Ko au tēnei: This is me - Exploring the lived experience of underrepresented groups with pharmacy services to inform the development of pharmacy case-based learning

INTRODUCTION

Demographic and social characteristics of underrepresented groups are often poorly described in pharmacy case-based learning, leading to poor representation of these groups in the pharmacy curriculum. This research project aimed to understand the lived experience of underrepresented groups with pharmacy services and to use this to inform the development of pharmacy case-based student learning materials.

METHODS

This was a single centre, grounded theory, qualitative study. Focus groups were undertaken with six underrepresented groups: Māori, Pacific, Asian, LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual), disability, and refugee. These focus groups were conducted in Dunedin, Aotearoa New Zealand from July to August 2022. Focus group sessions were recorded and analysed to identify beliefs, ideas, and themes shared between participants and groups.

FINDINGS

Participants in all focus groups had a strong desire to be seen and represented in pharmacy cases, however this was conditional on the learning being delivered in a way that upholds their beliefs, values, and voices. From these lived experiences, cultural, environmental, personal, and social factors were identified as being critical for inclusion in pharmacy case-based learning materials.

CONCLUSIONS

The lived experience of underrepresented populations provides critical insights that will enhance pharmacy case-based learning. The key factors that could be included in case-based learning are: ethnicity, personal beliefs, language, disability, gender identity, sexual identity, and family. To achieve health equity and improve cultural awareness and intelligence of our future pharmacy workforce, these experiences need to become more present in curricula.

Supplementation of protease and different nutrient density diets in growing-finishing pigs

This study was conducted to investigate the effects of protease supplementation and different nutrient density of diets in growing-finishing pigs. A total of one hundred-eight crossbred growing pigs ([Landrace × Yorkshire] × Duroc) with an initial body weight (BW; 18.74 ± 3.46 kg) were used for 15 weeks. Pigs were randomly assigned to six dietary treatments with 6 replicates of 3 pigs per pen in a 3 × 2 factorial through the following arrangement: Three groups of protease (1, Basal diets; 2, Protease A: 125 mg/kg protease derived from Streptomyces sps; 3, Protease B: 100 mg/kg protease derived from Bacillus licheniformis) at two different nutrient density diets (1, Basal requirement; 2, 0.94%-0.98% higher than requirement in dietary protein and 50 kcal/kg in energy). High nutrient (HN) diets showed higher average daily gain (ADG) (p < 0.05) and apparent total tract digestibility (ATTD) of crude protein (CP) (p < .0001) compared to basal nutrient (BN) diets during growing periods. Supplementation of protease showed higher BW (p < 0.05) and ADG (p < 0.05) compared to non-supplementation of protease during growing periods. Also, supplementation of protease showed higher ATTD of CP (p < 0.01), ATTD of gross energy (p < 0.05) and decreased blood urea nitrogen (BUN) level (p = 0.001) compared to non-supplementation of protease during finishing periods. Pigs which fed the protease showed decreased ammonia (NH3) emissions (p < 0.05) during experiment periods and decreased hydrogen sulfide (H2S) emissions (p < 0.01) during finishing periods. Interactions between nutrient density and protease were observed, which decreased the feed conversion ratio (p < 0.05) in HN diets without protease compared to BN diets without protease during weeks 4 to 6. Also, interaction between nutrient density and protease was observed, which resulted in improved ATTD of CP (p < 0.01) in response to PTA supplementation with HN diets during the finishing period. In conclusion, supplementation of protease reduces NH3 in feces and BUN in whole blood by increasing the digestibility of CP and improves growth performance. Also, diets with high nutrient density improved growth performance and nutrient digestibility in growing periods.

Effect of loading density and weather conditions on animal welfare and meat quality of slaughter pigs

There are several factors that affect the welfare and meat quality of pigs during pre-slaughter transport. Among various factors, the effects of weather conditions and loading density were studied. A total of 3,726 finishing pigs were allotted to one of nine groups arranged in a 3 × 3 factorial design according to the weather conditions (low temperature [LT], under 10°C; normal temperature [NT], 10°C-24°C; high temperature [HT], upper 24°C), and loading density (low density [LD], upper 0.43 m2/100 kg; normal density [ND], 0.37-0.43 m2/100 kg; high density [HD], under 0.37 m2/100 kg). Each treatment group follow as: LTLD, LTND, LTHD, NTLD, NTND, NTHD, HTLD, HTND, HTHD. In terms of carcass composition, pigs had the highest carcass weight and backfat thickness at LT. Comparing the HD transport to the ND transport, the meat quality indicated a lower pH and more drip loss. The incidence rate of pale, soft, exudative (PSE) pork was high in the order of the HD, LD, and the ND transport (20%, 9%, and 2%, respectively). The HT transport showed the lowest pH and greatest L* value under the given weather conditions. Pigs transported under the HTHD and LTLD conditions had the greatest rates of PSE pork (40% and 20%, respectively). Pigs exposed to HD transport had the shortest laying time and the highest overplap behavior. The LDLT transport pigs had a shorter laying time than the LDNT and LDHT transport pigs. In conclusion, too high or too low density transport is generally not excellent for meat quality or animal welfare, however it is preferable to transport at a slightly low density at high temperature and at a slightly high density at low temperature.

Effects of different levels of organic chromium and selenomethionine cocktails in broilers

Selenium (Se) is an essential trace mineral that plays an important role in physiological processes by regulating the antioxidant defense system and enhancing immunity. Chromium is an essential mineral involved in carbohydrate and lipid metabolism and also plays a role in maintaining normal insulin function. Based on these advantages, we hypothesized that the addition of selenomethionine (SeMet) and organic chromium (OC) to broiler diets would increase Se deposition, antioxidant capacity and immune response in meat. Therefore, this study analyzed the effects of OC and SeMet on growh performance, nutrients digestibility, blood profiles, intestinal morphology, meat quality characteristics, and taxonomic analysis of broilers. A total of 168 one-day-old broiler chicken (Arbor Acres) were randomly allotted to 3 groups based on the initial body weight of 37.33 ± 0.24 g with 7 replicate per 8 birds (mixed sex). The experiments period was 28 days. Dietary treatments were folloewd: Basal diets based on corn-soybean meal (CON), basal diet supplemented with 0.2 ppm OC and 0.2 ppm SeMet (CS4), and basal diet supplemented with 0.4 ppm OC and 0.4 ppm SeMet (CS8). Supplementation of OC and SeMet did not affect on growth performance, nutrient digestibility. However, CS8 supplementation increased in duodenum villus height and villus height : crypt depth, and increased in breast meat Se deposition. In addition, CS8 group showed higher uric acid and total antioxidant status than CON group. Taxonomic analysis at phylum level revealed that Proteobacteria and Firmicutes of CS4 and CS8 were lower than CON group. In genus level, the relative abundance of fecal Lactobacillus and Enterococcus of CS4 and CS8 groups were higher than CON group. In short, 0.4 ppm OC and 0.4 ppm SeMet supplementation to broiler diet supporitng positive gut microbiome change, also enhancing antioxidant capacity, and Se deposition in breast meat.

Effect of black soldier fly larvae as substitutes for fishmeal in broiler diet

This study investigated the effect of processed forms (defatted or hydrolyzed) of black soldier fly larvae (Hermetia illucens L., BSFL) as a protein substitute on broilers. Experiment 1 was a feeding experiment, and Experiment 2 was a metabolism experiment. In Experiment 1, a total of 120 day-old Arbor Acres broilers (initial body weight 39.52 ± 0.24 g) were used for 28 days. There were 8 replicate pens, and 5 broilers were assigned to each pen. In Experiment 2, a total of 36 day-old broilers (initial body weight 39.49 ± 0.21 g) were used for the metabolism trial. There were 2 broilers in a metabolism cage and six replicate cages per treatment. The dietary treatments were as follows: a basal diet (CON), a basal diet without fishmeal and substitute with defatted BSFL (T1), a basal diet without fishmeal and a substitute with hydrolyzed BSFL (T2). In Experiment 1, during the entire experimental period, the T2 group significantly increased (p < 0.05) body weight gain and feed intake compared to the CON and T1 groups. The feed conversion ratio showed a lower tendency (p = 0.057) in the T2 group than in the CON and T1 groups. At 2 weeks, the CON and T2 groups were significantly higher (p < 0.05) crude protein (CP) digestibility than the T1 group. At 4 weeks, the total protein level significantly increased (p < 0.05) in the CON and T2 groups compared to the T1 group. In Experiment 2, the CP digestibility significantly increased (p < 0.05) in the T2 group compared to the CON and T1 group at weeks 2 and 4. At week 4 amino acid digestibility, the T2 group significantly increased (p < 0.05) lysine, methionine, tryptophan, and glycine digestibility compared to the T1 group. There was no difference in fecal microbiota among the treatment groups. In conclusion, feeding hydrolyzed BSFL as a fishmeal substitute in broiler diets improved growth performance, CP digestibility, and specific amino acid digestibility. Therefore, it is considered that hydrolyzed BSFL in broiler diets can be sufficiently used as a new protein source.

Topical Cream Carrying Drug-Loaded Nanogels for Melanoma Treatment

In this study, nanogel creams carrying paclitaxel (PTX) and temozolomide (TMZ) were prepared for the topical treatment of melanoma. PTX and TMZ were first loaded in poly-(D,L-lactide-co-glycolide)-block-poly(ethylene glycol)-block-poly-(D,L-lactide-co-glycolide) (PLAG-b-PEG-b-PLGA) thermosensitive nanogels, which made a transition from a free-flowing sol (formation of micellar network) at 25°C with the z-average particle size of c.a. 96 nm to a gel (aggregation of micelles) at 33°C with the z-average particle size of c.a. 427 nm. An anhydrous absorption ointment base, aquaphor, was then added to drug-loaded nanogels to form nanogel creams carrying PTX and TMZ. Nanogel creams permitted controlled release of the payloads and improved the penetration of the payloads through the rodent skin compared to drug(s)-loaded nanogels. PTX and TMZ in a combination were synergistically effective in inhibiting SK-MEL28, A375, and B16-F10 melanoma cancer cells in vitro. Topically applied nanogel creams carrying TMZ/PTX (4 mg/1.5 mg/dose) showed a trend of tumor volume inhibition on B16-F10-bearing xenograft mice in vivo.

Effects of stimbiotic supplementation on gut health, immune response, and intestinal microbiota in weaned piglets challenged with E. coli

In order to make piglet diets more effective, it is necessary to investigate effective methods for breaking down xylan in cereal. The objective of this study was to determine the effects of dietary stimbiotic (STB) supplementation on growth performance, intestinal morphology, immune response and intestinal microbiota in weaned piglets. A total of 24 (Duroc × Yorkshire × Landrace) weaned pigs (initial body weight of 8.01 ± 0.38 kg and 28 ± 3 d old), were assigned to 4 treatments with 6 replicates per treatment. Pigs were housed in individual pens for 17 days, including 5 days adaption period and 12 days after the first Escherichia coli (E. coli) challenge. The experiment was conducted in a 2 × 2 factorial arrangement of treatments consisting of two levels of challenge (challenge and non-challenge) and two levels of STB (0 and 0.5 g/kg diet). Supplementations of STB 0.5 g/kg improved the gain to feed ratio (G:F) (P < 0.05) in piglets challenged with shiga toxigenic E. coli (STEC). STB supplementation decreased (P < 0.05) white blood cells, neutrophils, lymphocytes, and expression levels of tumor necrosis factor-alpha and interleukin-6. Supplementation of STB improved (P < 0.05) the lymphocytes and neutrophils in piglets challenged with STEC on 12 dpi. Supplementation of STB also improved (P < 0.05) the villus height to-crypt depth ratio of ileum in piglets challenged with STEC. Supplementation of STB increased (P < 0.05) the expression levels of claudin-1 of ileum. In genus level, supplementation of STB increased (P < 0.001) the abundance of Prevotella compared to non-supplementation of STB groups in pre-inoculation period. Also, supplementation of STB decreased (P < 0.05) the abundance of Faecalibacterium and Eubacterium_coprostanoligenes_group compared to non-supplementation of STB groups in post-inoculation period. In phylum level, supplementation of STB increased (P < 0.05) the abundance of Desulfobacterota and Fibrobacterota in pre-inoculation period. E. coli challenge increased the abundance of Fibrobacterota compared to non-challenged group in post-inoculation period. In conclusion, these findings indicated that STB supplementation could alleviate a decrease of the performance, immune response, and inflammatory response in piglets induced by the STEC challenge.

Effects of Combinations of Toxin Binders with or without Natural Components on Broiler Breeders Exposed to Ochratoxin A

The objective of this study was to investigate the effects of toxin binders on broiler breeders fed an ochratoxin A (OTA)-contaminated diet. A total of 60 45-week-old female Arbor Acres broiler breeder birds with an initial body weight of 3.65 ± 0.35 kg were randomly divided into 6 treatment groups, with 10 replicates per group and 1 bird per replicate. The trial was conducted for 9 weeks (including 1 week of adaptation). Feed additive 1 (FA1) was composed of clay minerals (85% bentonite and 12% clinoptilolite) with 3% charcoal. FA2 was composed of clay minerals (66.1% aluminosilicates) with natural components (0.8% artichoke and rosemary plant extracts), 7% yeast extract, 0.5% beta-glucans, and 25.6% carriers. The dietary treatment groups were as follows: (1) birds fed an OTA-free basal diet (Negative Control; NC); (2) lipopolysaccharide (LPS)-challenged birds fed a diet including OTA (4 mg/kg) (Positive Control, PC); (3) the PC with 0.05% FA1 (Treatment 1, T1); (4) the PC with 0.10% FA1 (Treatment 2, T2); (5) the PC with 0.10% FA2 (Treatment 3, T3); and (6) the PC with 0.20% FA2 (Treatment 4, T4). The LPS challenge (an intramuscular injection of 1 mg E. coli O55:B5 LPS per kg of body weight) was performed on the first day of the experiment. The results of this experiment show that the PC treatment negatively affected (p < 0.05) egg production, hatchability, Haugh unit, bone mineralization, relative organ weight (abdominal fat, liver), the levels of glutamic oxaloacetic transaminase (GOT), high-density lipoprotein (HDL), and total cholesterol in the blood, and OTA accumulation in the liver compared with the NC. However, supplementation with toxin binders mitigated (p < 0.05) the negative effects of the OTA. Specifically, supplementation with 0.10% FA1 and 0.10% FA2 increased (p < 0.05) eggshell strength by week 4, and the Haugh unit and bone mineralization (phosphorous) by week 8, while decreasing (p < 0.05) the relative weight of the liver and the levels of GOT and HDL in the blood. Supplementation with 0.10% FA2 led to greater improvements in various parameters, including laying performance and bone mineralization, than the other treatments. In conclusion, toxin binders with or without natural components can be effective tools in the mitigation of OTA-induced problems due to their synergistic effects.

Effects of dietary supplementation of Pediococcus pentosaceus strains from kimchi in weaned piglet challenged with Escherichia coli and Salmonella enterica

Escherichia coli (E. coli) and Salmonella enterica (SE) infections in pigs are major source associated with enteric disease such as post weaning diarrhea. The aim of this study was to investigate the effects of Pediococcus pentosaceus in weaned piglets challenged with pathogen bacteria. In Experiment.1 90 weaned piglets with initial body weights of 8.53 ± 0.34 kg were assigned to 15 treatments for 2 weeks. The experiments were conducted two trials in a 2 × 5 factorial arrangement of treatments consisting of two levels of challenge (challenge and non-challenge) with E. coli and SE, respectively and five levels of probiotics (Control, Lactobacillus plantarum [LA], Pediococcus pentosaceus SMFM2016-WK1 [38W], Pediococcus acidilactici K [PK], Lactobacillus reuteri PF30 [PF30]). In Experiment.2 a total of 30 weaned pigs (initial body weight of 9.84 ± 0.85 kg) were used in 4 weeks experiment. Pigs were allocated to 5 groups in a randomized complete way with 2 pens per group and 3 pigs per pen. Supplementation of LA and 38W improved (p < 0.05) growth performance, intestinal pathogen bacteria count, fecal noxious odor and diarrhea incidence. In conclusion, supplementation of 38W strains isolated from white kimchi can act as probiotics by inhibiting E. coli and SE.

Effects of exogenous protease on performance, economic evaluation, nutrient digestibility, fecal score, intestinal morphology, blood profile, carcass trait and meat quality in broilers fed normal diets and diets considered with matrix value

This study was conducted to estimate the effects of exogenous protease on performance, economic evaluation, nutrient digestibility, fecal score, intestinal morphology, blood profile, carcass traits, and meat quality in broilers fed normal diets and diets considered with matrix value. A total of 90, one-day-old Arbor Acres broiler chickens were randomly allocated to 3 dietary treatments with 6 replicates and each replicate of 5 broiler chickens. Treatments were as follows: 1) Basal diet (positive control, PC), 2) Basal diet formulated with full ProAct 360 matrix at 50 g/MT without addition of ProAct 360 (negative control, NC), 3) NC + 50 g/MT ProAct 360 (PA). Supplementation of exogenous protease to nutrient deficient NC diet by matrix values (PA) tended to increase growth performance and significantly improved intestinal morphology compared with the NC group. The PA group had significantly lower fecal score, and higher ATTD of crude protein and amino acids than those of the NC group. Furthermore, supplementation of exogenous protease to NC diet decreased feed cost, resulting in improved profit margin. However, there was no significant difference on carcass yield and relative organ weight. In conclusion, supplementation of exogenous protease using matrix value could be used as economic additive to improve growth, profit margin, digestibility, and gut health in broiler chickens.

Effects of supplemental different clay minerals in broiler chickens under cyclic heat stress

The objective of this study was to investigate the effect of supplementing clay minerals and organic chromium in feed on broiler chicken under heat stress (HS). A total of 90 one-day-old broiler chicken (Arbor Acres) with an initial body weight of 45.0 ± 0.2 g were assigned to five treatment groups (six replications, three birds each cage): 1) NC group, basal diet under room temperature environment; 2) PC group, basal diet under high temperature (HT) environment; 3) ILT group, basal diet + 1% illite + HT; 4) ZLT group, basal diet + 1% zeolite + HT; 5) OC group, basal diet + 400 ppb/kg organic chromium + HT. The ILT and ZLT groups had significantly higher body weight than the PC group in 4 weeks. Apparent total tract digestibility of gross energy was increased in the ILT, ZLT, and OC groups compared to the PC group. The NC group had lower foot-pad dermatitis score than other groups. Escherichia coli population in the cecum and feces was decreased in the ZLT group than in the PC group. Lactobacillus in cecum and feces was significantly increased in the ZLT group than in the PC group. Regarding blood profiles, blood cortisol was decreased in the NC and ILT groups compared to the PC group. Water holding capacity and pH were increased in the ZLT group than the PC group. In conclusion, according to the results of growth performance, nutrients digestibility, bacteria counts, and meat characteristics, supplementation of the ZLT in broiler diet can alleviate HS.

Healthcare utilisation for elderly people at the onset of the COVID-19 pandemic in South Korea

BACKGROUND

At the onset of the coronavirus disease 2019 (COVID-19) pandemic, health care systems were severely disrupted in many countries and in particular, elderly people vulnerable to COVID-19 may have been reluctant to receive their medical treatment.

METHODS

We conducted interrupted time series analyses (ITSA) using nationwide medical claim data between January 2020 and July 2020, with focus on different disease categories for the patients of 65 to 84-year-olds, i.e., acute upper respiratory infections (AURIs) vs. chronic diseases.

RESULTS

AURIs and chronic diseases showed a sharp contrast with respect to the change in healthcare service utilisation. First, the utilisation rate for chronic diseases changed little whereas for AURIs it dropped by 20.4% year-over-year (yoy) at the onset of the pandemic (week 6, 2020). Second, as social distancing relaxed (week 17, 2020), the AURIs patients trended up and even reached to 7.8% above yoy whereas no significant change found for chronic diseases.

CONCLUSIONS

The uninterrupted treatment for chronic diseases in contrast to the AURIs implies that the governmental and public responses to the pandemic outbreak worked for efficient healthcare provision to patients in needs of regular check-ups and treatment in the middle of an infectious disease crisis.

Discussion of ‘Estimating time-varying causal excursion effects in mobile health with binary outcomes’

In this discussion, we examine the contributions of Qian et al. (2021) and potential applications of the newly developed estimator for the causal excursion effect in binary outcome data. Specifically, we consider extension of their method to count outcomes and observational data, propose an alternative use of their method for analysing excursion effect trajectories and discuss ways of improving estimator efficiency.

MRI-Visible Perivascular Spaces in the Centrum Semiovale Are Associated with Brain Amyloid Deposition in Patients with Alzheimer Disease-Related Cognitive Impairment

BACKGROUND AND PURPOSE

The association of perivascular spaces in the centrum semiovale with amyloid accumulation among patients with Alzheimer disease-related cognitive impairment is unknown. We evaluated this association in patients with Alzheimer disease-related cognitive impairment and β-amyloid deposition, assessed with [¹⁸F] florbetaben PET/CT.

MATERIALS AND METHODS

MR imaging and [¹⁸F] florbetaben PET/CT images of 144 patients with Alzheimer disease-related cognitive impairment were retrospectively evaluated. MR imaging-visible perivascular spaces were rated on a 4-point visual scale: a score of ≥3 or <3 indicated a high or low degree of MR imaging-visible perivascular spaces, respectively. Amyloid deposition was evaluated using the brain β-amyloid plaque load scoring system.

RESULTS

Compared with patients negative for β-amyloid, those positive for it were older and more likely to have lower cognitive function, a diagnosis of Alzheimer disease, white matter hyperintensity, the Apolipoprotein E ε4 allele, and a high degree of MR imaging-visible perivascular spaces in the centrum semiovale. Multivariable analysis, adjusted for age and Apolipoprotein E status, revealed that a high degree of MR imaging-visible perivascular spaces in the centrum semiovale was independently associated with β-amyloid positivity (odds ratio, 2.307; 95% CI, 1.036-5.136; P = .041).

CONCLUSIONS

A high degree of MR imaging-visible perivascular spaces in the centrum semiovale independently predicted β-amyloid positivity in patients with Alzheimer disease-related cognitive impairment. Thus, MR imaging-visible perivascular spaces in the centrum semiovale are associated with amyloid pathology of the brain and could be an indirect imaging marker of amyloid burden in patients with Alzheimer disease-related cognitive impairment.

Point-of-care testing for the detection of SARS-CoV-2: a systematic review and meta-analysis

OBJECTIVE

To evaluate the diagnostic accuracy of the Food and Drug Administration Emergency Use Authorization (FDA-EUA) authorized point-of-care tests (POCTs) for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

MATERIALS AND METHODS

A systematic literature search was conducted using the PubMed, Embase, and Web of Science databases for articles published till August 10, 2020. We included studies providing information regarding diagnostic test accuracy of FDA-EUA POCTs for SARS-CoV-2 detection. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The review protocol is registered in the International Prospective Register of Systematic Reviews (protocol number CRD42020202248).

RESULTS

We included 26 studies describing a total of 3242 samples. The summary sensitivity and specificity were 0.94 [95% confidence interval (CI): 0.88-0.97] and 1.00 (95% CI: 0.99-1.00), respectively. The area under the summary receiver operating characteristic curve was 1.00 (95% CI: 0.99-1.00). A pooled analysis based on the index test revealed a summary sensitivity and specificity of Cepheid Xpert Xpress SARS-CoV-2 [0.99 (95% CI: 0.97-1.00) and 0.99 (95% CI: 0.94-1.00, respectively)] and ID NOW COVID-19 [0.78 (95% CI: 0.74-0.82) and 1.00 (95% CI: 0.98-1.00), respectively].

CONCLUSIONS

FDA-EUA POCTs, especially molecular assays, have high sensitivity, specificity, and overall diagnostic accuracy for detecting SARS-CoV-2. If approved, FDA-EUA POCTs can provide a rapid and practical way to identify infected individuals early on and help to limit the strain on the healthcare system. However, more high-quality clinical data are required to support our results.

Metabolomics Insights in Early Childhood Caries

Dental caries is characterized by a dysbiotic shift at the biofilm-tooth surface interface, yet comprehensive biochemical characterizations of the biofilm are scant. We used metabolomics to identify biochemical features of the supragingival biofilm associated with early childhood caries (ECC) prevalence and severity. The study's analytical sample comprised 289 children ages 3 to 5 (51% with ECC) who attended public preschools in North Carolina and were enrolled in a community-based cross-sectional study of early childhood oral health. Clinical examinations were conducted by calibrated examiners in community locations using International Caries Detection and Classification System (ICDAS) criteria. Supragingival plaque collected from the facial/buccal surfaces of all primary teeth in the upper-left quadrant was analyzed using ultra-performance liquid chromatography-tandem mass spectrometry. Associations between individual metabolites and 18 clinical traits (based on different ECC definitions and sets of tooth surfaces) were quantified using Brownian distance correlations (dCor) and linear regression modeling of log₂-transformed values, applying a false discovery rate multiple testing correction. A tree-based pipeline optimization tool (TPOT)-machine learning process was used to identify the best-fitting ECC classification metabolite model. There were 503 named metabolites identified, including microbial, host, and exogenous biochemicals. Most significant ECC-metabolite associations were positive (i.e., upregulations/enrichments). The localized ECC case definition (ICDAS ≥1 caries experience within the surfaces from which plaque was collected) had the strongest correlation with the metabolome (dCor P = 8 × 10^-3). Sixteen metabolites were significantly associated with ECC after multiple testing correction, including fucose (P = 3.0 × 10^-6) and N-acetylneuraminate (p = 6.8 × 10^-6) with higher ECC prevalence, as well as catechin (P = 4.7 × 10^-6) and epicatechin (P = 2.9 × 10^-6) with lower. Catechin, epicatechin, imidazole propionate, fucose, 9,10-DiHOME, and N-acetylneuraminate were among the top 15 metabolites in terms of ECC classification importance in the automated TPOT model. These supragingival biofilm metabolite findings provide novel insights in ECC biology and can serve as the basis for the development of measures of disease activity or risk assessment.

Salient safety conditioning improves novel discrimination learning

Generalized fear is one purported mechanism of anxiety that is a target of clinical and basic research. Impaired fear discrimination has been primarily examined from the perspective of increased fear learning, rather than how learning about non-threatening stimuli affects fear discrimination. To address this question, we tested how three Safety Conditioning protocols with varied levels of salience allocated to the safety cue compared to classic Fear Conditioning in their impact on subsequent innate anxiety, and differential fear learning of new aversive and neutral cues. Using a high anxiety strain of mice (129SvEv, Taconic), we show that Fear Conditioned animals show little exploration of the anxiogenic center of an open field 24 h later, and poor discrimination during new differential conditioning 7 days later. Three groups of mice underwent Safety Conditioning, (i) the safety tone was unpaired with a shock, (ii) the safety tone was unpaired with the shock and co-terminated with a house light signaling the end of the safety period, and (iii) the safety tone was unpaired with the shock and its beginning co-occurred with a house light, signaling the start of a safety period. Mice from all Safety Conditioning groups showed higher levels of open field exploration than the Fear Conditioned mice 24 h after training. Furthermore, Safety Conditioned animals showed improved discrimination learning of a novel non-threat, with the Salient Beginning safety conditioned group performing best. These findings indicate that high anxiety animals benefit from salient safety training to improve exploration and discrimination of new non-threating stimuli.

Development of 3D-Printed Layered PLGA Films for Drug Delivery and Evaluation of Drug Release Behaviors

3D printing has been widely used to rapidly manufacture a variety of solid dosage forms on-demand, without sacrificing precision. This study used extrusion-based 3D printing to prepare single-layered, tri-layered, and core-in-shell poly(lactic-co-glycolic acid) (PLGA) films carrying paclitaxel and rapamycin in combination or lidocaine alone. Each layer was composed of either low molecular weight (MW) PLGA or high MW PLGA. In vitro drug release kinetics of paclitaxel, rapamycin, and lidocaine for PLGA films were assessed and compared with PLGA-polyethylene glycol (PEG)-PLGA hydrogel discs. Regardless of the structure of PLGA film, paclitaxel (half-time: 54-63 days) was released faster than when compared with rapamycin (half-time: 74-80 days). In contrast, single-layered PLGA-PEG-PLGA discs released rapamycin (half-time 5.7 h) at a more rapid rate than paclitaxel (half-time: 7.3 h). Single-layered PLGA-PEG-PLGA discs enabled a faster drug release than PLGA films, noting that the disc matrices dissolve in water in 24 h. Similarly, lidocaine incorporated in PLGA films (half-time: 13-36 days) exhibited slower release patterns than that in PLGA-PEG-PLGA discs (half-time: 2.6 h). In vitro drug release patterns were explained using molecular models that simulate drug-polymer interactions. Analysis of models suggested that drug-polymer interactions, location of each drug in the polymeric matrix, and solubility of drugs in water were major factors that determine drug release behaviors from the polymeric films and discs.

MRI size assessment of cerebral microvasculature using diffusion-time-dependent stimulated-echo acquisition: A feasibility study in rodent

In this study, a stimulated-echo (STE) method was employed to robustify the cerebral vessel size estimation near air-tissue, bone-tissue interfaces, and large vessels. The proposed solution is to replace the relaxation rate change from gradient-echo (GRE) with that from STE with long diffusion time after the injection of an intravascular contrast agent, superparamagnetic iron oxide nanoparticles. The corresponding diffusion length of STE is shorter than the length over which the unwanted macroscopic field inhomogeneities but is still longer than the correlation length of the fields induced by small vessels. Therefore, the unwanted field inhomogeneities are refocused, while preserving microscopic susceptibility contrast from cerebral vessels. The mean vessel diameter (dimensionless) derived from the diffusion-time-varying STE method was compared to the mean vessel diameter obtained by a conventional spin-echo (SE) and GRE combination based on Monte-Carlo proton diffusion simulations and in vivo rat experiments at 7 ​T. The in vivo mean vessel diameter from the MRI experiments was directly compared to available reference mouse brain vasculature obtained by a knife-edge scanning microscope (KESM), which is considered to be the gold standard. Monte-Carlo simulation revealed that SE and GRE-based MR relaxation rate changes (ΔR₂ and ΔR₂∗, respectively) can be enhanced using single STE-based MR relaxation rate change (ΔR_STE) by regulating diffusion time, especially for small vessels. The in vivo mean vessel diameter from the STE method demonstrated a closer agreement with that from the KESM compared to the combined SE and GRE method, especially in the olfactory bulb and cortex. This study demonstrates that STE relaxation rate changes can be used as consistent measures for assessing small cerebral microvasculature, where macroscopic field inhomogeneity is severe and signal contamination from adjacent large vessels is significant.

Prevalence of human papillomavirus in oral gargles and tonsillar washings

OBJECTIVES

Human papillomavirus (HPV) infection drives carcinogenesis in the oropharynx. No standard sampling or HPV detection methods for evaluating oropharyngeal HPV infection exist. The prevalence of oral HPV infection in Japan is unknown.

MATERIALS AND METHODS

We examined 435 healthy Japanese individuals to address whether adding tonsillar washing to oral gargling would improve HPV detection. We compared HPV assessment using GENOSEARCH HPV31 versus nested PCR and direct sequencing. Associations between HPV infection and demographic and behavioral characteristics were examined.

RESULTS

Most participants who were HPV-positive based on oral gargles were also HPV-positive based on tonsillar washings: 11 (64.7%) of 17 on nested PCR and 12 (70.6%) of 17 on GENOSEARCH HPV31. Although HPV infection was more prevalent in oral gargles followed by tonsillar washings than in oral gargles alone, the difference was not statistically significant (nested PCR, 4.8% vs. 3.9%, P = 0.46; GENOSEARCH HPV31, 5.3% vs. 3.9%, P = 0.33). The overall agreement between nested PCR and GENOSEARCH HPV31 was 98.6%, with 76.0% positive agreement. The overall prevalence of oral HPV infection in Japan was 5.7% (95% confidence interval, 3.9-8.3%). Men had a significantly higher prevalence of oral HPV infection than women (8.3% vs. 2.6%, P = 0.02). Infection increased with number of lifetime sexual partners (P < 0.001 for trend).

CONCLUSION

The oropharynx is probably the major source of HPV-infected cells in oral gargles. Oral gargling could be a standard sampling method for evaluating oropharyngeal HPV infection. GENOSEARCH HPV31 could be an option for oral HPV detection.

Radiomics Study of Thyroid Ultrasound for Predicting BRAF Mutation in Papillary Thyroid Carcinoma: Preliminary Results

BACKGROUND AND PURPOSE

It is not known how radiomics using ultrasound images contribute to the detection of BRAF mutation. This study aimed to evaluate whether a radiomics study of gray-scale ultrasound can predict the presence or absence of B-Raf proto-oncogene, serine/threonine kinase (BRAF) mutation in papillary thyroid cancer.

MATERIALS AND METHODS

The study retrospectively included 96 thyroid nodules that were surgically confirmed papillary thyroid cancers between January 2012 and June 2013. BRAF mutation was positive in 48 nodules and negative in 48 nodules. For analysis, ROIs from the nodules were demarcated manually on both longitudinal and transverse sonographic images. We extracted a total of 86 radiomics features derived from histogram parameters, gray-level co-occurrence matrix, intensity size zone matrix, and shape features. These features were used to build 3 different classifier models, including logistic regression, support vector machine, and random forest using 5-fold cross-validation. The performance including accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve, of the different models was evaluated.

RESULTS

The incidence of high-suspicion nodules diagnosed on ultrasound was higher in the BRAF mutation-positive group than in the mutation-negative group (P  =  .004). The radiomics approach demonstrated that all classification models showed moderate performance for predicting the presence of BRAF mutation in papillary thyroid cancers with an area under the curve value of 0.651, accuracy of 64.3%, sensitivity of 66.8%, and specificity of 61.8%, on average, for the 3 models.

CONCLUSIONS

Radiomics study using thyroid sonography is limited in predicting the BRAF mutation status of papillary thyroid carcinoma. Further studies will be needed to validate our results using various diagnostic methods.

Preparations of Rectal Suppositories Containing Artesunate

Rectal artesunate suppositories are a useful option for pre-referral treatment of severe malaria, specifically in children under 6 years of age in remote malaria-endemic areas. The main challenges are to improve the solubility of drugs in the rectal fluids and prevent the product from turning rancid or melting in a tropical climate. In this short proof-of-concept study, three types of rectal suppositories of artesunate were prepared: (i) polyethylene glycol (PEG)-based suppositories carrying free artesunate (non-modified artesunate), (ii) PEG-based suppositories carrying artesunate-loaded micelles and (iii) 3D-printed suppositories carrying a PEG/artesunate mixture. Physical parameters of suppositories, release profiles of artesunate (the fastest to the slowest: ii≥i>iii) and thermostability (the most stable to the least stable: iii>ii>i) of suppositories at increased temperature were assessed to determine the advantages and disadvantages of each formulation.

Structural and molecular modelling studies of antimelanogenic piper-amide TRPM1 antagonists

Piper-amides exhibit diverse biological activities, including antimelanogenic effects. In our previous studies, we identified a potent piper-amide derivative that inhibited melanogenesis via the TRPM1 calcium channel. Despite its potential as a therapeutic target, the three-dimensional structure of TRPM1 is still not available. Thus, structure-guided compound design and the discovery of novel inhibitors of melanogenesis have been limited. In the present study, a series of computational methods, including homology modelling, docking, molecular dynamics simulation and field-based pharmacophore modelling, were integrated to explore the structural features of natural piper-amide-like compounds related to the TRPM1 target. These studies suggested the binding mode and provided a 3D pharmacophore model of the ligands, which can be helpful in understanding the TRPM1-ligand interactions at the molecular level and in designing potent antagonists of TRPM1.

Safety and efficacy of nivolumab in combination with S-1/capecitabine plus oxaliplatin in patients with previously untreated, unresectable, advanced, or recurrent gastric/gastroesophageal junction cancer: interim results of a randomized, phase II trial (ATTRACTION-4)

BACKGROUND

Nivolumab is approved as an option for third- or later-line treatment of advanced gastric/gastroesophageal junction (G/GEJ) cancer in several countries after ATTRACTION-2. To further improve the therapeutic efficacy of first-line therapy, exploration of a nivolumab-chemotherapy combination is warranted. In part 1 (phase II) of ATTRACTION-4, the safety and efficacy of nivolumab combined with S-1 plus oxaliplatin (SOX) or capecitabine plus oxaliplatin (CapeOX) as first-line therapy for unresectable advanced or recurrent human epidermal growth factor receptor 2 (HER2)-negative G/GEJ cancer were evaluated.

PATIENTS AND METHODS

Patients were randomized (1 : 1) to receive nivolumab (360 mg intravenously every 3 weeks) plus SOX (S-1, 40 mg/m2 orally twice daily for 14 days followed by 7 days off; oxaliplatin, 130 mg/m2 intravenously on day 1 every 3 weeks) or CapeOX (capecitabine, 1000 mg/m2 orally twice daily for 14 days followed by 7 days off; oxaliplatin, 130 mg/m2 intravenously on day 1 every 3 weeks) until disease progression, unacceptable toxicity, or consent withdrawal.

RESULTS

Of 40 randomized patients, 39 (nivolumab plus SOX, 21; nivolumab plus CapeOX, 18) and 38 (21 and 17, respectively) comprised the safety and efficacy populations, respectively. Most frequent (>10%) grade 3/4 treatment-related adverse events were neutropenia (14.3%) in the nivolumab plus SOX group, and neutropenia (16.7%), anemia, peripheral sensory neuropathy, decreased appetite, type 1 diabetes mellitus, and nausea (11.1% each) in the nivolumab plus CapeOX group. No treatment-related death occurred. Objective response rate was 57.1% (95% confidence interval 34.0-78.2) with nivolumab plus SOX and 76.5% (50.1-93.2) with nivolumab plus CapeOX. Median overall survival was not reached (NR) in both groups. Median progression-free survival was 9.7 months (5.8-NR) and 10.6 months (5.6-12.5), respectively.

CONCLUSION

Nivolumab combined with SOX/CapeOX was well tolerated and demonstrated encouraging efficacy for unresectable advanced or recurrent HER2-negative G/GEJ cancer. ATTRACTION-4 has proceeded to part 2 (phase III) to compare nivolumab plus SOX/CapeOX versus placebo plus SOX/CapeOX.

CLINICALTRIALS.GOV ID

NCT02746796.