Endoscopic ultrasound-guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction

Objectives

Malignant gastric outlet obstruction (GOO) has traditionally been managed with enteral stenting and surgical gastrojejunostomy. Our study aimed to compare outcomes between endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) using a lumen-apposing metal stent and robotic GJ (R-GJ) for unresectable malignant GOO.

Methods

Patients undergoing EUS-GJ or R-GJ for unresectable malignant GOO were retrospectively analyzed. The primary outcome was clinical success defined by the ability to tolerate oral intake at the time of discharge. Secondary outcomes included technical success, procedure duration, adverse events, and post-procedure length of stay (LOS).

Results

A total of 44 patients met the inclusion criteria. Of the 44, 29 underwent EUS-GJ and 15 underwent R-GJ. Age, gender, malignant etiology, and presence of ascites were similar between the two groups. Patients treated with EUS-GJ had a higher mean Charlson comorbidity index (10.3 vs. 7.0; p ≤ 0.0001) and a lower preoperative body mass index (22.3 vs. 27.2; p = 0.007). Technical and clinical success was achieved in 100% of patients in both groups (p > 0.99). EUS-GJ was associated with shorter procedure duration (57.5 vs. 146.3 min; p < 0.0001), hospital LOS (4.3 vs. 8.2 days, p = 0.0009), and time to oral intake (1.0 vs. 5.8 days; p < 0.0001) when compared to R-GJ. Adverse events occurred in 5 of the R-GJ patients and none of the EUS-GJ patients (p = 0.003).

Conclusions

EUS-GJ has similar efficacy and superior clinical outcomes compared to R-GJ in the management of malignant GOO. Prospective studies with longer follow-up duration are needed to validate these findings.

Polyamine depletion enhances oil body mobilization through possible regulation of oleosin degradation and aquaporin abundance on its membrane

Oil body (OB) mobilization, a crucial event associated with early seedling growth, is delayed in response to salt stress. Previous reports suggest that careful regulation of polyamine (PA) metabolism is essential for salt stress tolerance in plants. Many aspects of PA-mediated regulation of metabolism have been uncovered. However, their role in the process of OB mobilization remains unexplored. Interestingly, the present investigations reveal a possible influence of PA homeostasis on OB mobilization, while implicating complex regulation of oleosin degradation and aquaporin abundance in OB membranes in the process. Application of PA inhibitors resulted in the accumulation of smaller OBs when compared to control (-NaCl) and the salt-stressed counterparts, suggesting a faster rate of mobilization. PA deficit also resulted in reduced retention of some larger oleosins under controlled conditions but enhanced retention of all oleosins under salt stress. Additionally, with respect to aquaporins, a higher abundance of PIP2 under PA deficit both under control and saline conditions, is correlated with a faster mobilization of OBs. Contrarily, TIP1s, and TIP2s remained almost undetectable in response to PA depletion and were differentially regulated by salt stress. The present work, thus, provides novel insights into PA homeostasis-mediated regulation of OB mobilization, oleosin degradation, and aquaporin abundance on OB membranes.

Evolving academic and research partnerships in global health: a capacity-building partnership to assess primary healthcare in the Philippines

Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.

Combined interactions of amino acids and organic acids in heavy metal binding in plants

This research focused on the different approaches to the transport and internal chelation of metals with amino acids and organic acids in plants. Therefore, in the first phase, the plants studied were identified the characteristics of the bioaccumulation factors. Steria pumila, Echium angustifolium, Typha angustifolia, Sisymbrium austriacum were identified as hyperaccumulators (Cd, Ni), accumulators (Pb, Sn, and Se), excluders (Cr, Hg). On the other hand, the Sisymbrium austriacum only showed the characteristic of the accumulator for Cr. In the second phase, the combined effects of amino acids and organic acids on the chelation of heavy metals in plants were tested by a multi-linear regression model. Related to our hypothesis, Amino acids; Gly and Leu (Cd), Trp and Ile (Pb), Asp, Ser, and Leu (Cr), Ser (Hg), Trp and Glu (Ni), Asp, Thr, and Gly (Sn), Asn and Leu (Se), Organic acids; Malonic and Malic acid (Cd), Malonic acid (Pb), Oxalic and Malic acid (Cr), Oxalic, Succinic, Citric and Butyric acid (Hg), Malonic and Malic acid (Ni), Malonic, Maleic, and Malic acid (Sn), Malonic and Citric acid (Se) were concluded that had combined effect for heavy metal's phytochelation ability into plants.

Anion-templated silver nanoclusters: precise synthesis and geometric structure

Metal nanoclusters (NCs) are gaining much attention in nanoscale materials research because they exhibit size-specific physicochemical properties that are not observed in the corresponding bulk metals. Among them, silver (Ag) NCs can be precisely synthesized not only as pure Ag NCs but also as anion-templated Ag NCs. For anion-templated Ag NCs, we can expect the following capabilities: 1) size and shape control by regulating the central anion (anion template); 2) stabilization by adjusting the charge interaction between the central anion and surrounding Ag atoms; and 3) functionalization by selecting the type of central anion. In this review, we summarize the synthesis methods and influences of the central anion on the geometric structure of anion-templated Ag NCs, which include halide ions, chalcogenide ions, oxoanions, polyoxometalate, or hydride/deuteride as the central anion. This summary provides a reference for the current state of anion-templated Ag NCs, which may promote the development of anion-templated Ag NCs with novel geometric structures and physicochemical properties.

GABA: a key player of abiotic stress regulation

Abiotic stress is considered as the main culprit for reduction of global food production. Recent studies have reported GABA as a major regulator of abiotic stress and thus opening new avenues in research on emerging roles of GABA in abiotic stress acclimation in plants.

Economic and cost-effectiveness aspects of vaccines in combating antibiotic resistance

Antimicrobial resistance (AMR) is a global public health threat causing substantial morbidity and mortality as well as significant economic costs. Vaccines can contribute to combating antimicrobial resistance by reducing the incidence of resistant disease cases and lowering overall antibiotic use. Greater utilization and investments in vaccines as a tool for combating AMR might be hampered by limited economic evidence demonstrating the AMR-related value of vaccines. We reviewed the existing literature to assess the state of evidence. We found two modeling studies that provided estimates of AMR-related costs averted by pneumococcal vaccination and a few cost-effectiveness studies that exclusively focused on serotype replacement effects on overall vaccine cost-effectiveness. We did not find any cost-effectiveness studies that directly examined the cost-effectiveness of vaccines in slowing the development of AMR. Further evidence on the cost-effectiveness and economic value of vaccines in controlling AMR can help inform resource allocation decisions and guide development priorities.

Effects of drought stress on photosynthetic physiological characteristics, leaf microstructure, and related gene expression of yellow horn

Yellow horn grows in northern China and has a high tolerance to drought and poor soil. Improving photosynthetic efficiency and increasing plant growth and yield under drought conditions have become important research content for researchers worldwide. Our study goal is to provide comprehensive information on photosynthesis and some candidate genes breeding of yellow horn under drought stress. In this study, seedlings' stomatal conductance, chlorophyll content, and fluorescence parameters decreased under drought stress, but non-photochemical quenching increased. The leaf microstructure showed that stomata underwent a process from opening to closing, guard cells from complete to dry, and surrounding leaf cells from smooth to severe shrinkage. The chloroplast ultrastructure showed that the changes of starch granules were different under different drought stress, while plastoglobules increased and expanded continuously. In addition, we found some differentially expressed genes related to photosystem, electron transport component, oxidative phosphate ATPase, stomatal closure, and chloroplast ultrastructure. These results laid a foundation for further genetic improvement and deficit resistance breeding of yellow horn under drought stress.

Rheumatic heart disease burden, trends, and inequalities in Asia, 1990-2019

BACKGROUND

Rheumatic heart disease (RHD) is a serious global public health problem.

OBJECTIVES

This study aims to characterise the regional burden, trends, and inequalities of RHD in countries and territories in the Asian Region.

METHODS

The RHD disease burden was measured in terms of the numbers of cases and deaths, prevalence, disability-adjusted life years (DALYs), disability-loss healthy life years (YLDs), and years of life lost (YLLs) in 48 countries in the Asian Region. Data on RHD were extracted from the 2019 Global Burden of Disease. This study analysed changing trends in the burden between 1990 and 2019, quantified regional inequalities in mortality, and classified countries by 2019 YLLs.

RESULTS

There were an estimated 22 246 127 cases of RHD in the Asian Region in 2019 and 249 830 deaths. The prevalence of RHD in the Asian Region in 2019 was 9% lower than the global estimate, while mortality was 41% higher. The mortality rate for RHD in the Asian Region trended downwards from 1990 to 2019, with an average annual percentage change of -3.2% (95% UI -3.3 to -3.1). From 1990 to 2019, absolute inequality in RHD-related mortality decreased in the Asian Region while relative inequality increased. Of the 48 countries studied, twelve had the highest level of RHD YLLs in 2017 and the smallest reduction in YLLs from 1990 to 2019.

CONCLUSION

Although the burden of RHD in the Asian Region has steadily decreased since 1990, it remains a serious public health issue requiring greater attention. In the Asian Region, inequalities in the distribution of the RHD burden remain significant, with economically deprived countries typically bearing a greater share of the load.

Comparative metabolomic profiling reveals molecular mechanisms underlying growth promotion and disease resistance in wheat conferred by Piriformospora indica in the field

Piriformospora indica, a plant root-colonizing basidiomycete fungus, exhibits strong growth-promoting activity in symbiosis with a broad range of plants. Here, we report the potential of P. indica to improve growth, yield, and disease resistance in wheat in the field. In the present study, P. indica successfully colonized wheat through chlamydospores and formed dense mycelial networks that covered roots. Plants subjected to the seed soaking (SS) treatment with P. indica chlamydospore suspensions enhanced tillering 2.28-fold compared to the non-inoculated wheat in the tillering stage. In addition, P. indica colonization promoted vegetative growth significantly during the three-leaf, tillering, and jointing stages. Moreover, the P. indica-SS-treatment enhanced wheat yield by 16.37 ± 1.63%, by increasing grains per ear and panicle weight and decreased damage to wheat shoot and root architecture markedly, with high field control effects against Fusarium pseudograminearum (81.59 ± 1.32%), Bipolaris sorokiniana (82.19 ± 1.59%), and Rhizoctonia cerealis (75.98 ± 1.36%). Most of the primary metabolites, such as amino acids, nucleotides, and lipids, involved in vegetative reproduction were increased in P. indica-SS-treatment plants, whereas secondary metabolites, such as terpenoids, polyketides, and alkaloids, decreased following P. indica inoculation. The up-regulated processes of protein, carbohydrate, and lipid metabolism indicated that P. indica colonization increased growth, yield, and disease resistance via the acceleration of plant primary metabolism. In conclusion, P. indica improved morphological, physiological, and metabolic substance levels, and further promoted its growth, yield, and disease resistance in wheat.

Antibacterial and anti-Toxoplasma activities of Aspergillus niger endophytic fungus isolated from Ficus retusa: in vitro and in vivo approach

Emergent records propose that Aspergillus niger endophytic fungus is a vital source for various bioactive molecules possessing many biological properties. The current study was designed to inspect the antibacterial and anti-Toxoplasma potentials of Ficus retusa-derived endophytic fungi. After isolation and identification (using 18S rRNA gene sequencing) of A. niger endophytic fungus, LC/MS was utilized for identification and authentication of the chemical profile of the A. niger endophyte extract. Then, the fungal extract was assessed for its antibacterial and antibiofilm activities against Klebsiella pneumoniae clinical isolates. Additionally, its efficacy against Toxoplasma gondii was elucidated in vivo. The fungal extract displayed antibacterial activity against K. pneumoniae isolates with minimum inhibitory concentration values of 64-512 µg/mL. It also possessed a membrane potential dissipating effect using flow cytometry. Moreover, it formed distorted cells with rough surfaces and deformed shapes using a scanning electron microscope (SEM). Regarding its antibiofilm activity, it resulted in a dysregulation of the genes encoding biofilm formation (fimH, mrkA and mrkD) using qRT-PCR in nine K. pneumoniae isolates. The in vivo anti-Toxoplasma potential was demonstrated by decreasing the mortality rate of mice and reducing the tachyzoites' count in the peritoneal fluids and liver impression smears of mice. In addition, the deformities of the parasite decreased, as revealed by SEM and the inflammation in tissues diminished. Thus, A. niger endophytic fungi could be a valuable source of antibacterial and anti-Toxoplasma compounds.

The combined use of ultrasound examination of hemodynamics in the umbilical artery and urine microalbumin levels can predict adverse pregnancy outcomes in patients with severe preeclampsia

The aim of this study was to elucidate the application of ultrasound examination of umbilical artery (UA) hemodynamics with urine microalbumin (UmA) determination in evaluating the outcomes of sPE patients. Altogether 80 sPE patients and 75 healthy pregnant women were recruited. UmA, RI (resistance index) and PI (pulsatility index) were separately measured by ELISA and the ultrasonic Doppler flow detector. The correlation between parameters was analysed using Pearson's coefficient method. The independent risk factors of sPE were identified using the Logistic regression model. sPE patients had increased UmA, RI and PI (all p < 0.05). UmA level was positively correlated with RI and PI in sPE patients. RI, PI and UmA were independent risk factors of sPE (all p < 0.05). sPE can predict adverse pregnancy outcomes. High UmA levels may increase the risk of poor prognosis. Overall, ultrasound examination of UA hemodynamics with UmA determination can predict the adverse pregnancy outcomes of sPE patients.IMPACT STATEMENTWhat is already known on this subject? Doppler ultrasound and urine microalbumin (UmA) measurement are important tools in assessing the clinical severity of severe preeclampsia (sPE).What do the results of this study add? This study aims to unravel the application of ultrasound examination of hemodynamics in the umbilical artery (UA) combined with the determination of UmA in evaluating the outcomes of sPE patients.What are the implications of these findings for clinical practice and/or further research? Ultrasound examination of hemodynamics in UA combined with the determination of UmA can predict the adverse pregnancy outcomes of sPE patients.

Evaluation of new biomarkers in stage III and IV endometriosis

OBJECTIVE

To investigate the efficacy of new endometriosis biomarkers in diagnosis and treatment.

METHODS

Thirty women with Stage III-IV endometriosis who were given an indication for surgery and 49 control patients were compared. Preoperative and postoperative serum levels of Annexin A5 (ANXA5), soluble intercellular adhesion molecule-1 (sICAM-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), soluble vascular cell adhesion molecule-1 (sVCAM-1), vascular endothelial growth factors (VEGF) and Ca-125 measurements were compared.

RESULTS

AUCs of ANXA5, sICAM-1, IL-6, TNF-α, VCAM-1, VEGF biomarkers were not found to be significant in diagnosing endometriosis when evaluated alone (p > 0.05). Only the AUC of the Ca-125 biomarker values were found to be significant with 73% sensitivity and 98% specificity (p < 0.001). However, when Ca-125 and ANXA5 were evaluated together, it was concluded that the diagnosis of endometriosis could be made with 73% sensitivity and 100% specificity.

CONCLUSION

When Ca-125 and ANXA5 are evaluated together, it seems to be more valuable than Ca-125 alone in diagnosing endometriosis.

Correlation between kisspeptin and biochemical markers in obese and non-obese women with polycystic ovary syndrome

Introduction The purpose of this study was to determine the association between kisspeptin levels and obesity in patients with polycystic ovary syndrome (PCOS) or in healthy controls and to explore the correlation between levels of kisspeptin and various endocrine and metabolic indices in each group.Methods From August 2020 to December 2021, the clinical data of 78 patients with polycystic ovary syndrome and 78 healthy individuals were collected. The two groups were further divided into obese and non-obese groups based on a BMI cutoff of 25. Serum kisspeptin levels were measured using enzyme linked immunosorbent assay (ELISA). Pearson's correlation analysis was used to determine the correlation between PCOS and kisspeptin levels.Results The weight, body mass index (BMI), and waist circumference (WC), estradiol (E2), and testosterone (T) of the obese PCOS group were significantly higher than those of the study group (p < .05). WC, kisspeptin, triglycerides (TG), glucose (GLU), alanine amiotransferase (ALT), blood urea nitrogen (BUN), uric acid (UA), E2, luteinizing hormone (LH), prolactin (PRL), and T in the non-obese PCOS group were higher than those in the control group, and the difference was statistically significant (p < .05). Levels of E2 and TG in the obese PCOS group were significantly higher than those in the non-obese PCOS group (p < .05). Kisspeptin levels in the PCOS group exhibited a significant positive correlation with LH, T, and AMH levels; kisspeptin level positively correlated with T in the non-obese PCOS group and with anti-Müllerian hormone (AMH) in the obese PCOS group.Conclusion Serum kisspeptin levels are associated with hormone levels in patients with PCOS. Kisspeptin correlates with distinct biochemical indices in obese versus non-obese groups, indicating that kisspeptin may play a role in the prognostication, treatment, and clinical evaluation of patients with varying BMI.

Dietary and supplemental intake of vitamins C and E is associated with altered DNA methylation in an epigenome-wide association study meta-analysis

BACKGROUND

Dietary intake of antioxidants such as vitamins C and E protect against oxidative stress, and may also be associated with altered DNA methylation patterns.

METHODS

We meta-analysed epigenome-wide association study (EWAS) results from 11,866 participants across eight population-based cohorts to evaluate the association between self-reported dietary and supplemental intake of vitamins C and E with DNA methylation. EWAS were adjusted for age, sex, BMI, caloric intake, blood cell type proportion, smoking status, alcohol consumption, and technical covariates. Significant results of the meta-analysis were subsequently evaluated in gene set enrichment analysis (GSEA) and expression quantitative trait methylation (eQTM) analysis.

RESULTS

In meta-analysis, methylation at 4,656 CpG sites was significantly associated with vitamin C intake at FDR ≤ 0.05. The most significant CpG sites associated with vitamin C (at FDR ≤ 0.01) were enriched for pathways associated with systems development and cell signalling in GSEA, and were associated with downstream expression of genes enriched in the immune response in eQTM analysis. Furthermore, methylation at 160 CpG sites was significantly associated with vitamin E intake at FDR ≤ 0.05, but GSEA and eQTM analysis of the top most significant CpG sites associated with vitamin E did not identify significant enrichment of any biological pathways investigated.

CONCLUSIONS

We identified significant associations of many CpG sites with vitamin C and E intake, and our results suggest that vitamin C intake may be associated with systems development and the immune response.

Increased serum PCSK9 levels are associated with renal function impairment in patients with type 2 diabetes mellitus

PURPOSE

The purpose of this study was to investigate the association between serum proprotein convertase subtilisin/kexin type 9 (PCSK9) levels and renal function impairment in type 2 diabetes mellitus (T2DM) patients.

METHODS

PCSK9 levels were measured in T2DM patients, streptozotocin plus high-fat diet (STZ + HFD) mice, human proximal tubular epithelial (HK-2) cells treated with high glucose plus palmitic acid (HGPA) and the corresponding control groups. The T2DM patients were further divided into three groups according to serum PCSK9 levels. An analysis of clinical data was conducted, and a binary logistic regression model was used to test the relationship between potential predictors and urine albumin/urine creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR).

RESULTS

PCSK9 levels were higher in the DM group than in the control group in humans, mice and HK-2 cells. The systolic blood pressure (SBP), serum creatinine (Scr), blood urea nitrogen (BUN), triglyceride (TG), and urine α1-MG/urine creatinine ratio (UαCR) values in PCSK9 tertile 3 were significantly higher than those in PCSK9 tertile 1 (p < 0.05). The DBP and UACR values were significantly higher in PCSK9 tertile 3 than in PCSK9 tertile 1 and PCSK9 tertile 2 (both p < 0.05). In addition, URCR values were significantly higher in PCSK9 tertile 3 and PCSK9 tertile 2 than in PCSK9 tertile 1 (both p < 0.05). Serum PCSK9 levels were positively correlated with SBP, Scr, BUN, TG, URCR, UαCR and UACR but inversely correlated with eGFR. In STZ + HFD mice, serum PCSK9 levels were positively correlated with Scr, BUN and UACR, which was consistent with the findings in the patients. A logistic regression model revealed that serum PCSK9 is an independent risk factor for UACR ≥30 mg/g and eGFR <60 mL/min/1.73 m². The ROC curve showed that 170.53 ng/mL and 337.26 ng/mL PCSK9 were the best cutoff values for UACR ≥30 mg/g and eGFR <60 mL/min/1.73 m², respectively.

CONCLUSION

Serum PCSK9 levels are associated with renal function impairment in T2DM patients and in some patients lower PCSK9 may be helpful to decrease chronic kidney disease.

Synergistic effects of combined cisplatin and Clinacanthus nutans extract on triple negative breast cancer cells

Objective

Triple negative breast cancer (TNBC) is the most invasive breast cancer subtype enriched with cancer stem cells. TNBCs do not express estrogen, progesterone, or human epidermal growth factor receptor 2 (HER2) receptors, making them difficult to be targeted by existing chemotherapy treatments. In this study, we attempted to identify the effects of combined cisplatin and Clinacanthus nutans treatment on MDA-MD-231 and MDA-MB-468 breast cancer cells, which represent TNBC subtypes.

Methods

The phytochemical fingerprint of C. nutans ethanolic leaf extract was evaluated by LC-MS/MS analysis. We investigated the effects of cisplatin (0-15.23 μg/mL), C. nutans (0-50 μg/mL), and a combination of cisplatin (3.05 μg/mL) and C. nutans (0-50 μg/mL), on cell viability, proliferation, apoptosis, invasion, mRNA expression in cancer stem cells (CD49f, KLF4), and differentiation markers (TUBA1A, KRT18) in TNBC cells. In addition, we also studied the interaction between cisplatin and C. nutans.

Results

Derivatives of fatty acids, carboxylic acid ester, and glycosides, were identified as the major bioactive compounds with potential anticancer properties in C. nutans leaf extract. Reductions in cell viability (0-78%) and proliferation (2-77%), as well as a synergistic anticancer effect, were identified in TNBC cells when treated with a combination of cisplatin and C. nutans. Furthermore, apoptotic induction via increased caspase-3/7 activity (MDA-MB-231: 2.73-fold; MDA-MB-468: 3.53-fold), and a reduction in cell invasion capacity to 36%, were detected in TNBC cells when compared to single cisplatin and C. nutans treatments. At the mRNA level, cisplatin and C. nutans differentially regulated specific genes that are responsible for proliferation and differentiation.

Conclusion

Our findings demonstrate that the combination of cisplatin and C. nutans represents a potential treatment for TNBC.

The prevalence of diabetes distress among patients with type 2 diabetes in Jordan

Objectives

Diabetes distress (DD) is a state of emotional distress that evolves from living with chronic disease and the burden of daily adjustments of medications and lifestyle. This study investigated the prevalence of DD in patients with type 2 diabetes mellitus (T2DM) in Jordan and the related sociodemographic and medical factors.

Methods

We conducted a cross-sectional study in 608 patients with T2DM in Jordan, ranging from ages 15 to 80 years. The participants filled out a questionnaire where they were asked to self-assess their DD using the Diabetes Distress Scale. In all, 32 participants were excluded according to the exclusion criteria, which resulted in 576 people being included in this study.

Results

The overall prevalence of DD was 53% (25% had moderate distress and 28% had high distress). Emotional distress had the highest prevalence among the DD subscales, with a total prevalence of 58.8%. The data showed a significant association of DD with different factors including age, the presence of diabetic complications, the type of medication used, and medication adherence.

Conclusion

This study showed a high prevalence of DD (53%). This finding should raise awareness to healthcare providers about the importance of screening for DD as part of the treatment guidelines, especially in patients who are on multiple medication regimens for DM; patients who have previous medical complications related to DM; and those who exhibit poor adherence to medications, which was found to be a risk factor of DD in this study.

New drug-like small molecule antagonizes phosphatidylinositol (3,4,5)-trisphosphate (PIP3) in patients with conotruncal heart defects

Objectives

Conotruncal heart defects (CTDs) are highly heritable, and approximately one-third of all congenital heart defects are due to CTDs. Through post-analysis of GWAS data relevant to CTDs, a new putative signal transduction pathway, called Vars2-Pic3ca-Akt, associated with CTD has been hypothesized. Here, we aimed to validate the Vars2-Pic3ca-Akt pathway experimentally by measuring Vars2 and PIP3 in patients with CTDs and controls, and to construct a PIP3 inhibitor, as one of harmful-relevant CTD pathogenesis, through an Akt-based drug design strategy.

Methods

rs2517582 genotype and relative Vars2 expression in 207 individuals were determined by DNA sequencing and qPCR respectively, and free plasma PIP3 in 190 individuals was quantified through ELISA. An Akt-pharmacophore feature model was used to discover PIP3 antagonists with multiple computational and drug-like estimation tools.

Results

CTD pathogenesis due to Vars2-Pic3ca-Akt overstimulation was confirmed by elevated Vars2 and PIP3 in patients with CTDs. We identified a new small molecule, 322PESB, that antagonizes PIP3 binding. This molecule was prioritized via virtual screening of 21 hypothetical small molecules and it showed minimal RMSD change, high binding affinity andlower dissociation constant than PIP3-Akt complex by 1.99 Kcal/Mol, thus resulting in an equilibrium shift toward 322PESB-Akt complex formation. Moreover, 322PESB exhibited acceptable pharmacokinetics and drug likeness features according to ADME and Lipinski's rule of five classifiers. This compound is the first potential drug-like molecule reported for patients with CTDs with elevated PIP3.

Conclusion

PIP3 is a useful diagnostic biomarker for patients with CTDs. The Akt-pharmacophore feature model is a feasible approach for discovery of PIP3 signalling antagonists. Further 322PESB development and testing are recommended.

Ethnographic understandings of sexual and reproductive health and HIV care for adolescents in Blantyre, Malawi

Sexual and reproductive health (SRH) care and support are provided to adolescents living with HIV, with the aim to build safer sex negotiation skills, sexual readiness and reproductive preparedness while reducing unintended pregnancies and sexually transmitted infections. We consider how different settings might either constrain or facilitate access to resources and support. Ethnographic research was conducted in Malawi in teen club clinic sessions at an enhanced antiretroviral clinic from November 2018 to June 2019. Twenty-one individual and five group interviews were conducted with young people, caregivers, and healthcare workers, and were digitally recorded, transcribed, and translated into English for thematic analysis. Drawing on socio-ecological and resilience theories, we considered the different ways in which homes, schools, teen club clinics, and community settings all functioned as interactional, relational, and transformational spaces to allow young people to talk about and receive information on sexuality and health. Young people perceived that comprehensive SRH support enhanced their knowledge, sexual readiness, and reproductive preparedness. However, their desire to reproduce at an early age complicated their adoption of safer sex negotiation skills and SRH care. Engaging and talking about SRH and related issues varied according to physical and social space, suggesting the value of multiple locations for support and resources for young people with HIV.

Global, regional and national burden of orofacial clefts from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019

BACKGROUND

Orofacial clefts are the most common congenital malformation, but the global burden and trends of orofacial clefts have not been comprehensively analysed. The aim of this study was to assess the global incidence, deaths and disability-adjusted life years (DALYs) of orofacial clefts by countries, regions, sex and sociodemographic index (SDI) from 1990 to 2019.

METHODS

The data on orofacial clefts were obtained from the Global Burden of Disease Study 2019. The incidence, deaths and DALYs were analysed by countries, regions, sex and SDI. Age-standardized rates and estimated annual percentage change (EAPC) were calculated to evaluate the burden and temporal trend of orofacial clefts. The association between EAPC and the human development index was assessed.

RESULTS

Globally, the incidence, deaths and DALYs of orofacial clefts decreased from 1990 to 2019. The high SDI region showed the biggest downward trend in incidence rate from 1990 to 2019, along with the lowest age-standardized death rate and DALY rate. Some countries, such as Suriname and Zimbabwe, experienced increased death rate and DALY rate over time. The age-standardized death rate and DALY rate were negatively associated with the level of socioeconomic development.

CONCLUSION

Global achievement is evident in the control of the burden of orofacial clefts. The future focus of prevention should be on low-income countries, such as South Asia and Africa, by increasing healthcare resources and improving quality.KEY MESSAGESThis is the most recent estimate of the global epidemiology of orofacial clefts, with some countries not previously assessed.The global burden of orofacial clefts showed downward trends from 1990 to 2019; however, some low-income countries are still suffering from increasing burdens.Effective measures should be taken to reduce the burden of orofacial clefts in the uncontrolled regions.

The effect of e-learning on point-of-care ultrasound education in novices

BACKGROUND

Current studies assessed the learning efficacy of e-learning in ultrasound (US) training using questionnaires, or simulation in well-controlled conditions. This study investigates the effect of e-learning on the clinical US performance of the first postgraduate year (PGY-1) residents.

METHODS

In this prospective observational study, we enrolled PGY-1 and second postgraduate year (PGY-2) residents. The e-learning was introduced on the first day and each PGY-1 was authorized to access the e-learning platform. The point-of-care ultrasound (PoCUS) curriculum for the focused assessment of sonography for trauma (FAST) was conducted on the 7^th day for PGY-1 and the objective structured clinical examination (OSCE) followed. The PGY-2 received bedside one-to-one random learning before the study and did not have the authorization to access the e-learning. The FAST examinations performed by the PGY-1 and PGY-2 were collected on the 30th day. The clinical FAST performance was assessed by the instructor not involved in the curriculum and blinded to the use of e-learning, including numbers, image quality, and diagnostic accuracy between PGY-1 e-learning users, non-users, and the PGY-2.

RESULTS

One hundred and seventy PGY-1 with 736 FAST examinations and 53 PGY-2 residents with 134 examinations were included. Seventy PGY-1 used e-learning with a median time spent of 13.2 mins (IQR, 6.5-21.1 mins) at the first access. The PGY-2 had more PoCUS experience than the PGY-1, however, the 70 e-learning users performed more FAST examinations than the PGY-2 (median [IQR], 4 [2-6] vs. 2 [1-3], p = 0.0004) and had better image quality than the PGY-2 (3 [3-3.2] vs. 3 [2.7-3], p = 0.044). There were no significant differences in the diagnostic accuracy between the PGY-1 and PGY-2.

CONCLUSIONS

E-learning has a positive effect on US learning. The PGY-1 users had comparable performance with the PGY-2 and even better image acquisition although the PGY-2 had more PoCUS experience.

TRIAL REGISTRATION

NCT03738033 at ClinicalTrials.gov.

Does whey protein supplementation during resistance exercise have additional benefits for decreasing hepatic fat content?

BACKGROUND

Exercise and diet have positive effects on hepatic fat reduction, and protein supplementation is known to lower hepatic fat accumulation. However, the effect of a combination of exercise and whey protein supplementation (WPS) on hepatic fat content (HFC) is unknown.

METHODS

We investigated the effect of WPS on HFC during resistance exercise and diet control intervention for four weeks. A total of 34 sedentary males participated and were randomly assigned to two groups: a protein supplement group (PSG, n = 18) and a control group (CG, n = 16). The PSG took 60 g of WPS per day, and the CG took 60 g of an isocaloric placebo per day. All participants were fed a calorie-controlled diet throughout the study period, with their daily caloric intake determined by their resting metabolic rate and physical activity level. Both groups performed resistance exercises supervised by experts at 60-70% of their maximum efforts for 60 min/day, 6 days/week for 4 weeks. HFC was assessed using the controlled attenuation parameter (CAP) after an 8 h fast, at pre-, mid-, and post-intervention. Liver enzymes and lipid profile were also analyzed after an 8 h fast and pre- and post-intervention.

RESULTS

The CAP was significantly reduced after 4 weeks of intervention in both groups (PSG, p < .001; CG, p = .002). However, there was no significant interaction between the group and changes in CAP. Interestingly, when comparing the pre- and mid-tests, both groups also had significantly reduced CAP (PSG, p = .027; CG, p = .028), but there was a significant difference in the amount of change in CAP between the two groups (PSG, -47.2 ± 25.4 dB/m; CG, -19.5 ± 15.1 dB/m; p = .042). For liver enzymes, there was a significant interaction between the two groups and a change in aspartate transaminase (AST) (p = .038). However, alanine aminotransferase (ALT) levels were significantly decreased only in the PSG group (p = .002). In lipids, both groups showed significantly decreased total cholesterol (p < .001) and low-density lipoprotein cholesterol (p < .001) after the intervention.

CONCLUSION

Our data showed that WPS may not enhance the overall effects of resistance exercise on HFC and lipid profiles. However, in part, WPS may have a beneficial effect on liver enzymatic changes and rapid response to resistance exercise-induced HFC reduction.

Parents' lived experience of living with and caring for their burn-injured child in a home setting

PURPOSE

When a burn injured child is discharged from hospital to its home, the responsibility for the after-care treatment is transferred to the parent(s). A knowledge gap exists concerning how parents experience caring for a burn-injured child at home after discharge. The aim is to gain an in-depth understanding of parents' lived experience of living with and caring for their burn-injured child in a home setting.

METHODS

Twenty-four parents of burn-injured children treated at a Norwegian burn centre were interviewed 74 to 195 days after the burn accident (June 2017 to November 2018). A phenomenological hermeneutic approach was chosen, using a Ricoeur-inspired textual in-depth analysis method. NVivo 12 Plus and COREQ were used.

RESULTS

Four themes emerged. The parents' experienced feelings had been embodied and would stay forever. They felt left alone to continue the medical treatment at home without having the necessary skills. The parents grieved over the lost past and feared the unknown future. They longed to meet or b