Comparative analysis of Diospyros (Ebenaceae) plastomes: Insights into genomic features, mutational hotspots, and adaptive evolution.

Diospyros (Ebenaceae) is a widely distributed genus of trees and shrubs from pantropical to temperate regions, with numerous species valued for their fruits (persimmons), timber, and medicinal values. However, information regarding their plastomes and chloroplast evolution is scarce. The present study performed comparative genomic and evolutionary analyses on plastomes of 45 accepted Diospyros species, including three newly sequenced ones. Our study showed a highly conserved genomic structure across the Diospyros species, with 135-136 encoding genes, including 89 protein-coding genes, 1-2 pseudogenes (Ψycf1 for all, Ψrps19 for a few), 37 tRNA genes and 8 rRNA genes. Comparative analysis of Diospyros identified three intergenic regions (ccsA-ndhD, rps16-psbK and petA-psbJ) and five genes (rpl33, rpl22, petL, psaC and rps15) as the mutational hotspots in these species. Phylogenomic analysis identified the phylogenetic position of three newly sequenced ones and well supported a monophylogenetic (sub)temperate taxa and four clades in the pantropical taxa. The analysis codon usage identified 30 codons with relative synonymous codon usage (RSCU) values >1 and 29 codons ending with A and U bases. A total of three codons (UUA, GCU, and AGA) with highest RSCU values were identified as the optimal codons. Effective number of codons (ENC)-plot indicated the significant role of mutational pressure in shaping codon usage, while most protein-coding genes in Diospyros experienced relaxed purifying selection (d N/d S < 1). Additionally, the psbH gene showed positive selection (d N/d S > 1) in the (sub)temperate species. Thus, the results provide a meaningful foundation for further elaborating Diospyros's genetic architecture and taxonomy, enriching genetic diversity and conserving genetic resources.

Development and validation of a prognostic model for HER2-low breast cancer to evaluate neoadjuvant therapy.

Background: Human epidermal growth factor receptor 2 (HER2) low breast cancer (BC) accounts for 30-51% of all BCs. How to precisely assess the response to neoadjuvant therapy in this heterogenous tumor is currently unanswered. With the advance in multi-omics, refining the molecular subtyping other than the current hormone receptor (HR)-based subtyping to guide the neoadjuvant therapy for HER2-low BC is potentially feasible. Methods: The messenger RNA (mRNA), clinical, and pathological data of all HER2-low BC patients (n=368) from the Neoadjuvant I-SPY2 Trial, were retrieved. Ninety-eight patients achieved pathological complete response (pCR) were randomly divided into the training and validation sets with 8:2 ratio. The non-pCR cases were corporated into the above datasets with 1:1 ratio. The rest non-pCR cases were served as the test set. Random forest (RF), support vector machine (SVM), and fully connected neural network (FCNN) were applied to establish a 1-dimensional (1D) model based on mRNA data. The method with best prediction value among the 3 models was selected for further modeling when combining pathological features. A new classification of deep learning (CDn) was proposed based on a multi-omics model. After identifying pCR-related features by the integral gradient and unsupervised hierarchical clustering method, the responses to neoadjuvant therapy associated with these features across different subgroups were analyzed. Results: Compared with the RF and SVM models, the FCNN model achieved the best performance [area under the curve (AUC): 0.89] based on the mRNA feature. By combining mRNA and pathological features, the FCNN model proposed 2 new subtypes including CD1 and CD0 for HER2-low BC. CD1 increased the sensitivity to predict pCR by 23.5% [to 87.8%; 95% confidence interval (CI): 78% to 94%] and improved the specificity to pCR by 12.2% (to 77.4%; 95% CI: 69% to 87%) when comparing with the current HR classification for HER2-low BC. Conclusions: The new typing method (CD1 and CD0) proposed in this study achieved excellent performance for predicting the pCR to neoadjuvant therapy in HER2-low BC. The patients who were not sensitive to neoadjuvant therapy according to multi-omics models might receive surgical treatment directly.

Small lesion classification on abbreviated breast MRI: training can improve diagnostic performance and inter-reader agreement.

OBJECTIVE: To determine whether the diagnostic performance and inter-reader agreement for small lesion classification on abbreviated breast MRI (AB-MRI) can be improved by training, and can achieve the level of full diagnostic protocol MRI (FDP-MRI). METHODS: This retrospective study enrolled 1165 breast lesions (≤ 2 cm; 409 malignant and 756 benign) from 1165 MRI examinations for reading test. Twelve radiologists were assigned into a trained group and a non-trained group. They interpreted each AB-MRI twice, which was extracted from FDP-MRI. After the first read, the trained group received a structured training for AB-MRI interpretation while the non-trained group did not. FDP-MRIs were interpreted by the trained group after the second read. BI-RADS category for each lesion was compared to the standard of reference (histopathological examination or follow-up) to calculate diagnostic accuracy. Inter-reader agreement was assessed using multirater k analysis. Diagnostic accuracy and inter-reader agreement were compared between the trained and non-trained groups, between the first and second reads, and between AB-MRI and FDP-MRI. RESULTS: After training, the diagnostic accuracy of AB-MRI increased from 77.6 to 84.4%, and inter-reader agreement improved from 0.410 to 0.579 (both p < 0.001), which were higher than those of the non-trained group (accuracy, 84.4% vs 78.0%; weighted k, 0.579 vs 0.461; both p < 0.001). The post-training accuracy and inter-reader agreement of AB-MRI were lower than those of FDP-MRI (accuracy, 84.4% vs 92.8%; weighted k, 0.579 vs 0.602; both p < 0.001). CONCLUSIONS: Training can improve the diagnostic performance and inter-reader agreement for small lesion classification on AB-MRI; however, it remains inferior to those of FDP-MRI. KEY POINTS: • Training can improve the diagnostic performance for small breast lesions on AB-MRI. • Training can reduce inter-observer variation for breast lesion classification on AB-MRI, especially among junior radiologists. • The post-training diagnostic performance and inter-reader agreement of AB-MRI remained inferior to those of FDP-MRI.

Growth and Toxin Production of Gambierdiscus spp. Can Be Regulated by Quorum-Sensing Bacteria.

Gambierdiscus spp. are the major culprit responsible for global ciguatera fish poisoning (CFP). At present, the effects of microbiological factors on algal proliferation and toxin production are poorly understood. To evaluate the regulatory roles of quorum-sensing (QS) bacteria in the physiology of Gambierdiscus, co-culture experiments with screened QS strains were conducted in this study. Except for the growth-inhibiting effect from the strain Marinobacter hydrocarbonoclasticus, the algal host generally displayed much higher growth potential and toxin production ability with the existence of QS strains. In addition, Bacillus anthracis particularly exhibited a broad-spectrum growth enhancement effect on various Gambierdiscus types, as well as a remarkable influence on algal toxicity. The variations of algal physiological status, including growth rate, chlorophyll content, and responsive behaviors, are potential reasons for the observed positive or negative affection. This study suggests that QS bacteria regulate the algal growth and toxin production. Based on the evidence, we further speculate that QS bacteria may contribute to the site-specific distribution of CFP risk through regulating the algal host biomass and toxicity.

Posterior Vitreous Detachment Precipitated by Yoga.

Yoga has recently been touted as a means to improve physical and mental well-being. However, no form of exercise is without its risks. A 32-year-old Chinese female with moderate myopia complained of right eye sudden onset of floaters and mild blurring of vision after the head-down posture. The visual acuity was 6/12 in the right eye and 6/9 in the left eye. A right eye fundus examination showed posterior vitreous detachment, with a small blood clot located at the inferior margin of the optic disc. The patient was diagnosed with right eye vitreous hemorrhage secondary to acute posterior vitreous detachment and was managed conservatively. Acute changes in posture, especially between an upright and a head-down position, may cause acute posterior vitreous detachment. As yoga practitioners may be required to assume this head-down position, myopic patients should be warned of the possible ocular complications of this exercise.

Clinical Profile and Visual Outcome of Ocular Bartonellosis in Malaysia.

Background. Ocular bartonellosis can present in various ways, with variable visual outcome. There is limited data on ocular bartonellosis in Malaysia. Objective. We aim to describe the clinical presentation and visual outcome of ocular bartonellosis in Malaysia. Materials and Methods. This was a retrospective review of patients treated for ocular bartonellosis in two ophthalmology centers in Malaysia between January 2013 and December 2015. The diagnosis was based on clinical features, supported by a positive Bartonella spp. serology. Results. Of the 19 patients in our series, females were predominant (63.2%). The mean age was 29.3 years. The majority (63.2%) had unilateral involvement. Five patients (26.3%) had a history of contact with cats. Neuroretinitis was the most common presentation (62.5%). Azithromycin was the antibiotic of choice (42.1%). Concurrent systemic corticosteroids were used in approximately 60% of cases. The presenting visual acuity was worse than 6/18 in approximately 60% of eyes; on final review, 76.9% of eyes had a visual acuity better than 6/18. Conclusion. Ocular bartonellosis tends to present with neuroretinitis. Azithromycin is a viable option for treatment. Systemic corticosteroids may be considered in those with poor visual acuity on presentation.

Effects of propranolol on heart rate and development in Japanese medaka (Oryzias latipes) and zebrafish (Danio rerio).

Propranolol is a ß-adrenergic receptor antagonist (ß-blocker) that is frequently used to treat hypertension and other cardiovascular conditions in humans. Detected in surface waters due to discharge of domestic wastewater, propranolol has demonstrated significant species differences in toxicity between fish. The aim of this study was to investigate the effects of propranolol on heart rate and development in embryos of two species of fish; Japanese medaka (JM) Oryzias latipes and zebrafish (ZF) Danio rerio. Parents and fertilized embryos of each species were exposed to nominal (measured) concentrations of 0.1 (0.09), 1 (1.1) and 10 (8.3) µg/L of propranolol. Heart rate was monitored during subsequent exposure in embryos at incremental developmental periods (44, 54, 64 h post-fertilization (hpf) for ZF and 68, 116, 164 hpf for JM). Heart development and morphology was examined using whole mount immunostaining with distance measurements between the sinus venosus (SV) and bulbus arteriosis (BV). Morphological measurements were made at 44 hpf for ZF and 164 hpf for JM. In ZF, a significant reduction in heart rate was observed at 0.08 µg/L propranolol, along with an increase in the SV-BA distance at 44 hpf. Significant reductions in heart rate were also observed in ZF at 54 and 64 hpf at all concentrations of propranolol. For JM, heart rates generally decreased at all developmental timepoints (68, 116 and 164 hpf) after propranolol treatment, with concentration dependent decreases observed at 164 hpf and a lowest observed effect concentration (LOEC) of 0.09 µg/L propranolol at each timepoint. However, significant alterations in cardiac morphology were not observed in JM at 164 hpf. In contrast, heart rates and morphology in ZF were affected with a non-monotonic concentration response in morphology and a LOEC of 0.09 µg/L propranolol for morphological alterations at 44 hpf and for heart rate at each timepoint. These data indicated unique developmental stages of susceptibility between species and that combined parental and embryo exposures may lead to greater impairment of cardiac development and function in offspring than separate exposures of adults and embryos.

Student attitudes and educational support in caring for older people--a review of literature.

The ageing population is currently one of the main issues facing UK healthcare systems. Nurses of the future will be faced with the task of caring for this elderly population. Meanwhile, care standards and government policies have emphasized the need for preparing students to care for the older people. Preparing nursing students to meet the care needs of an expanding ageing population is a challenge for nursing education. Moreover, caring for older people are often not seen by students as an attractive option, a perception that exerts a considerable influence on the values that inform their future professional practice. This paper examines the literature related to the students' perceptions of caring for older people and suggests the need for specific curricular content, teaching and a structured approach to the educational preparation and support of students for their practice experience. If students are provided with the relevant preparation and support, they can engage in enriched learning experiences, deliver quality care and develop positive attitudes in caring for older people in their professional practice.

Academic staff perspectives of formative assessment in nurse education.

High quality formative assessment has been linked to positive benefits on learning while good feedback can make a considerable difference to the quality of learning. It is proposed that formative assessment and feedback is intricately linked to enhancement of learning and has to be interactive. Underlying this proposition is the recognition of the importance of staff perspectives of formative assessment and their influence on assessment practice. However, there appears to be a paucity of literature exploring this area relevant to nurse education. The aim of the research was to explore the perspectives of twenty teachers of nurse education on formative assessment and feedback of theoretical assessment. A qualitative approach using semi-structured interviews was adopted. The interview data were analysed and the following themes identified: purposes of formative assessment, involvement of peers in the assessment process, ambivalence of timing of assessment, types of formative assessment and quality of good feedback. The findings offer suggestions which may be of value to teachers facilitating formative assessment. The conclusion is that teachers require changes to the practice of formative assessment and feedback by believing that learning is central to the purposes of formative assessment and regarding students as partners in this process.

Refocusing formative feedback to enhance learning in pre-registration nurse education.

The essential feature of a teaching system designed to enhance learning and emulate professional practice is that the crucial assessments should be performance-based, allowing plenty of opportunity for students to offer their own ideas and solutions. This involves the use of formative assessment and feedback. High quality formative assessment has been linked to enhancement of learning and ultimately to higher student achievement. Although formative assessment is acknowledged as important in its effect on students' approaches to learning, it appears that the assessment practice is under utilized in pre-registration nurse education. This paper refocuses on the purpose of formative assessment of theory. It examines, from educational literature, some of the benefits of formative assessment and its pedagogical implications on deep learning, motivation and self-esteem, self-regulated learning and employability. It discusses what constitutes quality feedback to highlight that it is not just an essential component but also a central feature of formative assessment. The extent to which formative assessment and feedback can be applied to pre-registration nurse education is also explored. If formative assessment and feedback is well planned and conducted in assessment practice, it is suggested that effective learning can be facilitated in everyday learning activity.

Congenital calcinosis cutis of the ear.

Congenital calcinosis cutis is a relatively rare event. Herein we report 3 cases of congenital calcinosis cutis that all appeared in the exact same location on the ear. A possible mechanism of pathogenesis is discussed.

Cutaneous manifestations of hyper-IgE syndrome in infants and children.

We describe 8 children with hyper-IgE syndrome who had papulopustular eruption on the face and scalp in the first year of life. Seven of the 8 patients had persistent peripheral eosinophilia and 3 had leukocytosis noted before diagnosis. Skin biopsy specimens in 6 patients revealed spongiosis and perivascular dermatitis and/or folliculitis with a predominance of eosinophils. Two patients had bone fractures and osteopenia. Recurrent pneumonia occurred in 6 children and pneumatoceles in 5. The diagnosis of hyper-IgE syndrome was made an average of 18 months after the onset of the initial papulopustular eruption. These findings may lead to earlier recognition of the disease and institution of appropriate treatment.

The perceptions of nursing students of practice-based teaching.

The issue of students learning in practice has been an ongoing debate and link lecturers are increasingly expected to be involved in teaching in the practice setting. This is of particular relevance in light of current government and professional recommendations, which emphasise the importance of learning in practice settings in pre-registration programmes. This study aims to provide insights into the students' perceptions of practice-based teaching facilitated by link lecturers in pre-registration education. Focus group interviews were used as the method of data collection. The sample consisted of three focus groups of 4-14 students each. Three focus group interviews were conducted and data analysed to identify common themes. The following themes emerged from the result: integration of theory to practice, development of the skill of reflection, student support, peer support and shared learning and motivation. The future of practice-based teaching is discussed in relation to the enhancement of: integration of theory to practice, development of the skill of reflection and student support. Suggestions for the ways in which practice-based teaching could be facilitated are offered and these include having an educational structure which supports regular teaching sessions in practice settings and a strategy for staff development.