BVN008, Diphtheria-tetanus-acellular pertussis combined vaccine has no effects on fertility and prenatal and postnatal developmental toxicity in female Sprague-Dawley rats

Tdap is an acronym for tetanus(T), diphtheria(D), and acellular pertussis(aP), and is a preventive vaccine that combines vaccines against three diseases. BVN008 is a Tdap vaccine designed to protect against three diseases: diphtheria, tetanus, and pertussis. The lower-case "d" and "p" in Td and Tdap means these vaccines use smaller amounts of diphtheria and whooping cough. The lower doses are appropriate for adolescents and adults. The purpose of this study was to identify adverse effects in pregnant or lactating female Sprague-Dawley rats including maternal fertility and toxicity, and development of the embryos, fetus, and pups following intramuscular administration of BVN008. Two groups of 50 female Sprague-Dawley rats were administered four or five intramuscular injections of the vaccine (human dose of 0.5 mL at 4 and 2 weeks before pairing, on gestation day (GD) 8 and 15, and lactation day (LD) 7. A negative control group was administered 0.9% saline at the same dose four or five times. There were no adverse effects on fertility, reproductive performance, or maternal toxicity of the F0 females. There was no effect of developmental toxicity in F1 fetuses and pups including fetal body weight and morphology, postnatal growth, development, and behavior until weaning. Antibodies against tetanus, diphtheria, and pertussis were transferred to the F1 fetuses and F1 pups via placenta and milk. These results demonstrate that BVN008 had no detectable adverse effects in either the F0 female rats, the F1 fetuses or pups.

Effect of Warm-Up Exercise on Functional Regulation of Motor Unit Activation during Isometric Torque Production

In this study, we tested several hypotheses related to changes in motor unit activation patterns after warm-up exercise. Fifteen healthy young men participated in the experiment and the main task was to produce voluntary torque through the elbow joint under the isometric condition. The experimental conditions consisted of two directions of torque, including flexion and extension, at two joint angles, 10° and 90°. Participants were asked to increase the joint torque to the maximal level at a rate of 10% of the maximum voluntary torque. The warm-up protocol followed the ACSM guidelines, which increased body temperature by approximately 1.5°C. Decomposition electromyography electrodes, capable of extracting multiple motor unit action potentials from surface signals, were placed on the biceps and triceps brachii muscles, and joint torque was measured on the dynamometer. The mean firing rate and the recruitment threshold of the decomposed motor units were quantified. In addition, a single motor unit activity from the spike train was quantified for each of five selected motor units. The magnitude of joint torque increased with the warm-up exercise for all the experimental conditions. The results of the motor unit analyses showed a positive and beneficial effect of the warm-up exercise, with an increase in both the mean firing rate and the recruitment threshold by about 56% and 33%, respectively, particularly in the agonist muscle. Power spectral density in the gamma band, which is thought to be the dominant voluntary activity, was also increased by the warm-up exercise only in the high threshold motor units.

What Is A Family? A Constitutive-Affirmative Account

Bio-heteronormative conceptions of the family have long reinforced a nuclear ideal of the family as a heterosexual marriage, with children who are the genetic progeny of that union. This ideal, however, has also long been resisted in light of recent social developments, exhibited through the increased incidence and acceptance of step-families, donor-conceived families, and so forth. Although to this end some might claim that the bio-heteronormative ideal is not necessary for a social unit to count as a family, a more systematic conceptualization of the family-the kind of family that matters morally-is relatively underexplored in the philosophical literature. This paper makes a start at developing and defending an account of the family that is normatively attractive and in line with the growing prevalence of non-conventional families and methods of family-formation. Our account, which we call a constitutive-affirmative model of the family, takes the family to be constituted by an ongoing process of relevant affective and affirmative relations between the putative family members.

Metabolomic profiles of ovariectomized mice and their associations with body composition and frailty-related parameters in postmenopausal women

BACKGROUND

Menopause, a dramatical estrogen-deficient condition, is considered the most significant milestone in women's health.

PURPOSE

To investigate the metabolite changes attributed to estrogen deficiency using random forest (RF)-based machine learning (ML) modeling strategy in ovariectomized (OVX) mice as well as determine the clinical relevance of selected metabolites in older women.

METHODS AND RESULTS

Untargeted and targeted metabolomic analyses revealed that metabolites related to TCA cycle, sphingolipids, phospholipids, fatty acids, and amino acids, were significantly changed in the plasma and/or muscle of OVX mice. Subsequent ML classifiers based on RF algorithm selected alpha-ketoglutarate (AKG), arginine, carnosine, ceramide C24, phosphatidylcholine (PC) aa C36:6, and PC ae C42:3 in plasma as well as PC aa 34:1, PC aa C34:3, PC aa C36:5, PC aa C32:1, PC aa C36:2, and sphingosine in muscle as top featured metabolites that differentiate the OVX mice from the sham-operated group. When circulating levels of AKG, arginine, and carnosine, which showed the most significant changes in OVX mice blood, were measured in postmenopausal women, higher plasma AKG levels were associated with lower bone mass, weak grip strength, poor physical performance, and increased frailty risk.

CONCLUSIONS

Metabolomics- and ML-based methods identified the key metabolites of blood and muscle that were significantly changed after ovariectomy in mice, and the clinical implication of several metabolites was investigated by looking at their correlation with body composition and frailty-related parameters in postmenopausal women. These findings provide crucial context for understanding the diverse physiological alterations caused by estrogen deficiency in women.

Novel Screw Placement Method for Extremely Small Lumbar Pedicles in Scoliosis

Study Design: Consecutive case series. Objective: To propose a screw placement method in patients with extremely small lumbar pedicles (ESLPs) (<2 mm) to maintain screw density and correction power, without relying on the O-arm navigation system. Summary of Background Data: In scoliosis surgery, ESLPs can hinder probe passage, resulting in exclusion or substitution of the pedicle screws with a hook. Screw density affects correction power, making it necessary to maximize the number of screw placements, especially in the lumbar curve. Limited studies provide technical guidelines for screw placement in patients with ESLPs, independent of the O-arm navigation system. Methods: We enrolled 19 patients who underwent scoliosis correction surgery using our novel screw placement method for ESLPs. Clinical, radiological, and surgical parameters were assessed. After posterior exposure of the spine, the C-arm fluoroscope was rotated to obtain a true posterior-anterior view and both pedicles were symmetrically visualized. An imaginary pedicle outline was presumed based on the elliptical or linear shadow from the pedicle. The screw entry point was established at a 2 (or 10) o'clock position in the presumed pedicle outline. After adjusting the gear-shift convergence, both cortices of the transverse process were penetrated and the tip was advanced towards the lateral vertebral body wall, where an extrapedicular screw was placed with tricortical fixation. Results: Out of 90 lumbar screws in 19 patients, 33 screws were inserted using our novel method, without correction loss or complications during an average follow-up period of 28.44 months, except radiological loosening of one screw. Conclusions: Our new extrapedicular screw placement method into the vertebral body provides an easy, accurate, and safe alternative for scoliosis patients with ESLPs without relying on the O-arm navigation system. Surgeons must consider utilizing this method to enhance correction power in scoliosis surgery, regardless of the small size of the lumbar pedicle.

Survival Analysis as a Basis for Testing Hypotheses when Using Quantitative Ordinal Scale Disease Severity Data

Disease severity in plant pathology is often measured by the amount of a plant or plant part that exhibits disease symptoms. This is typically assessed using a numerical scale, which allows a standardized, convenient, and quick method of rating. These scales, known as quantitative ordinal scales (QOS), divide the percentage scale into a predetermined number of intervals. There are various ways to analyze these ordinal data, with traditional methods involving the use of midpoint conversion to represent the interval. However, this may not be precise enough, as it is only an estimate of the true value. In this case, the data may be considered interval-censored, meaning that we have some knowledge of the value but not an exact measurement. This type of uncertainty is known as censoring, and techniques that address censoring, such as survival analysis (SA), use all available information and account for this uncertainty. To investigate the pros and cons of using SA with QOS measurements, we conducted a simulation based on three pathosystems. The results showed that SA almost always outperformed midpoint conversion with data analyzed using a t test, particularly when data were not normally distributed. Midpoint conversion is currently a standard procedure. In certain cases, the midpoint approach required a 400% increase in sample size to achieve the same power as the SA method. However, as the mean severity increases, fewer additional samples are needed (approximately an additional 100%), regardless of the assessment method used. Based on these findings, we conclude that SA is a valuable method for enhancing the power of hypothesis testing when analyzing QOS severity data. Future research should investigate the wider use of survival analysis techniques in plant pathology and their potential applications in the discipline.

Economic Inequality, Social Determinants of Health, and the Right to Social Security

This paper discusses economic inequality as a key social determinant of health. It highlights the potentially transformative role of social protection systems in addressing economic inequality and health inequalities. How to finance social protection and how to distribute benefits among people are key questions in the pursuit of a transformative social protection system that can adequately tackle economic inequalities. This paper argues that a human rights approach can provide a normative orientation in the political process that decides the distribution of burdens and benefits in relation to social protection, calling for an assessment of its impact on socioeconomic inequalities and on disadvantaged groups of people. While the right to social security is at the center of a human rights approach to social protection, the rights to health, education, housing, and work also provide important normative elements for social protection. A human rights-based social protection system requires comprehensive protection for major social risks and challenges throughout the life cycle; universal access to quality services such as health, education, child care, and services for older people or people with disabilities; and a progressive financing mechanism. In this regard, the International Labour Organization's Social Protection Floors Recommendation No. 202 provides strong guidance on the implementation of the right to social security for all.

Search for Boosted Dark Matter in COSINE-100

We search for energetic electron recoil signals induced by boosted dark matter (BDM) from the galactic center using the COSINE-100 array of NaI(Tl) crystal detectors at the Yangyang Underground Laboratory. The signal would be an excess of events with energies above 4 MeV over the well-understood background. Because no excess of events are observed in a 97.7  kg·yr exposure, we set limits on BDM interactions under a variety of hypotheses. Notably, we explored the dark photon parameter space, leading to competitive limits compared to direct dark photon search experiments, particularly for dark photon masses below 4 MeV and considering the invisible decay mode. Furthermore, by comparing our results with a previous BDM search conducted by the Super-Kamionkande experiment, we found that the COSINE-100 detector has advantages in searching for low-mass dark matter. This analysis demonstrates the potential of the COSINE-100 detector to search for MeV electron recoil signals produced by the dark sector particle interactions.

Extracellular matrix-degrading enzymes as a biofilm control strategy for food-related microorganisms

Biofilm is one of the major problems in food industries and is difficult to be removed or prevented by conventional sanitizers. In this review, we discussed the extracellular matrix-degrading enzymes as a strategy to control biofilms of foodborne pathogenic and food-contaminating bacteria. The biofilms can be degraded by using the enzymes targeting proteins, polysaccharides, extracellular DNA, or lipids which mainly constitute the extracellular polymeric substances of biofilms. However, the efficacy of enzymes varies by the growth medium, bacterial species, strains, or counterpart microorganisms due to a high variation in the composition of extracellular polymeric substances. Several studies demonstrated that the combined treatment using conventional sanitizers or multiple enzymes can synergistically enhance the biofilm removal efficacies. In this review, the application of the immobilized enzymes on solid substrates is also discussed as a potential strategy to prevent biofilm formation on food contact surfaces.

Individual Patient Data Analysis of 17 Randomized Trials vs. Real-World Data for Men with Localized Prostate Cancer Receiving Radiotherapy

PURPOSE/OBJECTIVE(S)

Prior work has demonstrated poor correlation between the results of randomized controlled trials (RCTs) and real-world evidence (RWD). However, patients enrolled in RCTs are often considered to poorly represent the real-world population. Herein, we utilize multiple large data repositories to determine differences in baseline characteristics and long-term outcomes between patients enrolled in RCTs and RWD that received radiotherapy for localized prostate cancer.

MATERIALS/METHODS

Meta-Analysis of Randomized trials in Cancer of the Prostate (MARCAP) Consortium was leveraged, and 17 phase III randomized trials were included. RWD were accessed through the Staging Collaboration for Cancer of the Prostate (STAR-CAP) cohort, a cohort that is comprised of >60 centers across the United States and Europe. Additionally, RWD was assessed via the Surveillance, Epidemiology, and End Results (SEER) database. MARCAP and STAR-CAP both contain outcomes for distant metastasis (DM), metastasis-free survival (MFS), prostate cancer-specific mortality (PCSM), and overall survival (OS). SEER only contains PCSM and OS. Wilcoxon signed-rank test and chi-square test were used to compare continuous and categorical variables, respectively. Inverse probability of treatment weighting (IPTW) analysis was conducted, balancing for age, PSA, Gleason score, T stage, and treatment year in the three cohorts. Cox and Fine-Gray regression models were used to compare disease outcomes between RCTs vs. RWD.

RESULTS

Data from 10,666 patients from RCTs, 6,530 patients in STAR-CAP, and 117,586 patients in SEER were included. SEER patients were slightly younger (p<0.001, median age 68 (IQR 62-73) than those in RCTs (70, IQR 65-74) and in STAR-CAP (70, IQR 64-74). 10-year OS in RCTs was 65.4%, STAR-CAP 70.2%, SEER 64.1%. OS was superior in STAR-CAP (RCTs as reference; HR 0.91, 95% CI 0.85-0.96, p<0.0001), but there was no significant difference between SEER and RCTs (HR 0.96, 95% CI 0.91-1.02, p = 0.22). 10-year PCSM cumulative incidence was 7.4% in RCTs, 8.1% in STAR-CAP, and 11.0% in SEER. There was no significant difference in PCSM between STAR-CAP RWD and RCTs (HR 0.88, 95% CI 0.78-1.01, p = 0.08), whereas PCSM was worse in SEER than RCTs (HR 1.37, 95% CI 1.21-1.55, p<0.0001). There was no significant difference in DM between STAR-CAP RWD and RCTs (HR 0.93, 95% CI 0.83-1.04, p = 0.2).

CONCLUSION

While baseline differences exist in patients enrolled on localized prostate cancer RCTs and real-world datasets, there were small if any significant relative differences in oncologic outcomes. This provides reassurance that RCT results are generally applicable to patients in routine practice.

Development and initial psychometric properties of the Warwick-Edinburgh Mental Wellbeing Scale-Intellectual Disability version

BACKGROUND

The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; Tennant et al., 2007) is yet to be validated in the intellectual disability (ID) population. The aim of this study was to report the development process and assess the psychometric properties of a newly adapted version of the WEMWBS and the Short WEMWBS for individuals with mild to moderate IDs (WEMWBS-ID/SWEMWBS-ID).

METHOD

The WEMWBS item wordings and response options were revised by clinicians and researchers expert in the field of ID, and a visual aid was added to the scale. The adapted version was reviewed by 10 individuals with IDs. The measure was administered by researchers online using screenshare, to individuals aged 16+ years with mild to moderate IDs. Data from three UK samples were collated to evaluate the WEMWBS-ID (n = 96). A subsample (n = 22) completed the measure again 1 to 2 weeks later to assess test-retest reliability, and 95 participants additionally completed an adapted version of the adapted Rosenberg Self-Esteem Scale to examine convergent validity. Additional data from a Canadian sample (n = 27) were used to evaluate the SWEMWBS-ID (n = 123).

RESULTS

The WEMWBS-ID demonstrated good internal consistency (ω = 0.77-0.87), excellent test-retest reliability [intraclass correlation coefficient (ICC) = .88] and good convergent validity with the self-esteem scale (r = .48-.60) across samples. A confirmatory factor analysis for a single factor model demonstrated an adequate fit. The SWEMWBS-ID showed poor to good internal consistency (ω = 0.36-0.74), moderate test-retest reliability (ICC = .67) and good convergent validity (r = .48-.60) across samples, and a confirmatory factor analysis indicated good model fit for a single factor structure.

CONCLUSIONS

The WEMWBS-ID and short version demonstrated promising psychometric properties, when administered virtually by a researcher. Further exploration of the scales with larger, representative samples is warranted.

Who should provide the uterus? The ethics of live donor recruitment for uterus transplantation

Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children - often the mothers of recipients - tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus - such as transgender men, or cisgender women who do not wish to gestate or to have children - tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups.

Ease of Use ratings and real-world child restraint system errors from Safe Kids Illinois seat checks, 2015-2019

BACKGROUND

Child restraint systems (CRSs) significantly reduce risk of crash-related injury, however installation and use errors undermine their benefits. The National Highway Traffic Safety Administration (NHTSA) created the Ease of Use (EOU) rating system to help guide consumers and incentivize manufacturers to improve their products. The EOU rating system assigns one to five stars to four CRS features and overall. Our study assessed the relationship between EOU ratings and CRS installation and use errors documented in seat checks conducted by child passenger safety technicians (CPSTs).

METHODS

We performed a secondary analysis of data from Safe Kids Illinois seat check records from 2015 through 2019 and EOU ratings from 2008 to 2020. Five types of errors were documented by CPSTs. Study authors (JYL and MLM) used a tiered system to match seat check model numbers to EOU ratings. We calculated chi-square statistics and performed logistic regression analyses to assess for EOU as a predictor of relevant CRS errors (e.g., tether errors for forward-facing CRSs).

RESULTS

Our analyses included 2132 seat check observations, of which 217 (10.2%) were exact, 244 (10.5%) were probable, and 1671 (78.4%) were near matches via sorting and web search. Errors were most common for seat belts (70.7%) and least common for recline angle (36.9%). Star ratings for instructions, vehicle installation, and labels were associated with recline angle and seat belt errors. Star ratings for instructions, labels, and securing child were associated with harness errors. CRSs with 4-star and 5-star ratings had lower odds of errors for recline angle (Odds Ratio (OR) 0.62; 95% Confidence Interval (CI): 0.43, 0.89 and OR 0.31; 95% CI: 0.17, 0.56) lower anchors (OR 0.59; 95% CI 0.40, 0.89 and OR 0.38; 95% CI: 0.21, 0.68), and harness (OR 0.56; 95% CI: 0.40, 0.76 and OR 0.19; 95% CI: 0.10, 0.35) when compared with 1 and 2-star CRSs.

CONCLUSIONS

This study provides evidence in support of NHTSA's EOU ratings as predictors of some CRS installation and use errors among caregivers who obtain seat checks. A higher star rating may be helpful for caregivers when choosing a CRS that will yield lower installation errors.

Cutaneous warmth and hotness thresholds to radiation heat exposure at a distance of 10 cm from 17 body regions

The purpose of the present study was to evaluate body regional differences in cutaneous warmth and hotness thresholds in relation to radiant heat exposure. Fourteen male subjects participated in this study (age: 25 ± 5 y, height: 176.6 ± 5.5 cm, body weight: 70 ± 5.8 kg). Cutaneous warmth and hotness thresholds were measured on the forehead, neck, chest, abdomen, upper back, lower back, upper arm, forearm, palm, back of hand, front thigh, shin, top of foot, buttock, back thigh, calf, and sole. The forehead (34.8 ± 0.2 °C), lower back (34.1 ± 1.2 °C) and palm (34.3 ± 0.7 °C) had the highest warmth thresholds, whereas the foot (29.8 ± 1.9 °C) and sole (28.0 ± 2.1 °C) had the lowest values among the 17 regions (P<0.001). Higher warmth thresholds were related to higher initial skin temperatures (Tsk) (r=0.972, P<0.001). Increases in Tsk for detecting warmth sensation were smaller for the lower back with a rise of 0.2 ± 0.4 °C and the abdomen (0.3 ± 0.3 °C) than for the buttock (0.9 ± 0.8 °C) and sole (0.8 ± 0.6 °C) (P<0.05). Increases in Tsk for detecting hotness sensation ranged from 0.5 to 1.5 °C. Warmth and hotness thresholds on the abdomen or sole had significant relationships with body mass index, indicating that the overweight are less sensitive to detecting radiant heat on the abdomen or sole. Thermal thresholds from radiant heat exposure of 100 cm2 were lower than the values from conductive heat exposure of 6.25 cm2, which might be explained by the effect of spatial summation.

Spatial summation of thermal sensitivity is limited to small areas: Comparisons of the forehead, forearm, abdomen, and foot

The purpose of the present study was to examine if spatial summation in thermal sensitivity exists when stimulating areas larger than about 1% of body surface area (BSA) (approximately 200 cm2). We hypothesized that spatial summation would exist within a limited area and the effect would be insignificant for over the 1%BSA. Fifteen young males participated in this study and we measured their warmth and hot sensation thresholds on the four body regions (the forehead, forearm, abdomen, and instep) using the three sizes of radiant film heaters (10 × 10, 15 × 15, and 20 × 20 cm2 heating film area). The heating panel was kept at a distance of 10 cm from the skin and the surface temperature of the heating panel increased by 1 °C·s-1. The results showed that warmth and hot sensation thresholds were higher for the 100 cm2 condition than the 225 or 400 cm2 conditions (P < 0.05), but no differences were found between the 225 and 400 cm2 conditions. Secondly, the instep was most insensitive to the gradual increase of radiant heat among the four body regions for all three stimulating film sizes, even though the hot threshold was lowest for the instep because the initial foot temperature was lower than other skin temperatures. In summary, spatial summation in thermal sensitivity was found for the 100 and 225 cm 2 conditions, but not for the 225 and 400 cm2 conditions. These results suggest that spatial summation exists but limited to small stimulating areas, smaller than approximately 1% BSA.

Safety and efficacy of trastuzumab biosimilar plus irinotecan or gemcitabine in patients with previously treated HER2 (ERBB2)-positive non-breast/non-gastric solid tumors: a phase II basket trial with circulating tumor DNA analysis

BACKGROUND

Human epidermal growth factor receptor 2 (HER2) (ERBB2)-directed agents are standard treatments for patients with HER2-positive breast and gastric cancer. Herein, we report the results of an open-label, single-center, phase II basket trial to investigate the efficacy and safety of trastuzumab biosimilar (Samfenet®) plus treatment of physician's choice for patients with previously treated HER2-positive advanced solid tumors, along with biomarker analysis employing circulating tumor DNA (ctDNA) sequencing.

METHODS

Patients with HER2-positive unresectable or metastatic non-breast, non-gastric solid tumors who failed at least one prior treatment were included in this study conducted at Asan Medical Center, Seoul, Korea. Patients received trastuzumab combined with irinotecan or gemcitabine at the treating physicians' discretion. The primary endpoint was the objective response rate as per RECIST version 1.1. Plasma samples were collected at baseline and at the time of disease progression for ctDNA analysis.

RESULTS

Twenty-three patients were screened from 31 December 2019 to 17 September 2021, and 20 were enrolled in this study. Their median age was 64 years (30-84 years), and 13 patients (65.0%) were male. The most common primary tumor was hepatobiliary cancer (seven patients, 35.0%), followed by colorectal cancer (six patients, 30.0%). Among 18 patients with an available response evaluation, the objective response rate was 11.1% (95% confidence interval 3.1% to 32.8%). ERBB2 amplification was detected from ctDNA analysis of baseline plasma samples in 85% of patients (n = 17), and the ERBB2 copy number from ctDNA analysis showed a significant correlation with the results from tissue sequencing. Among 16 patients with post-progression ctDNA analysis, 7 (43.8%) developed new alterations. None of the patients discontinued the study due to adverse events.

CONCLUSIONS

Trastuzumab plus irinotecan or gemcitabine was safe and feasible for patients with previously treated HER2-positive advanced solid tumors with modest efficacy outcomes, and ctDNA analysis was useful for detecting HER2 amplification.

Self-esteem and its relationship with depression and anxiety in adults with intellectual disabilities: a systematic literature review

BACKGROUND

In the general population, low self-esteem has been linked with poorer mental and physical health. This systematic literature review aimed to summarise and evaluate the findings of studies that examined self-esteem in adults with intellectual disabilities and links with mental health outcomes.

METHOD

A systematic search of PsycINFO, Web of Science and CINAHL was conducted to identify studies published between 1990 and 2021. The studies were appraised using the QualSyst tool.

RESULTS

Twenty-six articles were identified of which two studies were removed from the review due to low quality. Studies reported mixed evidence regarding levels of self-esteem compared with the general population. Engagement in activities appeared to be linked with positive self-esteem, and perception of negative interpersonal life events as having a negative impact was associated with lower self-esteem. There was evidence of co-occurrence of low self-esteem and depression, but no studies examined the relationship between self-esteem and anxiety.

CONCLUSION

Reviewed studies provided mixed evidence on levels of self-esteem in this population, suggesting that factors such as engagement in life were related to higher self-esteem and demonstrating the co-occurrence of low self-esteem and depression. However, clear causal links have yet to be identified, and more research is needed using longitudinal designs to answer questions about trajectory.

Heat strain of Japanese firefighters wearing personal protective equipment: a review for developing a test method

The aim of this review was to develop a test method for the evaluation of heat strain for structural firefighters wearing personal protective equipment (PPE) in Japan. We analysed a series of our laboratory's questionnaires and experimental studies and reviewed international standards on test methods. We investigated the actual average working conditions (total firefighting time on one incidence, working time with full PPE, maximum temperature and humidity during firefighting) at structural firefighting site in Japan by conducting a large-scale questionnaire survey of Japanese firefighters. We discussed test subjects (firefighters vs. non-firefighters; body size; physical fitness), exercise intensity (absolutes vs. relative; light vs. heavy) and duration, experimental temperature and relative humidity, experimental clothing items including station uniforms (shorts vs. long), and measurement variables (physiological and subjective responses), and suggested a standard test method to evaluate the heat strain of firefighters in hot and humid environments.Practitioner summary: We reviewed studies on human wear trials of firefighting personal protective equipment (PPE) in hot environments and suggested a standard test method to evaluate the heat strain of firefighters. The test method can be internationally utilised to examine the comfort functions and heat stress of PPE in hot, humid environments.

Psychometric properties of measures designed to assess common mental health problems and wellbeing in adults with intellectual disabilities: a systematic review

BACKGROUND

Multiple measures of mental health problems and mental wellbeing for adults with intellectual disabilities are available, but investigations into their reliability and validity are still in the early stages. The aim of this systematic review was to provide an update to previous evaluations of measures of common mental health problems and wellbeing in adults with mild to moderate intellectual disabilities (ID).

METHODS

A systematic search was performed across three databases (MEDLINE, PsycINFO and SCOPUS). The literature search was limited to the years from 2009 to 2021 and to the original English versions. Ten papers evaluating nine measures were reviewed, and the psychometric properties of these measures were discussed using the Characteristics of Assessment Instructions for Psychiatric Disorders in Persons with Intellectual Developmental Disorders as a framework.

RESULTS

Four measures had at least one rating of 'good' across both dimensions of reliability and at least one dimension of validity and were deemed to have promising psychometric properties: the Clinical Outcomes in Routine Evaluation-Learning Disabilities, Impact of Events Scale-Intellectual Disabilities, Lancaster and Northgate Trauma Scales and Self-Assessment and Intervention (self-report section). Additionally, these measures were developed through consultations with mental health professionals and/or people with IDs and thus were deemed to have good content validity.

CONCLUSIONS

This review informs measurement choice for researchers and clinicians while highlighting a need for continued research efforts into the quality of measures available for people with IDs. The results were limited by incomplete psychometric evaluations of measures available. A paucity of psychometrically robust measures of mental wellbeing was observed.

Surrogacy: beyond the commercial/altruistic distinction

In this article, I critique the commonly accepted distinction between commercial and altruistic surrogacy arrangements. The moral legitimacy of surrogacy, I claim, does not hinge on whether it is paid ('commercial') or unpaid ('altruistic'); rather, it is best determined by appraisal of virtue-abiding conditions constitutive of the surrogacy arrangement. I begin my article by problematising the prevailing commercial/altruistic distinction; next, I demonstrate that an assessment of the virtue-abiding or non-virtue-abiding features of a surrogacy is crucial to navigating questions about the moral legitimacy of surrogacy; in the final part, I reject other moral heuristics that might be proposed as alternatives to the commercial/altruistic dichotomy, and reiterate that a virtue-ethical framework is the most suitable way forward.

How humans adapt to hot climates learned from the recent research on tropical indigenes

This review mainly aimed to introduce the findings of research projects comparing the responses of tropical and temperate indigenes to heat. From a questionnaire survey on thermal sensation and comfort of Indonesians and Japanese, we found that the thermal descriptor “cool” in tropical indigenes connotes a thermally comfortable feeling, suggesting that linguistic heat acclimatization exists on a cognitive level. Ten male students born and raised in Malaysia were invited to Fukuoka, Japan, and compared their responses with 10 Japanese male students with matched physical fitness and morphological characteristics. Cutaneous thermal sensitivity: The sensitivities were measured at 28 °C. The forehead warm sensitivity was significantly blunted in Malaysians. The less sensitivity to the warmth of tropical indigenes is advantageous in respect to withstanding heat stress with less discomfort and a greater ability to work in hot climates. Passive heat stress: Thermoregulatory responses, especially sweating, were investigated, during the lower leg hot bathing (42 °C for 60 min). The rectal temperature at rest was higher in Malaysians and increased smaller during immersion. There was no significant difference in the total amount of sweating between the two groups, while the local sweating on the forehead and thighs was lesser in Malaysians, suggesting distribution of sweating was different from Japanese. Exercise: Malaysian showed a significantly smaller increase in their rectal temperature during 55% maximal exercise for 60 min in heat (32 °C 70% relative humidity), even with a similar sweating and skin blood flow response in Japanese. The better heat tolerance in Malaysians could be explained by the greater convective heat transfer from the body core to the skin due to the greater core-to-skin temperature gradient. In addition, when they were hydrated, Malaysian participants showed better body fluid regulation with smaller reduction in plasma volume at the end of the exercise compared to the non-hydrated condition, whereas Japanese showed no difference between hydration conditions. We further investigated the de-acclimatization of heat adaptation by longitudinal observation on the heat tolerance of international students who had moved from tropical areas to Fukuoka for several years.

Cluster Analysis of DSC MRI, Dynamic Contrast-Enhanced MRI, and DWI Parameters Associated with Prognosis in Patients with Glioblastoma after Removal of the Contrast-Enhancing Component: A Preliminary Study

BACKGROUND AND PURPOSE

No report has been published on the use of DSC MR imaging, DCE MR imaging, and DWI parameters in combination to create a prognostic prediction model in glioblastoma patients. The aim of this study was to develop a machine learning-based model to find preoperative multiparametric MR imaging parameters associated with prognosis in patients with glioblastoma. Normalized CBV, volume transfer constant, and ADC of the nonenhancing T2 high-signal-intensity lesions were evaluated using K-means clustering.

MATERIALS AND METHODS

A total of 142 patients with glioblastoma who underwent preoperative MR imaging and total resection were included in this retrospective study. From the normalized CBV, volume transfer constant, and ADC maps, the parametric data were sorted using the K-means clustering method. Patients were divided into training and test sets (ratio, 1:1), and the optimal number of clusters was determined using receiver operating characteristic analysis. Kaplan-Meier survival analysis and log-rank tests were performed to identify potential parametric predictors. A multivariate Cox proportional hazard model was conducted to adjust for clinical predictors.

RESULTS

The nonenhancing T2 high-signal-intensity lesions were divided into 6 clusters. The cluster (class 4) with the relatively low normalized CBV and volume transfer constant value and the lowest ADC values was most associated with predicting glioblastoma prognosis. The optimal cutoff of the class 4 volume fraction of nonenhancing T2 high-signal-intensity lesions predicting 1-year progression-free survival was 9.70%, below which the cutoff was associated with longer progression-free survival. Two Kaplan-Meier curves based on the cutoff value showed a statistically significant difference (P = .037). When we adjusted for all clinical predictors, the cluster with the relatively low normalized CBV and volume transfer constant values and the lowest ADC value was an independent prognostic marker (hazard ratio, 3.04; P = .048). The multivariate Cox proportional hazard model showed a concordance index of 0.699 for progression-free survival.

CONCLUSIONS

Our model showed that nonenhancing T2 high-signal-intensity lesions with the relatively low normalized CBV, low volume transfer constant values, and the lowest ADC values could serve as useful prognostic imaging markers for predicting survival outcomes in patients with glioblastoma.

The limitations of liberal reproductive autonomy

The common liberal understanding of reproductive autonomy - characterized by free choice and a principle of non-interference - serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses of reproductive technologies and third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices.

Distributed source localization of epileptiform discharges in juvenile myoclonic epilepsy: Standardized low-resolution brain electromagnetic tomography (sLORETA) Study

Juvenile myoclonic epilepsy (JME) is a common generalized epilepsy syndrome considered the prototype of idiopathic generalized epilepsy. To date, generalized and focal seizures have been the fundamental concepts for classifying seizure types. In several studies, focal features of JME have been reported predominantly in the frontal lobe. However, results in previous studies are inconsistent. Therefore, we investigated the origin of epileptiform discharges in JME. We performed electroencephalography source localization using a distributed model with standardized low-resolution brain electromagnetic tomography. In 20 patients with JME, standardized low-resolution brain electromagnetic tomography images corresponding to the midpoint of the ascending phase and the negative peak of epileptiform discharges were obtained from a total of 362 electroencephalography epochs (181 epochs at each timepoint). At the ascending phase, the maximal current source density was located in the frontal lobe (58.6%), followed by the parietal (26.5%) and occipital lobes (8.8%). At the negative peak, the maximal current source density was located in the frontal lobe (69.1%), followed by the parietal (11.6%) and occipital lobes (9.4%). In the ascending phase, 41.4% of discharges were located outside the frontal lobe, and 30.9% were in the negative peak. Frontal predominance of epileptiform discharges was observed; however, source localization extending to various cortical regions also was identified. This widespread pattern was more prominent in the ascending phase (P = .038). The study results showed that JME includes widespread cortical regions over the frontal lobe. The current concept of generalized epilepsy and pathophysiology in JME needs further validation.

Comparative analysis of background EEG activity based on MRI findings in neonatal hypoxic-ischemic encephalopathy: a standardized, low-resolution, brain electromagnetic tomography (sLORETA) study

Background

It is important to assess the degree of brain injury and predict long-term outcomes in neonates diagnosed with hypoxic-ischemic encephalopathy (HIE). However, routine studies, including magnetic resonance imaging (MRI) and conventional encephalography (EEG) or amplitude-integrated EEG (aEEG), have their own limitations in terms of availability and accuracy of evaluation. Recently, quantitative EEG (qEEG) has been shown to improve the predictive reliability of neonatal HIE and has been further refined with brain mapping techniques.

Methods

We investigated background EEG activities in 29 neonates with HIE who experienced therapeutic hypothermia, via qEEG using a distributed source model. MRI images were evaluated and classified into two groups (normal-to-mild injury vs moderate-to-severe injury), based on a scoring system. Non-parametric statistical analysis using standardized low-resolution brain electromagnetic tomography was performed to compare the current density distribution of four frequency bands (delta, theta, alpha, and beta) between the two groups.

Results

Electrical neuronal activities were significantly lower in the moderate-to-severe injury group compared with the normal-to-mild injury group. Background EEG activities in moderate-to-severe HIE were most significantly reduced in the temporal and parietal lobes. Quantitative EEG also revealed a decrease in background activity at all frequency bands, with a maximum in decrease in the delta component. The maximum difference in current density was found in the inferior parietal lobule of the right parietal lobe for the delta frequency band.

Conclusions

Our study demonstrated quantitative and topographical changes in EEG in moderate-to-severe neonatal HIE. They also suggest possible implementation and evaluation of conventional EEG and aEEG in neonatal HIE. The findings have implications as biomarkers in the assessment of neonatal HIE.

Usefulness of Wave-CAIPI for Postcontrast 3D T1-SPACE in the Evaluation of Brain Metastases

BACKGROUND AND PURPOSE

High-resolution postcontrast 3D T1WI is a widely used sequence for evaluating brain metastasis, despite the long scan time. This study aimed to compare highly accelerated postcontrast 3D T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolution by using wave-controlled aliasing in parallel imaging (wave-T1-SPACE) with the commonly used standard high-resolution postcontrast 3D T1-SPACE for the evaluation of brain metastases.

MATERIALS AND METHODS

Among the 387 patients who underwent postcontrast wave-T1-SPACE and standard SPACE, 56 patients with suspected brain metastases were retrospectively included. Two neuroradiologists assessed the number of enhancing lesions according to lesion size, contrast-to-noise ratio_{lesion/parenchyma}, contrast-to-noise ratio_{white matter/gray matter}, contrast ratio_{lesion/parenchyma}, and overall image quality for the 2 different sequences.

RESULTS

Although there was no significant difference in the evaluation of larger enhancing lesions (>5 mm) between the 2 different sequences (P = .66 for observer 1, P = .26 for observer 2), wave-T1-SPACE showed a significantly lower number of smaller enhancing lesions (<5 mm) than standard SPACE (1.61 [SD, 0.29] versus 2.84 [SD, 0.47] for observer 1; 1.41 [SD, 0.19] versus 2.68 [SD, 0.43] for observer 2). Furthermore, mean contrast-to-noise ratio_{lesion/parenchyma} and overall image quality of wave-T1-SPACE were significantly lower than those in standard SPACE.

CONCLUSIONS

Postcontrast wave-T1-SPACE showed comparable diagnostic performance for larger enhancing lesions (>5 mm) and marked scan time reduction compared with standard SPACE. However, postcontrast wave-T1-SPACE showed underestimation of smaller enhancing lesions (<5 mm) and lower image quality than standard SPACE. Therefore, postcontrast wave-T1-SPACE should be interpreted carefully in the evaluation of brain metastasis.

Determination of thermal sensation levels for Koreans based on perceived temperature and climate chamber experiments with hot and humid settings

People perceive thermal sensation differently despite the same temperature value of thermal comfort index depending on various factors such as climate, culture, and physiological characteristics. The use of the thermal comfort index without optimization may lead to biases in assessment of thermal stress and sensation. This study aims to derive the perceived temperature (PT) ranges of thermal sensation levels related to heat stress for Koreans. The experiments were designed using a controlled environmental chamber to derive the PT ranges and were performed with subjects who are residents of Seoul, South Korea. The experiments were carried out in the summers of 2017 and 2018, and the thermal sensation votes were surveyed from 19 subjects whose mean age, height, weight, and body mass index were 22.5 years, 171 cm, 72 kg, and 23 kg⋅m^-2, respectively. The derived PT ranges for Koreans led to a better performance than the reference PT ranges for Germans based on the results of validation. The thresholds of 'Warm,' 'Hot,' and 'Very hot' thermal sensation classes for Koreans were 28 °C, 36 °C, and 43 °C, respectively: higher than those for Germans. The results indicate that Koreans may have higher heat resistance or lower heat sensitivity than Germans.

Nondestructive versus advanced post-transplant lymphoproliferative disorder in a single-center pediatric kidney transplant population

BACKGROUND

Pediatric kidney transplant recipients are at risk for the development of post-transplant lymphoproliferative disorders (PTLD), a group of potentially devastating diseases that present on a spectrum of severity ranging from nondestructive PTLD to more histologically destructive lesions. Currently, there is inadequate evidence to guide evaluation and management of nondestructive PTLD.

METHODS

This is a single-center case series of pediatric kidney transplant recipients between January 1, 2008 and December 31, 2019, who were diagnosed with PTLD. The aim was to describe clinical characteristics, presentation, and management of nondestructive versus advanced PTLD.

RESULTS

Eighteen patients were diagnosed with nondestructive PTLD and seven with more advanced PTLD histopathology. The majority (66.7%) of nondestructive PTLD patients (n = 16) presented with tonsillar hypertrophy and/or snoring and were managed conservatively, with minimal reduction in tacrolimus dose and no further evaluation. No patient progressed to more advanced PTLD. Advanced PTLD patients (n = 7) were more likely to present with fever, elevated creatinine, a new mass of gastrointestinal symptoms. They received workup with imaging and oncology consultation, and were managed with chemotherapy.

CONCLUSIONS

Patients with nondestructive PTLD often present with symptoms of sleep-disordered breathing and can be managed conservatively with excellent clinical outcomes. More study is needed to guide care of this under-researched population.

A review of test methods for evaluating mobility of firefighters wearing personal protective equipment

This review aimed to suggest useful, potential measurements as standard test methods for evaluating the mobility of structural firefighters wearing personal protective equipment (PPE). Based on our previous research on Japanese firefighters' activities related to mobility as well as previous literature results, the findings were categorized (e.g., simulated firefighting activities, test method for mobility assessment, and participants groups), and discussed. We identified four categories that can be used to test and evaluate mobility: (1) simulated firefighting activities consisting of step-ups, obstacle strides, crawling, dragging, and jumping; (2) in terms of balance ability, the postural sway and functional balance tests (functional reach and timed up and go) were useful measurements; (3) range of motion can be used to estimate the mobility associated with the various designs of PPE, as well as the effect of wearing the PPE itself; and (4) subjective evaluations of individuals wearing PPE were available for the mobility assessments. Professional firefighters who were familiar with wearing PPE were suitable for the suggested test method. This review provides useful information for firefighters, researchers, and PPE manufacturers that can be used to develop more comfortable and safer PPE.

Comparative analysis of background EEG activity in juvenile myoclonic epilepsy during valproic acid treatment: a standardized, low-resolution, brain electromagnetic tomography (sLORETA) study

Background

By definition, the background EEG is normal in juvenile myoclonic epilepsy (JME) patients and not accompanied by other developmental and cognitive problems. However, some recent studies using quantitative EEG (qEEG) reported abnormal changes in the background activity. QEEG investigation in patients undergoing anticonvulsant treatment might be a useful approach to explore the electrophysiology and anticonvulsant effects in JME.

Methods

We investigated background EEG activity changes in patients undergoing valproic acid (VPA) treatment using qEEG analysis in a distributed source model. In 17 children with JME, non-parametric statistical analysis using standardized low-resolution brain electromagnetic tomography was performed to compare the current density distribution of four frequency bands (delta, theta, alpha, and beta) between untreated and treated conditions.

Results

VPA reduced background EEG activity in the low-frequency (delta-theta) bands across the frontal, parieto-occipital, and limbic lobes (threshold log-F-ratio = ±1.414, p < 0.05; threshold log-F-ratio= ±1.465, p < 0.01). In the delta band, comparative analysis revealed significant current density differences in the occipital, parietal, and limbic lobes. In the theta band, the analysis revealed significant differences in the frontal, occipital, and limbic lobes. The maximal difference was found in the delta band in the cuneus of the left occipital lobe (log-F-ratio = −1.840) and the theta band in the medial frontal gyrus of the left frontal lobe (log-F-ratio = −1.610).

Conclusions

This study demonstrated the anticonvulsant effects on the neural networks involved in JME. In addition, these findings suggested the focal features and the possibility of functional deficits in patients with JME.

An empirical investigation of firefighting personal protective equipment and burn injuries in Korea

This study aimed to investigate the current situation of firefighting burn injuries and personal protective equipment (PPE) in Korea using a questionnaire. A questionnaire was constructed and then distributed to fire stations via the Fire & Disaster Headquarters of Korea. Responses from a total of 536 firefighters who were currently responsible for suppressing fire or doing rescue work were analysed (39.2 ± 8.58 y in age, 173.8 ± 5.0 cm in height, 73.4 ± 8.9 kg in body weight). The results showed that 22% of firefighters had experienced burns but of these 93% of were burns of less than 1% of total body surface area. The most common body site of burn injury was the hands (37%) and the head (face and neck) (34%). There were significant relationships between PPE non-compliance and career years, especially for the hood and boots. According to firefighters their gloves were the most vulnerable part of their PPE. We also elucidated relationships between the body sites most vulnerable to burn injuries and PPE wear compliance by item. The present results suggest that officially-undisclosed minor burn injuries but prevailing among firefighters can be reduced through improving firefighters' protective helmet, hoods and gloves.

Acute procedural outcomes of his bundle pacing with or without electrophysiology mapping system: a multicenter study

Funding Acknowledgements

Type of funding sources: None.

Introduction

His bundle pacing (HBP) is associated with improved clinical outcomes compared to right ventricular apical pacing. However, it can be technically challenging and may result in prolonged fluoroscopy and procedural time.

Purpose

We sought to compare the feasibility of performing HBP with or without electrophysiology mapping (EP) system, focusing on evaluating acute procedural success, complication rates and short-term outcomes.

Methods

HBP patients at 3 hospitals were recruited between August 2018 to December 2020. HBP was performed with EP mapping system in 1 center, and without EP mapping in the other 2 centers. Acute procedural success was defined as either selective or non-selective His bundle capture with a threshold of less than or equal to 1.5V at 1ms at the end of procedure implantation.

Results

A total of 233 patients were recruited, of which HBP was performed with EP mapping in 77 patients (33.0%) and without EP mapping in 156 patients (67.0%). Both groups were similar in age (73.2 ± 11.0 years vs 75.3 ± 9.5 years, p = 0.125) and male sex (58.4% vs 48.1%, p = 0.136). There were more patients with ischemic heart disease (45.5% vs 22.4%, p &lt; 0.01) and reduced left ventricular ejection fraction ≤ 40% (28.6% vs 10.9%, p &lt; 0.01) in the group with EP mapping. The indications for HBP was for high-grade atrioventricular block (55.8%), sick sinus syndrome (35.6%) and cardiac resynchronization therapy (CRT) (8.6%). There were more patients who required CRT in the center with EP mapping (18.2% vs 3.8%, p &lt; 0.01). HBP was successful in 39 patients (50.6%) with EP mapping and 93 patients (59.6%) without EP mapping (p= 0.382). The median R wave at implant was similar in both groups [4.0 (2.9 – 6.2) mV vs 4.3 (4.3 – 7.0) mV, p = 0.808]. Impedance at implant (607 ± 195 ohms vs 547 ± 166 ohms, p &lt; 0.01) and selective His bundle bipolar threshold at implant [1.25 (0.75-1.75) V vs 0.7 (0.5 – 1.25) V, p = 0.01] was higher in patients with EP mapping while non-selective His bundle bipolar threshold at implant [1.75 (1.0 – 3.0) V vs 1.5 (0.9 – 2.2) V, p = 0.133] and paced QRS duration (116.4 ± 25.4 ms vs 114.4 ± 24.2 ms, p =0.655) were similar. There were no differences in procedural or fluoroscopy time between groups (111 ± 36.9 min vs 107 ± 40.7 min, p = 0.479; and 10.3 ± 8.9 min vs 12.1± 14.0 min, p = 0.328 respectively). There was a similar rate of acute procedural complications (5.2% vs 1.3%, p = 0.076) and patients requiring wound or lead revision (6.8% vs 1.9%, p = 0.115) after a median follow up duration of 205 days (67-397). The prevalence of new onset paroxysmal atrial fibrillation  (11.7% vs 4.2%, p = 0.037) and all cause mortality (12.3% vs 3.2%, p = 0.029) was increased in patients who underwent HBP with EP mapping.

Conclusion

HBP in centers with or without EP mapping showed similar acute procedure success and complication rates. The use of EP mapping system was not shown to affect procedural or fluoroscopy duration.

Development of Older Adult Food Insecurity Index to Assess Food Insecurity of Older Adults

OBJECTIVES

Quantifying the number of older adults that are food insecure in a specific geographic area is critical in developing and scaling public health prevention and response programs at the local level. However, current estimates of older adult food insecurity only consider financial constraints, following the same methodology as the general population, even though the drivers for older adults are different and multidimensional. This study aims to build a general approach to quantify the food-insecurity among older adults at the local level, using publicly available data that can be easily obtained across the country.

METHODS

13 risk factors for food insecurity among older adults were identified leveraging existing studies, following the Social Ecological Model (SEM), and the weighted impact of each factor was determined. Publicly available data sources were identified for each factor, ZIP code level data was compared to national averages, and the weighted data for each factor were aggregated to determine the overall food insecurity at the local level.

RESULTS

Based on the averaged odds ratios across all the studies, of the 13 risk factors, beyond financial constraints, having a disability was the most impactful factor and distance to the nearest grocery store was the least impactful. A ZIP code level model of Honolulu County was developed as an example to demonstrate the approach, showing that food insecurity among older adults in the county was 2.5 times that which was reported from the Current Population Survey (16.5% versus 6.5%).

CONCLUSION

This evidence-based model considered factors that impact food insecurity among older adults across all the spheres of the SEM. The drivers of food insecurity among older adults are different than the drivers for the general population, resulting in a higher percentage of older adults being food insecure than currently reported.

A novel model to predict tooth bleaching efficacy using autofluorescence of the tooth

OBJECTIVES

We aimed to confirm whether autofluorescence emitted from teeth can predict tooth bleaching efficacy and establish a novel model combining natural color parameters and tooth autofluorescence data to improve the predictability of tooth bleaching.

METHODS

A total of 61 tooth specimens were prepared from extracted human molars/premolars and immersed in 35% hydrogen peroxide for 1 h for tooth bleaching. The changes in laser-induced fluorescence (∆LIF) were assessed using Raman spectrometry. Tooth color and autofluorescence data were obtained using quantitative light-induced fluorescence (QLF) technology. Pearson correlation analyses were used to confirm the relationship between ∆LIF and autofluorescence. Intraclass correlation coefficients (ICC) were calculated to compare the conventional and new prediction models. Decision tree analysis was performed to evaluate clinical applicability.

RESULTS

The yellowness-to-blueness value from fluorescence imaging showed a moderate correlation with ∆LIF (r= -0.409, p = 0.001). The degree of agreement between the actual efficacy and that predicted by our novel model was high (ICC=0.933, p = 0.002). Decision tree analysis suggested that tooth autofluorescence could be a key factor in prediction of tooth bleaching outcomes.

CONCLUSIONS

Our findings showed that autofluorescence detected from QLF images may be used to predict tooth bleaching efficacy. Our proposed model appeared to improve the predictability of tooth bleaching.

Acute Extrapyramidal Side Effects from Smoked Haloperidol

INTRODUCTION

Haloperidol is a dopamine receptor antagonist used to treat patients with psychotic disorders. Especially at high doses, haloperidol carries a higher risk of extrapyramidal symptoms (EPS) compared to second-generation antipsychotics. Few cases of haloperidol misuse are found in the medical literature. Case Presentation. We describe a patient with schizophrenia who smoked marijuana mixed with crushed haloperidol tablets. After the smoking of cannabis and haloperidol, the patient presented to the emergency department (ED) with suicidal ideation, psychosis, and acute dystonia. With the administration of intramuscular diphenhydramine at the ED, the dystonia resolved in less than an hour. To our knowledge, this is the first report on haloperidol misuse by smoking.

CONCLUSION

Clinicians should be aware that patients might misuse prescribed antipsychotics via unconventional routes, potentially combined with other substances.

Empirical assessment of biases in cerebrospinal fluid biomarkers of Alzheimer's disease: an umbrella review and re-analysis of data from meta-analyses

OBJECTIVE

Alzheimer's disease (AD) is a leading cause of years lived with disability in older age, and several cerebrospinal fluid (CSF) markers have been proposed in individual meta-analyses to be associated with AD but field-wide evaluation and scrutiny of the literature is not available.

MATERIALS AND METHODS

We performed an umbrella review for the reported associations between CSF biomarkers and AD. Data from available meta-analyses were reanalyzed using both random and fixed effects models. We also estimated between-study heterogeneity, small-study effects, excess significance, and prediction interval.

RESULTS

A total of 38 meta-analyses on CSF markers from 11 eligible articles were identified and reanalyzed. In 14 (36%) of the meta-analyses, the summary estimate and the results of the largest study showed non-concordant results in terms of statistical significance. Large heterogeneity (I2≥75%) was observed in 73% and small-study effects under Egger's test were shown in 28% of CSF biomarkers.

CONCLUSIONS

Our results suggest that there is an excess of statistically significant results and significant biases in the literature of CSF biomarkers for AD. Therefore, the results of CSF biomarkers should be interpreted with caution.

Waist circumference and the risk of lumbar and femur fractures: a nationwide population-based cohort study

Although obesity is known to have an influence on fracture, the relationship between lumbar and femur fractures and weight or waist circumference is controversial. We investigated the incidence of fracture with regards to waist circumference using the customised database of the Korean National Health Insurance Service (NHIS). Among 8,922,940 adults who participated at least twice in the NHIS National Health Check-up Program in South Korea between 2009 and 2011, 1,556,751 subjects (780,074 men and 776,677 women) were extracted. Over a mean follow-up of 6.5 years, multivariate-adjusted logistic regression analysis demonstrated that higher waist circumference was associated with an increased risk of femur fractures in both males and females. Moreover, the incidence of lumbar fractures was also positively associated with an increased waist circumference in males and females. An increased waist circumference showed a positive linear relationship with the risk of lumbar and femur fractures in both males and females.

Synthesis and Biological Evaluation of Salicylic Acid Analogues of Celecoxib as a New Class of Selective Cyclooxygenase-1 Inhibitor

A series of salicylic acid analogues of celecoxib where the phenylsulfonamide moiety in the structure of celecoxib is replaced by salicylic acid moiety was synthesized and tested for in vitro cyclooxygenase (COX)-1 and COX-2 enzyme inhibition. Among the series, 5-substituted-2-hydroxy-benzoic acid analogues (7a-7h) generally showed better inhibitory activities on both enzymes than 4-substituted-2-hydroxy-benzoic acid analogues (12a-12h). In particular, the chloro analogue 7f which had the highest inhibitory effect (IC₅₀ = 0.0057 µM) to COX-1 with excellent COX-1 selectivity (SI = 768) can be classified as a new potent and selective COX-1 inhibitor. The high inhibitory potency of 7f was rationalized through the docking simulation of this analogue in the active site of COX-1 enzyme.

Hand and forearm cooling: exploring deep-body cooling in hyperthermic individuals following exercise-induced heating at three different work rates

The purpose of this study was to evaluate upper-limb cooling following (treadmill) exercise performed in the heat (33℃, 70% relative humidity) at each of three speeds: light (6 km.h^-1), intermediate (8 km.h^-1) and moderate intensity (10 km.h^-1). In all trials, exercise ceased when rectal temperature reached 39.0℃. Participants adopted a sitting position for a 20-min recovery, and liquid-cooling sleeves with cold water (6.3℃ were immediately positioned. The chosen work rates resulted in a two-fold difference in exercise duration across those trials, which terminated without significant between-trial differences within either auditory canal or rectal temperatures. Auditory canal temperature elevation rates became progressively faster as the work rate increased: 0.03℃.min^-1 (light), 0.05℃.min^-1 (intermediate) and 0.07℃.min^-1 (moderate) (p<0.05). However, heat extraction during recovery did not differ among those treatments: -11.2 W (SE 0.5; light), -11.8 W (0.6; intermediate) and -12.3 W (0.5; moderate; p>0.05). That outcome was reflected in auditory canal cooling rates (0.03℃.min^-1 [light], 0.04℃.min^-1 [intermediate] and 0.05℃.min^-1 [moderate]). Nevertheless, rectal temperatures continued to rise throughout recovery. It is concluded that heat extraction from moderately hyperthermic individuals, using upper-limb cooling sleeves, appears to be equally rapid, regardless of heating speed, providing the same level of hyperthermia was attained prior to initiating treatment.

P–153 Comparison outcome of vitrified human embryos stored in vapor phase liquid nitrogen (LN2) and direct LN2

Study question

Is vapor cryopreserved LN2 storage beneficial for clinical outcomes of vitrified human embryos that are frozen compared to vitrified human embryos having direct contact with LN2.

Summary answer

There are no significant differences compared to clinical outcomes of human embryos stored in LN2 vapor and direct store in LN2.

What is known already

There has been concerned about potential cross-contamination and biohazard issues of embryos for long term storage using direct LN2. This study aimed to compare clinical outcomes of human embryos transfer between vapor phase and liquid LN2.

Study design, size, duration

The embryo has undergone vitrification for long term storage with vapor or direct contact in LN2. After the thawing of the embryo, we checked on the survival rates. We transferred only one or two embryos per patient and kept analyzing the implantation and pregnancy rates

Participants/materials, setting, methods

This retrospective study was carried out from January 2018 to December 2019 with 3272cycles 4713embryos; vitrified for long term storage in vapor phase or direct contact with LN2. We compared the clinical outcomes of frozen embryo transfer cycles using vitrified for long term storage in vapor phase and direct contact with LN2. Clinical outcomes monitored were embryo survival, subsequent implantation and pregnancy after single or double embryo transfer

Main results and the role of chance

A total of 4713 fertilized human embryos are vitrified and then stored in LN2 vapor (n = 2520 cycles) or direct contact LN2 (n = 752 cycles). The study showed that the blastocyst stored in vapor able to retain full development. Survival was 97.8% (vapor) and 97.6% (direct contact LN2), and the vapor storage of human embryos had no significant difference in survival rates after a long term storage. For single blastocyst transfer, pregnancy and implantation rates were 51.5%, 52.4% in vapor, 54.6%, 54.9% in direct LN2; respectively (p=NS). In double blastocyst transfer, the pregnancy and implantation rates were 61.8%, 42.0% in vapor and 64.7%, 44.5% in direct LN2; respectively (p=NS). There were also no significant differences between two groups.

Limitations, reasons for caution

The study showed that the blastocyst stored in vapor can retain full development. A vapor storage system thus is safe and effective for long term vapor storage of vitrified human embryos.Within the limits of this study, there was no detection of an adverse effect of vapor storage.

Wider implications of the findings: Vapor storage systems thus represent a useful alternative for safe and effective long-term storage of vitrified human embryos that can avoid cross contamination chances from having direct contact with LN2.

Trial registration number

Not applicable

Estimation of core body temperature by near-infrared imaging of vein diameter change in the dorsal hand

Core body temperature (T_core ) is a key indicator of personal thermal comfort and serves as a monitor of thermal strain. Multi-parametric sensors are not practical for estimating core temperature because they require long data collection times and a wide variety of settings. This study introduces dorsal hand vein dynamics as a novel indicator along with heart rate (HR) and dorsal hand skin temperature (T_hand ) for predicting T_core during rest following T_core elevation. Twelve healthy males aged 27 ± 9 years old participated in the experiment. The experimental procedure consisted of a 10-min rest followed by 60 min of passive heat stress induced by leg immersion in hot water at 42°C and a 40-min thermal relaxation period after the legs were removed from the water. A near-infrared (NIR) imaging system was configured to monitor the dorsal hand veins during the entire experimental session. The values of HR, T_hand , and T_core were continuously monitored while the ambient temperature and relative humidity (RH) were maintained in a climate chamber at 20°C and 50%, respectively. Our selected predictor parameters demonstrated similar patterns in the T_core such that the value increased as a result of passive heat stress and decreased in the thermal relaxation phase. The experimental data were divided into two phases: thermal stress and relaxation. At the resting condition, inclusion of the hand vein diameter (VD) improved the multiple linear regression value (R² ) about 26%. At the relaxation phase, however, training regressions R²  = 0.68 and R²  = 0.94 were observed in the regression model with and without considering VD, respectively. The test regression value of R²  = 0.88 and the root mean square error (RMSE) of 0.18°C showed good agreement with the predicted values. These findings demonstrate acceptable validity of the non-invasive T_core estimation at the resting condition. In particular, the inclusion of VD as a predictor in the regression analysis increases the prediction accuracy with a lower RMSE value.

Body mass index and mortality in patients with cardiovascular disease: an umbrella review of meta-analyses

OBJECTIVE

Although many previous meta-analyses of epidemiological studies have demonstrated a relationship between body mass index (BMI) and mortality, inconsistent findings among cardiovascular disease patients have been observed. Thus, we performed an umbrella review to understand the strength of evidence and validity of claimed associations between BMI and mortality in patients with cardiovascular diseases.

MATERIALS AND METHODS

We comprehensively re-analyzed the data of meta-analyses of observational studies and randomized controlled trials on associations between BMI and mortality among patients with cardiovascular diseases. We also assessed the strength of evidence of the re-analyzed outcomes, which were determined from the criteria including statistical significance of the p-value of random-effects, as well as fixed-effects meta-analyses, small-study effects, between-study heterogeneity, and a 95% prediction interval.

RESULTS

We ran comprehensive re-analysis of the data from the 21 selected studies, which contained a total of 108 meta-analyses; 23 were graded as convincing evidence and 12 were suggestive, 42 were weak, and 23 were non-significant.

CONCLUSIONS

Underweight increased mortality in acute coronary syndrome (ACS), heart failure, and after therapeutic intervention for patients with cardiovascular diseases. Overweight, on the other hand decreased mortality in patient's ACS, atrial fibrillation, and heart failure with convincing evidence.