.1 Gy to 84.4 Gy and 73.9 Gy to 67.8 Gy on the right and left side respectively. A subgroup of patients with HRCTV D90 ≥84.3 Gy prior to reoptimisation saw a greater reduction in ureter dose of 13.3%. These were smaller tumours with better HRCTV coverage at the outset. Larger tumours with poorer HRCTV coverage (<84.3 Gy) saw a smaller reduction in ureter dose of 6.4%. Organ at risk dose to rectum, sigmoid and bladder were also significantly reduced.

Patients treated with MRI guided brachytherapy and interstitial needles are at risk of ureteric stenosis. Contouring ureters and setting dose constraints should be considered to reduce ureteric dose while tracking HRCTV coverage.
Patients treated with MRI guided brachytherapy and interstitial needles are at risk of ureteric stenosis. Contouring ureters and setting dose constraints should be considered to reduce ureteric dose while tracking HRCTV coverage.
Over the past 30 years, functional magnetic resonance imaging (fMRI) has emerged as a powerful tool to non-invasively study the activity and function of the human brain. But along with the potential of fMRI to shed light on neurological, psychiatric, and psychological processes, there are methodological challenges and criticisms.

We herein provide an fMRI primer designed for a diverse audience, from the neuroimaging novice to the experienced user.

This primer is structured as follows Part 1 Overview "What is fMRI and what can it tell us?." Part 2 Basic fMRI principles MR physics, the BOLD signal, and components of a typical scan session. Part 3 Basic fMRI experimental design why timing is critical, and common sources of noise in the signal. Part 4 Basic fMRI analysis methods software, the 3 stages of data analysis (preprocessing, individual, and group level), and a survey of advanced topics and methods including connectivity, machine learning, and assessing statistical significance. Part 5 Criticism, cr in individuals brain activity also impact the pace at which fMRI for sexual medicine can move from the scanner to the clinic.

This primer provides the novice an understanding of the appropriate uses and limitations of fMRI, and for the experienced user, a concise update on current issues and methodological advances. Mills-Finnerty C, Frangos E, Allen K, et al. Functional Magnetic Resonance Imaging Studies in Sexual Medicine A Primer. J Sex Med 2022;191073-1089.
This primer provides the novice an understanding of the appropriate uses and limitations of fMRI, and for the experienced user, a concise update on current issues and methodological advances. Mills-Finnerty C, Frangos E, Allen K, et al. Functional Magnetic Resonance Imaging Studies in Sexual Medicine A Primer. J Sex Med 2022;191073-1089.Prolonged monocropping of commodity crops, such as peanuts (Arachis hypogea L.) in West Africa, typically strips nutrients from soils and may exacerbate vulnerability to insects and diseases. In this paper, we focus on aflatoxins, toxic chemicals produced by certain molds growing on moist crops, as one risk of growing importance for its negative impacts on human health, crop yields, and agricultural livelihoods and ecosystems. We link the increased prevalence of this deadly fungus to the long history of peanut monoculture, exacerbated by market liberalization and China's increased investment and export demand for peanuts, climate change, food insecurity, as well as disregard for and displacement of traditional agricultural knowledge. We use a political ecology approach to place the public health threat from aflatoxin in the context of both historical pressures for cash-crop production of peanuts and contemporary soil degradation, food insecurity, climate change precarity and changes within social and economic systems of agriculture in Senegal.
Tissue glue has been examined extensively for its effectiveness in pediatrics, and the findings are good. The purpose of this research was to examine the effectiveness of tissue glue compared to absorbable sutures for wound approximation in pediatric circumcision.

A systematic review and meta-analysis on children who had circumcision using tissue glue and absorbable suture were done in line with the PRISMA criteria. RevMan 5.4 was used to perform the meta-analysis. The mean differences for continuous and dichotomous data are determined using inverse variance, and the odds ratio is calculated using the Mantel-Haenszel technique.

The inclusion criteria were met by six trials containing a total of 817 patients. According to the analysis, tissue glue significantly reduces the duration of the operation (MD - 7.98; 95% CI -12.35, -3.62; p=0.0003), pain severity (SMD -0.57; 95%CI -0.80, -0.32; p<0.00001) and the duration of pain (MD - 2.33; 95% CI -2.57, -2.08; p<0.00001) compared to absorbable suture. However, we found that there was no significant difference in the incidence of postoperative bleeding, infection, dehiscence, or overall complication when comparing tissue glue to traditional suture.

Our systematic review and meta-analysis using the most recent data suggest that tissue glue usage might reduce the operation time, as well as the intensity and duration of postoperative pain.
Our systematic review and meta-analysis using the most recent data suggest that tissue glue usage might reduce the operation time, as well as the intensity and duration of postoperative pain.Medullary thyroid cancer (MTC) is a rare neuroendocrine disease, encompassing about 5% of all thyroid cancers. Due to its peculiar features, this rare tumour offers unique possibilities for translational research studies. It arises from neuroendocrine parafollicular cells in an endocrine organ, and appears as a nodule apparently indistinguishable from thyroid nodules. It has a very peculiar progression with micro metastases difficult to identify, often-remaining stable during years and suddenly undergoing a rapid and unrestrainable progression. Moreover, MTC is one of the neoplasms with the best genetic characterization either in its sporadic or familial form, providing a valuable background to test targeted drugs. In the era of precision medicine, this review aims to give an update on the diagnostic tools, the therapeutic options for advanced MTC, and the most promising opportunities for a personalized follow up.
The COVID-19 pandemic has had a profound impact on radiography services globally. The reshaping of service delivery continues to impact patient management and the experience of the radiography workforce should be evaluated to determine how effective service delivery can be maintained in the ongoing and post-pandemic world.

A mixed methods approach was adopted. Questionnaires, designed using Qualtrics (Qualtrics, Provo, UT) online survey software, were used to survey radiographers throughout Northern Ireland (NI). Semi-structured interviews were conducted with radiography service managers in the NHS and private sector in NI. All interviews were digitally recorded, transcribed and coded independently by 2 researchers.

A total of 106 Radiographers completed the online survey i.e. 82 Diagnostic and 24 Therapeutic. Variations were reported regarding staff concern for contracting COVID-19 and passing it on. Clinical workload was reported to fluctuate during the early period of the pandemic, however, both diagnostic and therapeutic radiographers reported workloads which were higher than normal at the time of the data collection. Nine service managers participated in the interviews plus two band 8 superintendent radiographers. Staff faced many challenges whilst delivering services due to COVID-19. The two most frequently cited challenges included issues related to (i) Implementation of PPE and (ii) Changes to work practices.

A pre-prepared pandemic plan should be established and stress tested for the future. The plan should be devised in consultation with both the public and private sector to determine the very best use of resources.

The radiography workforce has worked continuously throughout the pandemic and needs to be supported to deal with the potential increase in demand for services in the post-pandemic world.
The radiography workforce has worked continuously throughout the pandemic and needs to be supported to deal with the potential increase in demand for services in the post-pandemic world.We report elexacaftor-tezacaftor-ivacaftor (ETI) treatment of a F508del carrier who was pregnant with a F508del homozygous fetus. At 23-weeks gestation meconium ileus (MI) was evident on ultrasound including dilated, hyperechoic bowel, which persisted on subsequent imaging. Through shared decision-making, the mother began ETI at 32 weeks with intent to treat fetal MI. The ultrasound findings persisted at treatment day 13, but bowel dilation had resolved by imaging on treatment day 27. A female infant was delivered vaginally at 36 weeks with no complications. The mother continued ETI while breastfeeding. Stool elastase at age 2 weeks was 240 mcg/g. Sweat chloride measurement was 64 and 62 mEq/L. Maternal and infant liver function testing have been normal. Maternal ETI treatment likely led to resolution of the MI and there is evidence supporting continued infant benefit through breastmilk. Logistical and ethical considerations regarding treatment of a carrier mother for infant benefit are discussed.
Nonprescription cannabis products are becoming widely available and being promoted for various health conditions. Safety profile of these products apart from psychoactive effects has not been studied and published well. Liver dysfunction is well described in literature with high doses of recreational tetrahydrocannabinol and cannabidiol products but not with nonprescription phytocannabinoids products used for various medicinal values.

A 2-year-old unimmunized male with infantile spasms and refractory seizures, managed with clobazam and zonisamide, presented for respiratory illness and incidentally diagnosed with severe liver dysfunction with elevated coagulation markers. He did not manifest any clinical signs of liver failure. On further review, it was found that parents were using nonprescription phytocannabinoids (hemp extract) for his neurological condition. He required supportive care for his liver dysfunction, and liver enzymes down trended gradually after holding his phytocannabinoid products. The Wness of potential life-threatening consequences of these products and educating the patient and the caregivers of these risks. The case also emphasizes the need for serial liver enzymes monitoring for patients receiving these therapies as well as extensive research focusing on safety profile of these products in terms of different organ system affection other than their psychoactive potential.
Ensuring the quality and safety of the pharmaceutical supply chain is a key policy focus vital to protecting the public from harmful or potentially harmful medications. Although the Food and Drug Administration (FDA) reports the number of recalled products per fiscal year and categorizes recalls based on product type and recall classification, these reports do not distinguish between manufactured and compounded products.

This research aims to categorize drug recalls based on the reason for recall and then to compare this reason between manufacturers and compounders.

All publicly available drug recall data were downloaded from the FDA Data Dashboard website on January 24, 2021. Two reviewers independently categorized the recalling firm, distribution pattern, and reason for recall, and a third reviewer resolved all conflicts. Descriptive statistics were reported for recall event classification, distribution, and recall reason for the full sample. Chi-square test of independence was used to assess categoritured and compounded products.
There was a statistically significant difference in the reason for a drug to be recalled, the distribution level, and the product class for manufactured and compounded products.
This study aimed to conduct a systematic review of cost-utility studies of internet-based and face-to-face cognitive behavioral therapy (CBT) for depression from childhood to adulthood and to examine their reporting and methodological quality.

A structured search for cost-utility studies concerning CBT for depression was performed in 7 comprehensive databases from their inception to July 2020. Two reviewers independently screened the literature, abstracted data, and assessed quality using the Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies checklists. The primary outcome was the incremental cost-effectiveness ratio (ICER) across all studies. To make a relevant comparison of the ICERs across the identified studies, cost data were inflated to the year 2020 and converted into US dollars.

Thirty-eight studies were included in this review, of which 26 studies (68%) were deemed of high methodological quality and 12 studies (32%) of fair quality. Despite diffeildren and adolescents depression remains inconclusive.
Fair or high-quality evidence showed that CBT monotherapy or combination therapy for adult depression was cost-effective; whether CBT-related therapy was cost-effective for children and adolescents depression remains inconclusive.The replacement of replication-coupled histones with non-canonical histone variants provides chromatin with additional properties and contributes to the plasticity of the epigenome. MacroH2A histone variants are counterparts of the replication-coupled histone H2A. They are characterized by a unique tripartite structure, consisting of a histone fold, an unstructured linker, and a globular macrodomain. MacroH2A1.1 and macroH2A1.2 are the result of alternative splicing of the MACROH2A1 gene and can have opposing biological functions. Here, we discuss the structural differences between the macrodomains of the two isoforms, resulting in differential ligand binding. We further discuss how this modulates gene regulation by the two isoforms, in cases resulting in opposing role of macroH2A1.1 and macroH2A1.2 in development and differentiation. Finally, we share recent insight in the evolution of macroH2As. Taken together, in this review, we aim to discuss in unprecedented detail distinct properties and functions of the fascinating macroH2A1 splice isoforms.Centromeres are highly specialised chromosome domains defined by the presence of an epigenetic mark, the specific histone H3 variant called CENP-A (centromere protein A). They constitute the genomic regions on which kinetochores form and when defective cause segregation defects that can lead to aneuploidy and cancer. Here, we discuss how CENP-A is established and maintained to propagate centromere identity while subjected to dynamic chromatin remodelling during essential cellular processes like DNA repair, replication, and transcription. We highlight parallels and identify conserved mechanisms between different model organism with a particular focus on 1) the establishment of CENP-A at centromeres, 2) CENP-A maintenance during transcription and replication, and 3) the mechanisms that help preventing CENP-A localization at non-centromeric sites. We then give examples of how timely loading of new CENP-A to the centromere, maintenance of old CENP-A during S-phase and transcription, and removal of CENP-A at non-centromeric sites are coordinated and controlled by an intricate network of factors whose identity is slowly being unravelled.Ribosomes are macromolecular machines that are globally required for the translation of all proteins in all cells. Ribosome biogenesis, which is essential for cell growth, proliferation and survival, commences with transcription of a variety of RNAs by RNA Polymerases I and III. RNA Polymerase I (Pol I) transcribes ribosomal RNA (rRNA), while RNA Polymerase III (Pol III) transcribes 5S ribosomal RNA and transfer RNAs (tRNA) in addition to a wide variety of small non-coding RNAs. Interestingly, despite their global importance, disruptions in Pol I and Pol III function result in tissue-specific developmental disorders, with craniofacial anomalies and leukodystrophy/neurodegenerative disease being among the most prevalent. Furthermore, pathogenic variants in genes encoding subunits shared between Pol I and Pol III give rise to distinct syndromes depending on whether Pol I or Pol III function is disrupted. In this review, we discuss the global roles of Pol I and III transcription, the consequences of disruptions in Pol I and III transcription, disorders arising from pathogenic variants in Pol I and Pol III subunits, and mechanisms underpinning their tissue-specific phenotypes.
Dexmedetomidine in opioid-sparing analgesia promotes enhanced recovery and improves postoperative outcomes.

This study aimed to explore the safety and efficacy of dexmedetomidine in bariatric surgery.

Meta-analysis.

We selected studies from Pubmed, Embase, Web of Science, and the Cochrane Central Registry of Controlled Trials before 20 April, 2021. The primary outcomes were pain scores and intravenous morphine equivalents (IVME) in the post anesthesia care unit (PACU) and postoperative day 1 (POD1). The secondary outcomes included postoperative nausea and vomiting (PONV), the length of hospital stay (LOS), intraoperative mean arterial pressure (MAP) and heart rate (HR).

We extracted 697 participants from 10 randomized controlled trials. Dexmedetomidine reduced PACU pain scores (MD = -1.51, 95% confidence interval [CI] -2.60 to -.42) after bariatric surgery, especially laparoscopic Roux-en-Y gastric bypass (MD = -3.05, 95%CI -3.77 to -2.33), but it did not affect POD1 pain scores (MD = .20, 95%CI -.85 to 1.26). Dexmedetomidine can reduce PACU IVME (MD = -4.29, 95%CI -6.59 to -1.99), but does not reduce POD1 IVME (MD = -.36, 95%CI -2.41 to 1.68). In addition, dexmedetomidine significantly reduced PONV both in PACU (OR = .28, 95%CI .14-.54) and POD1 (OR = .24, 95%CI .14-.4), shortened LOS (MD = -.29, 95%CI -.49 to -.10), and had little effect on intraoperative MAP (MD = -6.64, 95%CI -9.52 to -3.76) and HR (MD = -4.8, 95%CI -11.55 to 1.94).

In conclusion, the use of dexmedetomidine in opioid-sparing analgesia contributes to postoperative analgesia after bariatric surgery, but the heterogeneity was high. In addition, dexmedetomidine is beneficial for enhanced recovery.
In conclusion, the use of dexmedetomidine in opioid-sparing analgesia contributes to postoperative analgesia after bariatric surgery, but the heterogeneity was high. In addition, dexmedetomidine is beneficial for enhanced recovery.
Gallbladder mucinous adenocarcinoma (GBMAC) is a rare type of gallbladder malignant tumor, whereas little is known regarding the clinicopathological features and surgical outcomes of GBMAC.

From January 2000 till December 2015, 54 GBMAC patients who underwent curative-intent surgical resection at our institution were retrospectively reviewed. We compared the clinicopathological features and surgical outcomes of these GBMAC patients with a relatively large cohort of surgically resected conventional gallbladder adenocarcinoma (GBAC) patients without existence of mucinous components.

The clinicopathological features of GBMAC were significantly different from conventional GBAC, including poorer tumor differentiation (P<0.001), higher CA19-9 levels (P<0.001), larger tumor sizes (P=0.020), advanced AJCC tumor stage (P=0.002), higher frequency of liver parenchyma invasion (P=0.020), portal vein invasion (P=0.003), lymph node metastasis (P=0.016), lympho-vascular invasion (P<0.001) and perineural invasion (P=0.025). Relative to conventional GBAC patients, GBMAC patients showed significantly worse overall survival (OS) (29.0 vs 15.0 months; P<0.001). Multivariate analysis confirmed the surgical margin (P=0.046), tumor differentiation grade (P=0.018), lymph node metastasis (P=0.024), and presence of signet-ring cell component (P=0.005) as independent prognostic factors influencing OS of patients with GBMAC.

GBMAC always had more aggressive biological behaviors and poor survival outcomes even after curative surgery. GBMAC patients with the presence of signet-ring cell component showed even worse survival outcome.
GBMAC always had more aggressive biological behaviors and poor survival outcomes even after curative surgery. GBMAC patients with the presence of signet-ring cell component showed even worse survival outcome.
Early-onset pancreatic cancer (≤50 years, EOPC) is uncommon. This study aims to characterize the clinical and survival characteristics of EOPC in comparison to late-onset pancreatic cancer (>50 years, LOPC).

We retrospectively investigated consecutive PC patients treated at our institution between 2010 and 2019. We analyzed and compared clinicopathological characteristics, treatments, and outcomes of EOPC and LOPC.

Of 1646PC patients identified (768 resectable/borderline resectable; 248 locally advanced; 630 metastatic), 127 (8%) had EOPC. Current smoking and heavy drinking were associated with EOPC. EOPC presented at a more advanced stage and had higher neutrophil-to-lymphocyte ratios than LOPC. Survival outcomes were similar between the two groups, both in the entire cohort and in each resectability group. In patients undergoing resection, EOPC tended to have a higher N stage (p=0.099) and had a higher pathological stage (stage IV, 20% vs. 7%, p=0.005) and a lower rate of macroscopically curative resection (80% vs. 93%, p=0.006). Liver recurrence was more commonly observed in EOPC (42% vs. 23%, p=0.015). In the metastatic cohort, combination chemotherapy regimens were more frequently administered in EOPC as first-line treatment (79% vs. 64%, p=0.028). Both median PFS (4.4 vs. 5.3 months, p=0.647) and OS (11.5 vs. 9.5 months, p=0.183) were not significantly different between the two groups.

EOPC presented with a more aggressive tumor biology. Survival outcomes were similar to LOPC due to more intensive treatment.
EOPC presented with a more aggressive tumor biology. Survival outcomes were similar to LOPC due to more intensive treatment.A recent study reported that patients with interstitial lung disease (ILD) are at increased risk of death from coronavirus disease 2019 (COVID-19). However, there are no studies on the outcome of COVID-19 patients with preexisting ILD treated with corticosteroids or antiviral drugs. We extracted 26 patients with preexisting ILD by medical records and HRCT pattern. Of 503 patients with COVID-19, we selected 52 patients as control matched for age and sex. Twenty out of the 26 ILD patients (76.9%) received corticosteroid therapy, and 23 patients (88.5%) also received antiviral treatment with remdesivir or favipiravir. Although no statistical difference was found, the proportion of severe patients in ILD group tended to be higher than in non-ILD group (23.1% vs. 42.3%; p = 0.114). Also, mortality rate in ILD group tended to be higher than in non-ILD patients (11.5% vs. 3.8%; p = 0.326). In univariate analysis to evaluate risk factors for severe condition, diagnosis of idiopathic pulmonary fibrosis, usual interstitial pneumonia pattern, and honeycomb lung were not risk factors of severe disease. Treatment with corticosteroids, antiviral drugs, and immunosuppressive agents may affect the outcome of COVID-19 patients with ILD.The underlying mechanisms of chronic pruritus (CP), which is often very debilitating for patients, are still not well understood. Over the past few years, peripheral and central mechanisms involving different classes of pruriceptive and nociceptive neuron (e.g., C- and Aδ-fibers), immune cells (e.g., eosinophils, basophils, Th1, Th2, and mast cells) and epithelial cells (e.g., keratinocytes) have been investigated. Based on these, numerous promising target-specific therapies are under development. In this review, we highlight the cells, key mediators, and receptors involved in itch perception and CP, and conclude by summarizing the therapies developed for these conditions.The Tiniest Babies Registry was launched in the year 2000 as a web-based registry for patients who survived to discharge after being born with birth weights below 400 grams. The registry began with 15 patients and by January 2022 had grown to 291, ranging in birth weight from 212 to 399 grams and in gestational age from 21 to 34 weeks. Three patients were born in the 1930s, and no others were born until 1985. The greatest number in a single year was 21 in 2010. The infants were born in 16 countries, but 166 of 291 (57%) were born in the U.S. All except 10 of the infants were small for gestational age at birth. No systematic data on the long-term outcomes of these patients is available, but the information submitted by selected registry participants indicates they are at increased risk for continued delays in growth and development.Genetic testing is a critical tool in the medical management of disease; however, for variants of uncertain significance there is insufficient evidence to prove a connection between the variant and disease and they should not be used as a basis for clinical decisions.
The objectives of this study were to simulate long-term orthodontic tooth movement in en-masse retraction using the finite element method and investigate the effects of power arms on tooth movements when using a lingual appliance in comparison with a labial appliance.

A 3-dimensional finite element model of the maxillary dentition was constructed with 0.018-in brackets and 0.016 × 0.022-in stainless steel archwire. An en-masse retraction was performed by applying retraction force at various lengths of the power arm (4, 6, 8, and 10 mm) to the second molar tube, and long-term tooth movements with the lingual and labial appliances were analyzed using the finite element method.

Although lingual crown tipping of the incisor was more marked with the lingual appliance than with the labial appliance in the early phase of space closure, only a slight difference was evident after space closure. Although the power arm was effective for achieving better-controlled tooth movement and reducing vertical and transverse bowing effects, bodily movement of the incisor could not be achieved, and bowing effects could not be eliminated.

To provide better torque control of the incisor or prevent a vertical bowing effect, the incorporation of extra torque into brackets of incisors was recommended, and the use of power arms for the lingual appliance. To prevent a transverse bowing effect, incorporation of the antibowing bend or application of retraction force from both buccal and lingual sides or temporary skeletal anchorage devices was recommended.
To provide better torque control of the incisor or prevent a vertical bowing effect, the incorporation of extra torque into brackets of incisors was recommended, and the use of power arms for the lingual appliance. To prevent a transverse bowing effect, incorporation of the antibowing bend or application of retraction force from both buccal and lingual sides or temporary skeletal anchorage devices was recommended.
To assess the efficacy of IL-6 inhibitors compared to standard of care (SOC) in COVID-19 patients.

A systematic review of the MEDLINE and Scopus databases (last search October 8
, 2021) was performed according to the PRISMA statement.

Randomized control trials (RCTs) comparing IL-6 inhibitors to SOC in hospitalized COVID-19 patients were deemed eligible.

Individual patient data were extracted from the Kaplan-Meier curves or were obtained from authors of included studies. Additionally, the reviewers independently abstracted data and assessed study quality of each eligible report.

Eleven studies were identified, incorporating 7467 patients (IL-6 inhibitors 4103, SOC 3364). IL-6 inhibitors were associated with decreased risk for death compared to SOC at the one-stage meta-analysis (Hazard Ratio [HR] 0.75, 95% Confidence interval [CI] 0.69-0.82, p<0.0001) and the two-stage meta-analysis (HR 0.85, 95%CI 0.77-0.93, p<0.001, I
=0.0%). Meta-regression analysis revealed that the difference in OS between the two groups was not influenced by the mean age of patients. At secondary meta-analyses, IL-6 inhibitors were associated with decreased odds for intubation OR0.74, 95%CI0.65-0.85, p<0.001, I
=0.0%). IL-6 inhibitors were associated with increased odds for discharge compared to SOC (OR1.28, 95% CI1.15-1.42, p<0.001, I
=0.0%).

This meta-analysis of individual patient data from randomized trials shows that IL-6 inhibitors significantly reduce the risk of death compared to SOC. IL-6 inhibitors are also associated with better outcomes in terms of intubation and discharge rates compared to SOC.
This meta-analysis of individual patient data from randomized trials shows that IL-6 inhibitors significantly reduce the risk of death compared to SOC. IL-6 inhibitors are also associated with better outcomes in terms of intubation and discharge rates compared to SOC.
Intrathecal drug delivery systems (IDDS) and spinal cord stimulation (SCS) have been proposed and assessed for the management of cancer pain; however, such treatments remain underused. We conducted a systematic review to evaluate the effectiveness and safety of IDDS and SCS for cancer pain.

Electronic databases MEDLINE, CENTRAL, EMBASE, and WikiStim were searched from 1988 to March 2021. Randomized controlled trials and observational studies of adults with pain related to cancer or its treatment who received an implantable IDDS or SCS were eligible for inclusion. The primary outcome of the review was change in pain intensity from baseline to the last available follow-up, measured using a visual analog scale or numerical rating scale. The protocol for this review is registered on PROSPERO (CRD42021240717).

A total of 22 studies (24 reports) included a total of 3043 participants who received either IDDS or SCS for cancer pain. Eight studies reporting data for 405 participants with an IDDS could be includeg pain intensity for patients with cancer pain when compared with pretreatment.
Deep brain stimulation (DBS) surgery is an established treatment for many patients with neurologic disease, and a common complication of DBS is surgical site infection (SSI). In 2016, neurosurgeons at our institution began enclosing implantable pulse generators (IPGs) within fully absorbable, antibacterial envelopes in patients who underwent initial DBS implantation. We sought to determine whether the use of antibacterial envelopes reduced IPG-related SSIs.

We performed a retrospective chart review of all adult patients who underwent initial DBS implantation at Stanford Hospital between November 14, 2012, and November 9, 2020. Operative details, perioperative antibiotics, comorbidities, and postoperative complications were extracted for all patients. Univariate and multivariate logistic regression were used to identify factors associated with SSIs within three months of surgery, and interrupted time-series analysis was performed to assess whether the departmental adoption of the antibacterial envelope leds not conclusively establish that the use of antibacterial pouches in patients who underwent initial DBS implantation reduces the incidence of IPG SSIs. Future prospective studies that control for confounding variables are necessary to determine the efficacy of antibacterial envelopes in reducing post-DBS infections at the IPG site before clear recommendationscan be made.
The adoption of antibacterial envelopes was found to reduce IPG SSIs at the univariate level, but this association did not remain significant after controlling for confounding variables including perioperative antibiotic administration. Although encouraging, this study does not conclusively establish that the use of antibacterial pouches in patients who underwent initial DBS implantation reduces the incidence of IPG SSIs. Future prospective studies that control for confounding variables are necessary to determine the efficacy of antibacterial envelopes in reducing post-DBS infections at the IPG site before clear recommendations can be made.
Depressive symptoms among adolescents are a major concern for increased risk of adverse health condition outcomes later in life. Specifically, previous studies have reported that multicultural adolescents experience more depressive symptoms than non-multicultural ones. Using the Korean Children and Youth Panel Survey, this study examined the relationships between ego-resilience, social support, and depression among multicultural adolescents in South Korea, as well as the moderating effect of social support on the association between ego-resilience and depression.

A total of 1500 multicultural adolescents were included in the analyses, where generalized estimating equation models were employed.

Depression scores increased slightly from 2012 to 2015. Higher levels of ego-resilience, family support, and friend support were associated with lower levels of depression, while teacher support was not a significant predictor. The moderating effect of friends and family support on the association between ego-resilience and depression was not statistically significant.

To reduce the level of depression among multicultural adolescents, future research should develop interventions that enhance ego-resilience ability, as well as necessary social systems that strengthen family and friend support.

Supportive interventions, such as enhancing ego-resilience to reduce depression should be provided to multicultural adolescents. It is recommended to include family and friends to develop effective intervention programs for multicultural adolescents who are suffering from depression.
Supportive interventions, such as enhancing ego-resilience to reduce depression should be provided to multicultural adolescents. It is recommended to include family and friends to develop effective intervention programs for multicultural adolescents who are suffering from depression.In response to rising costs and growing concerns about safety, quality, equity and affordability of health care, many countries have now developed and deployed performance-based incentives, targeted at facilities as well as individuals. Evidence of the effect of these efforts has been mixed; it remains unclear how effective strategies of varying design and magnitude (relative to provider salary) are at incentivizing individual-level performance. This study reviews the current evidence on effectiveness of individual-level performance-based incentives for health care in Organisation for Economic Co-operation and Development countries, which are relatively well situated to implement, monitor and evaluate performance-based incentives programs. We delineate the conditions under which sanctions or rewards - in the context of gain-seeking, loss aversion, and increased social pressure to modify behaviors - may be more effective. We find that programs that utilized positive reinforcement methods are most commonly observed - with slightly more overall bonus incentives than payment per output or outcome achieved incentives. When comparing the outcomes from negative reinforcement methods with positive reinforcement methods, we found more evidence that positive reinforcement methods are effective at improving health care worker performance. Overall, just over half of the studies reported positive impacts, indicating the need for care in designing and adopting performance-based incentives programs.
Young adult anxiety/depression (mental health) symptoms have increased from prior to the COVID-19 pandemic. This study assessed young adult (aged 18-25 years) anxiety/depressive symptoms, mental health care utilization (prescription drug use, counseling, and/or either), and unmet counseling/therapy needs utilizing the national Household Pulse Survey data from June to July2021.

Young adult (n= 2,809) rates and subgroup differences in mental health symptoms (Generalized Anxiety Disorder-2 and/or Patient Health Questionnaire-2) were assessed, as were mental health care utilization and unmet counseling/therapy needs.

In total, 48% of young adults had mental health symptoms. Among those, 39% received treatment and 36% reported unmet mental health counseling/therapy needs.

These findings highlight young adults' ongoing mental health needs and low services receipt. Interventions and further research to reduce barriers to seeking and utilizing mental health care and to increase the capacity of providers to deliver culturally appropriate mental health care are needed.
These findings highlight young adults' ongoing mental health needs and low services receipt. Interventions and further research to reduce barriers to seeking and utilizing mental health care and to increase the capacity of providers to deliver culturally appropriate mental health care are needed.
The association between visceral adiposity index (VAI) and chronic kidney disease (CKD) remains debatable. We aimed to prospectively investigate the relationship between VAI and CKD.

A total of 8808 participants from the China Health and Retirement Longitudinal Study were included. Males and females were divided into four groups according to gender-specific quartiles of VAI scores. CKD was based on self-reported physicians' diagnosis or personal eGFR level. A logistic regression model was established to analyze the correlation between VAI and CKD. A meta-analysis was conducted to incorporate the results of the current study and previous studies on the association of VAI with CKD. During 7 years of follow-up, a total of 826 participants (9.38%) experienced CKD. In multivariable-adjusted analyses, the adjusted odds ratios (95% confidence intervals) for the highest versus lowest quartile of VAI was 1.33 (1.03-1.77) for male, and 1.10 (0.81-1.48) for female, respectively. The meta-analysis found the significant associations between VAI and CKD in total, male and female participants (pooled relative risk for highest vs lowest VAI quartile were 2.24(1.70-2.95), 2.36(1.54-3.61) and 2.57 (1.57-4.22), respectively).

Higher VAI score was associated with increased risk of CKD, independently of established risk factors. The VAI may be a predictor of incident CKD, but only among male participants based on present study.
Higher VAI score was associated with increased risk of CKD, independently of established risk factors. The VAI may be a predictor of incident CKD, but only among male participants based on present study.
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