Skeletal fluorosis: an uncommon cause, yet a rescue treatment?

PURPOSE: Skeletal fluorosis (SF) results from chronic exposure to fluoride (F-) causing excessive aberrantly mineralized brittle bone tissue, fractures, and exostoses. There is no established treatment other than avoiding the source of F-. Still, excess F- can persist in bone for decades after exposure ceases. CASE PRESENTATION: A 50-year-old woman presented with multiple, recurrent, low AQ2 trauma fractures yet high radiologic bone mineral density. Serum F- was elevated, and osteomalacia was documented by non-decalcified transiliac biopsy. She reported intermittently "huffing" a keyboard cleaner containing F- (difluoroethane) for years. Following cessation of her F- exposure, we evaluated the administration of the parathyroid hormone analog, abaloparatide, hoping to increase bone remodeling and diminish her skeletal F- burden. CONCLUSION: Due to the prolonged half-life of F- in bone, SF can cause fracturing long after F- exposure stops. Anabolic therapy approved for osteoporosis, such as abaloparatide, may induce mineralized bone turnover to replace the poorly mineralized osteomalacic bone characteristic of SF and thereby diminish fracture risk. Following abaloparatide treatment for our patient, there was a decrease in bone density as well as a reduction in F- levels.

Perineuronal nets in the rat medial prefrontal cortex alter hippocampal-prefrontal oscillations and reshape cocaine self-administration memories.

The medial prefrontal cortex (mPFC) is a major contributor to relapse to cocaine in humans and to reinstatement behavior in rodent models of cocaine use disorder. Output from the mPFC is modulated by parvalbumin (PV)-containing fast-spiking interneurons, the majority of which are surrounded by perineuronal nets (PNNs). Here we tested whether chondroitinase ABC (ABC)- mediated removal of PNNs prevented the acquisition or reconsolidation of a cocaine self-administration memory. ABC injections into the dorsal mPFC prior to training attenuated the acquisition of cocaine self-administration. Also, ABC given 3 days prior to but not 1 hr after memory reactivation blocked cue-induced reinstatement. However, reduced reinstatement was present only in rats given a novel reactivation contingency, suggesting that PNNs are required for the updating of a familiar memory. In naive rats, ABC injections into mPFC did not alter excitatory or inhibitory puncta on PV cells but reduced PV intensity. Whole-cell recordings revealed a greater inter-spike interval 1 hr after ABC, but not 3 days later. In vivo recordings from the mPFC and dorsal hippocampus (dHIP) during novel memory reactivation revealed that ABC in the mPFC prevented reward-associated increases in beta and gamma activity as well as phase-amplitude coupling between the dHIP and mPFC. Together, our findings show that PNN removal attenuates the acquisition of cocaine self-administration memories and disrupts reconsolidation of the original memory when combined with a novel reactivation session. Further, reduced dHIP/mPFC coupling after PNN removal may serve as a key biomarker for how to disrupt reconsolidation of cocaine memories and reduce relapse.

Recurrent Hypoglycemia Secondary to Insulinoma in an Adult With Beckwith-Wiedemann Syndrome.

Beckwith-Wiedemann syndrome (BWS) is a rare genetic disorder characterized by genetic and epigenetic changes on the chromosome 11p15.5 region, which includes genes that are important for fetal and postnatal growth. Children with BWS have a higher chance of having hypoglycemia, hyperinsulinemia, and malignancies early in life, although hypoglycemia caused by an insulinoma that develops later in life has not been reported. We describe the diagnosis of insulinoma in a 53-year-old man with BWS in this case report. This is the first case report of insulinoma in an adult with this syndrome.

Classification of stages in cervical cancer MRI by customized CNN and transfer learning.

Cervical cancer is the common cancer among women, where early-stage diagnoses of cervical cancer lead to recovery from the deadly cervical cancer. Correct cervical cancer staging is predominant to decide the treatment. Hence, cervical cancer staging is an important problem in designing automatic detection and diagnosing applications of the medical field. Convolutional Neural Networks (CNNs) often plays a greater role in object identification and classification. The performance of CNN in medical image classification can already compete with radiologists. In this paper, we planned to build a deep Capsule Network (CapsNet) for medical image classification that can achieve high accuracy using cervical cancer Magnetic Resonance (MR) images. In this study, a customized deep CNN model is developed using CapsNet to automatically predict the cervical cancer from MR images. In CapsNet, each layer receives input from all preceding layers, which helps to classify the features. The hyper parameters are estimated and it controls the backpropagation gradient at the initial learning. To improve the CapsNet performance, residual blocks are included between dense layers. Training and testing are performed with around 12,771 T2-weighted MR images of the TCGA-CESC dataset publicly available for research work. The results show that the accuracy of Customized CNN using CapsNetis higher and behaves well in classifying the cervical cancer. Thus, it is evident that CNN models can be used in developing automatic image analysis tools in the medical field.

Socioemotional health, trauma exposure, and internalizing symptoms in students attending an alternative high school.

Students attending alternative schools often present with internalizing symptoms, likely related to high rates of trauma. Little is known about factors that buffer the relationship between trauma exposure and internalizing symptoms in this population. The present study examined the role of internal (i.e., self-efficacy, self-awareness, persistence) and external resources (i.e., peer support, family coherence, school support) as buffers in the association between trauma exposure and symptoms of depression and anxiety in 113 students (55% female, 91% Black, 8% Hispanic or Latinx, Mage = 18.0, SD = 1.5) attending an alternative school in a large, southeastern city. Results showed that trauma exposure was positively associated with depression and anxiety symptoms, while self-awareness and family coherence were negatively associated with depression and anxiety symptoms. Additionally, significant interactions revealed that trauma exposure was associated with depression symptoms at low but not high levels of self-awareness, and at low but not high levels of family coherence. Understanding strengths to support alternative high school students exposed to trauma is a valuable component of mental health intervention. Future research should investigate ways to cultivate self-awareness and enhance family coherence to address the complex needs of alternative school students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Spatial variation of covid-19 morbidity status and identification of risk zone in Tamil Nadu (India) during first wave.

COVID-19 is a pandemic disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The study area, Tamilnadu, is a southern state in India. The present study demonstrates the significance of mapping in identifying the risk zones of COVID-19 disease by taking a study of COVID-19 cases in Tamilnadu state. The main objective of the study was to identify the risk zone of COVID-19 disease in the first wave of Tamilnadu through geospatial mapping. Data on COVID-19 cases collected during March 2020 to March 2021 month wise in all 37 districts (unit area) of Tamilnadu in two-month interval wise was analysed. The study is based on secondary sources from respective office in Tamilnadu. Z-score techniques were used for standardizing data. Correlation analysis provided a measure of correlation between COVID-19 and working population. Location Quotient analysis aided the identification of COVID-19 risk zones in Tamilnadu. Present study indicates tertiary workers are more vulnerable to COVID-19 disease.

Bacterial Associates of a Desert Specialist Fungus-Growing Ant Antagonize Competitors with a Nocamycin Analog.

Fungus-growing ants are defended by antibiotic-producing bacterial symbionts in the genus Pseudonocardia. Nutrients provisioned by the ants support these symbionts but also invite colonization and competition from other bacteria. As an arena for chemically mediated bacterial competition, this niche offers a window into ecological antibiotic function with well-defined competing organisms. From multiple colonies of the desert specialist ant Trachymyrmex smithi, we isolated Amycolatopsis bacteria that inhibit the growth of Pseudonocardia symbionts under laboratory conditions. Using bioassay-guided fractionation, we discovered a novel analog of the antibiotic nocamycin that is responsible for this antagonism. We identified the biosynthetic gene cluster for this antibiotic, which has a suite of oxidative enzymes consistent with this molecule's more extensive oxidative tailoring relative to similar tetramic acid antibiotics. High genetic similarity to globally distributed soil Amycolatopsis isolates suggest that this ant-derived Amycolatopsis strain may be an opportunistic soil strain whose antibiotic production allows for competition in this specialized niche. This nocamycin analog adds to the catalog of novel bioactive molecules isolated from bacterial associates of fungus-growing ants, and its activity against ant symbionts represents, to our knowledge, the first putative ecological function for the widely distributed enoyl tetramic acid family of antibiotics.

Structural and psychological empowerment and its influencing factors among nursing students in Oman.

BACKGROUND: This study explored the empowerment of nursing students to contribute to nursing education and recommend ways of increasing the engagement of nursing students in their training. The development of empowerment among nursing students leads to the maximum achievement of learning competencies and enables them to eventually become competent nurses. PURPOSE: This study examined the relationship between student nurses' characteristics, structural empowerment, and psychological empowerment. METHODS: A total of 185 nursing students were recruited through systematic sampling at Sultan Qaboos University, with a 92% response rate. Nursing students' level of psychological empowerment, in terms of meaning, competence, self-determination, and impact, and their level of structural empowerment, in terms of access to opportunity, support, information, and resources were investigated using a self-designed questionnaire. RESULTS: The results showed that "access to support" was rated as the highest dimension by the students, followed by "access to information," "informal power," "access to opportunity," "access to resources," and "formal power." The global empowerment mean score was 3.64 (SD = 1.01), and the total structural empowerment score was 20.58 (SD = 3.62). The multivariate multiple regression analysis revealed that students' year level and involvement in school organizations had multivariate effects on the four dimensions of psychological empowerment. Students who were involved in school organizations had higher scores for the dimensions of "meaning," "competence," and "impact" than students who were not involved in any school organization. CONCLUSION: Power can be either developed or acquired, and its definition is expressed based on the achievement objective. Age is not a barrier, as it had little or no impact on nursing student experiences and no correlation with structural empowerment.

Self-directed learning readiness and learning styles among Omani nursing students: Implications for online learning during the COVID-19 pandemic.

OBJECTIVE: The emergence of the COVID-19 pandemic compelled many academic institutions to resort to distance learning and online education, requiring a higher degree of student self-direction and motivation to learn. This study explored self-directed learning (SDL) readiness among nursing students in Oman, their learning styles (LS), and the association of demographic variables and LS with SDL. METHODS: The study, which followed a descriptive, cross-sectional design, surveyed 236 Omani nursing students via an online questionnaire containing two standardized scales: the Self-Directed Learning Readiness Scale for Nursing Education and the Learning Style Scales. RESULTS: Nursing students were identified as having a low level of SDL (mean = 149.58). Probation status (ß = -0.165; p = 0.021) was negatively associated with SDL. In terms of LS, solitary (ß = 0.217; p = 0.001), competitive (ß = 0.201; p = 0.005), imaginative (ß = 0.19; p = 0.012), and perceptive LS (ß = 0.437; p = 0.0) were positively associated with SDL. An analytical LS was negatively associated with SDL (ß = -0.155; p = 0.022). CONCLUSION: Academic probation status and an analytical LS both yielded lower SDL scores. Perceptive, solitary, competitive, or imaginative learners tended to have higher SDL scores. Deliberate planning and strategies are necessary to help probation students cope with academic demands, especially with the advent of intensified digital education. Because no single learning environment can fulfill the needs of every LS, nurse educators must implement SDL-aimed teaching and learning strategies that appeal to a variety of learners.

Extended embryo culture is effective for patients of an advanced maternal age.

The aim of this study was to determine the effectiveness of extended embryo culture in advanced maternal age (AMA) patients (37-43 years). In this retrospective analysis, 21,301 normally fertilized zygotes from 4952 couples were cultured until the blastocyst stage. Blastocyst development, including kinetics and morphology, transfer rate, implantation and live birth rates, were measured. In AMA patients, the blastocyst rate was significantly decreased as compared to that in younger women. On day 5, blastocysts underwent growth retardation in AMA patients, which was highlighted by a decreased rate of full/expanded blastocysts. Organization of the cells (trophectoderm and inner cell mass) was unaffected by age. However, in AMA patients, a 'good' morphology blastocyst had a decreased probability to implant compared with an 'average' morphology blastocyst in younger women. While the rates of blastocyst transfer and useful blastocysts were similar to younger patients, in AMA patients, both implantation and live birth rates were significantly reduced. Our results support the idea that extended embryo culture is not harmful for AMA patients. However, embryo selection allowed by such culture is not powerful enough to avoid chromosomal abnormalities in the developed blastocysts and therefore cannot compensate for the effect of a woman's age.

Ketone body 3-hydroxybutyrate as a biomarker of aggression.

Human aggression is a complex behaviour, the biological underpinnings of which remain poorly known. To gain insights into aggression biology, we studied relationships with aggression of 11 low-molecular-weight metabolites (amino acids, ketone bodies), processed using 1H nuclear magnetic resonance spectroscopy. We used a discovery sample of young adults and an independent adult replication sample. We studied 725 young adults from a population-based Finnish twin cohort born 1983-1987, with aggression levels rated in adolescence (ages 12, 14, 17) by multiple raters and blood plasma samples at age 22. Linear regression models specified metabolites as the response variable and aggression ratings as predictor variables, and included several potential confounders. All metabolites showed low correlations with aggression, with only one-3-hydroxybutyrate, a ketone body produced during fasting-showing significant (negative) associations with aggression. Effect sizes for different raters were generally similar in magnitude, while teacher-rated (age 12) and self-rated (age 14) aggression were both significant predictors of 3-hydroxybutyrate in multi-rater models. In an independent replication sample of 960 adults from the Netherlands Twin Register, higher aggression (self-rated) was also related to lower levels of 3-hydroxybutyrate. These exploratory epidemiologic results warrant further studies on the role of ketone metabolism in aggression.

Emergent "core communities" of microbes, meiofauna and macrofauna at hydrothermal vents.

Assessment of ecosystem health entails consideration of species interactions within and between size classes to determine their contributions to ecosystem function. Elucidating microbial involvement in these interactions requires tools to distil diverse microbial information down to relevant, manageable elements. We used covariance ratios (proportionality) between pairs of species and patterns of enrichment to identify "core communities" of likely interacting microbial (<64 µm), meiofaunal (64 µm to 1 mm) and macrofaunal (>1 mm) taxa within assemblages hosted by a foundation species, the hydrothermal vent tubeworm Ridgeia piscesae. Compared with samples from co-located hydrothermal fluids, microbial communities within R. piscesae assemblages are hotspots of taxonomic richness and are high in novelty (unclassified OTUs) and in relative abundance of Bacteroidetes. We also observed a robust temperature-driven distinction in assemblage composition above and below ~25 °C that spanned micro to macro size classes. The core high-temperature community included eight macro- and meiofaunal taxa and members of the Bacteroidetes and Epsilonbacteraeota, particularly the genera Carboxylicivirga, Nitratifractor and Arcobacter. The core low-temperature community included more meiofaunal species in addition to Alpha- and Gammaproteobacteria, and Actinobacteria. Inferred associations among high-temperature core community taxa suggest increased reliance on species interactions under more severe hydrothermal conditions. We propose refinement of species diversity to "core communities" as a tool to simplify investigations of relationships between taxonomic and functional diversity across domains and scales by narrowing the taxonomic scope.

Knowledge, attitude, and practice towards COVID-19 among student nurses in Manila, Philippines: A cross-sectional study.

Background: Assessing the current understanding of future health care workers about the COVID-19 is very important in order to identify gaps that affect their perceptions and responses, which they can integrate into the people in the community. Objective: This study aimed to investigate the knowledge, attitude, and practice towards COVID-19 of student nurses in Manila, Philippines. Methods: This study utilized a descriptive cross-sectional survey of 314 individuals from October 2020 to December 2020 to evaluate the association of different factors to knowledge, attitude, and practice towards COVID-19. Frequency, percentage, mean, standard deviation, t-test, and one-way ANOVA were used to analyze the data gathered. Results: The survey revealed that the respondents have a mean knowledge score of 18.76 (SD = 1.64), a mean score for attitude of 26.58 (SD = 2.71) and a mean score for practice of 4.26 (SD = 0.93). A significant different were noted in terms of year level with level 3 having a higher mean score (M = 19.01, F = 2.696, p = 0.046) compared to other levels and type of school, with public university students having a higher level of knowledge (M = 18.97, t = 2.070, p = 0.039). In terms of attitude, females have higher mean scores (M = 26.85, t = -2.630, p = 0.009 and students from public university have higher scores (M = 2.81, t = -4.406, p = 0.000) than students from private university. For practice, a significant difference was noted in terms of year level, with level 3 students having a higher mean score (M = 4.42, F = 3.180, p = 0.024) compared to other year levels. Conclusion: Filipino student nurses have a high level of knowledge about COVID-19 and are mainly optimistic about controlling the pandemic. Nevertheless, having constant reminder from the authorities and health care professionals are the solution to aid public knowledge and comprehension relating to COVID-19.

The utilization of social networking sites, their perceived benefits and their potential for improving the study habits of nursing students in five countries.

BACKGROUND: The abundance of easy and accessible information and the rapid development of social networking sites (SNSs) have proven that the world is small and within reach. The great implication of this interconnectivity is attributable to the change in the learning and sharing environment, which for the most part is something that classrooms are lacking. Considering the potential implications of SNSs in nursing education reveals the benefits of SNSs in allowing students to communicate and interact with a wider audience and beyond the classroom. The aim of this study is to identify the extent of SNS utilization, the perceived benefits of SNSs and the potential of SNSs for improving the study habits of nursing students in five countries (Israel, Iraq, Oman, the Philippines and Turkey). METHODS: This study is a quantitative cross-sectional study that determined the relationship between the utilization of SNSs, the perceived benefits of SNSs, and the potential of SNSs for improving the study habits of nursing students in the five participating countries (Israel, Iraq, Oman, the Philippines, and Turkey). This paper is based on carefully analysing the survey responses of a sample of 1137 students from an online hosting site. The online instrument focuses on the extent of the utilization and benefits of SNSs according to their accessibility, usability, efficiency and reliability. RESULTS: Based on the Pearson correlation coefficient (r) our findings, reveal a significant positive correlation between the extent of a possible improvement in study habits and the extent of SNS utilization in terms of the four domains, namely, accessibility (r = 0.246), usability (r = 0.377), reliability (r = 0.287) and efficiency (r = 0.387). CONCLUSION: It can be concluded that there is a significant positive correlation between students' study habits and the extent of SNS utilization, meaning that the more students devote themselves to their study habits, the higher the level of SNS utilization. The use of SNSs by nursing students has positive and negative implications, and there is greater potential for further improving approaches to nursing education through the adaptation of curricula based on the proper utilization of SNSs.

A Multicountry Study on Nursing Students' Self-Perceived Competence and Barriers to Evidence-Based Practice.

BACKGROUND: Nursing education and training are essential in the attainment of evidence-based practice (EBP) competence in nursing students. Although there is a growing literature on EBP among nursing students, most of these studies are confined to a single cultural group. Thus, cross-cultural studies may provide shared global perspectives and theoretical understandings for the advancement of knowledge in this critical area. AIMS: This study compared self-perceived EBP competence among nursing students in four selected countries (India, Saudi Arabia, Nigeria, and Oman) as well as perceived barriers to EBP adoption. METHODS: A descriptive, cross-sectional, and comparative survey of 1,383 nursing students from India, Saudi Arabia, Nigeria, and Oman participated in the study. The Evidence-Based Practice Questionnaire (EBP-COQ) and the BARRIERS scale were used to collect data during the months of January 2016 to August 2017. RESULTS: Cross-country comparisons revealed significant differences in EBP competence (F = 24.437, p < .001), knowledge (F = 3.621, p = .013), skills (F = 9.527, p < .001), and attitudes (F = 74.412, p < .001) among nursing students. Three variables including nursing students' gender (ß = .301, p < .001), type of institution, (ß = -0.339, p = .001), and type of nursing student (ß = .321, p < .001) were associated with EBP competence. Barriers to EBP adoption included having no authority to change patient care policies (M = 1.65, SD = 1.05), slow publication of evidence (M = 1.59, SD = 1.01), and paucity of time in the clinical area to implement the evidence (M = 1.59, SD = 1.05). LINKING EVIDENCE TO ACTION: Both academe and hospital administration can play a pivotal role in the successful acquisition of EBP competence in nursing students.

A Fatal Case of Septic Shock Secondary to Acinetobacter Bacteremia Acquired from a Platelet Transfusion.

BACKGROUND: Transfusion of blood products is a frequent and often necessary lifesaving intervention. While changes to blood bank practices over the past several decades have reduced the infectious complications associated with transfusions, risks still exist. Septic transfusion reactions caused by bacterial contamination of blood products, especially platelets, still occur relatively frequently. Unfortunately, clinical recognition of septic transfusion reactions is difficult due to significant symptom, exam, and laboratory abnormality overlap between different types of transfusion reactions, as well as other conditions. Novel methods have been developed to detect blood product contamination but have yet to be widely implemented in the United States. CASE REPORT: A 67-year-old male with chronic thrombocytopenia was transfused with platelets prior to a planned procedure. Shortly afterwards, he developed fever and hypotension. He was transferred to the intensive care unit where he was treated with aggressive fluid resuscitation and broad-spectrum antibiotics. The patient went on to develop progressively worsening shock and profound disseminated intravascular coagulation. Blood cultures from the patient and the transfused platelets grew an Acinetobacter species. Despite aggressive resuscitative efforts and appropriate antibiotics, the patient died approximately 48 hours following the transfusion reaction. CONCLUSION: We report a fatal case of septic shock associated with Acinetobacter bacteremia caused by platelet transfusion. Our review of the literature revealed only one other documented platelet transfusion associated fatality caused by Acinetobacter species. Novel pathogen reduction and contamination detection methods have been developed but have yet to be widely adopted in the United States.

Artificial blastocyst collapse prior to vitrification significantly improves Na+/K+-ATPase-dependent post-warming blastocoel re-expansion kinetics without inducing endoplasmic reticulum stress gene expression in the mouse.

Blastocoel expansion during embryo development is known to be reliant on the Na+/K+-ATPase pump, but little is known about the relative contribution of active (Na+/K+-ATPase pump) and facilitated diffusion (aquaporins) water transport during blastocoel re-expansion after vitrification. The aims of this study were to examine potential effects of artificial blastocoel collapse (ABC) on markers of embryo stress and the contribution of active and facilitated diffusion water transport mechanisms to blastocoel re-expansion. Day 5 mouse embryos were vitrified using either a standard protocol, laser pulse ABC, a hyperosmotic sucrose ABC protocol or both laser pulse and sucrose. Using real-time polymerase chain reaction, no differences were found in the gene expression of the endoplasmic reticulum (ER) stress markers activating transcription factor 4 (Atf4) or heat shock protein 90-alpha (Hsp90α) 2h after warming. Similarly, expression of the Na+/K+-ATPase pump gene, ATPase, Na+/K+ transporting, beta 1 polypeptide (Atp1b1) and protein did not differ between groups. Aquaporin 8 (Aqp8) gene expression was significantly lower in the laser+sucrose ABC group than in fresh controls, and aquaporin 3 (Aqp3) expression significantly higher in standard vitrified embryos compared with all other groups. Ouabain, a potent and specific Na+/K+-ATPase pump inhibitor, inhibited blastocoel re-expansion in both standard protocol- and laser ABC-vitrified embryos, reducing both groups to the same rate of re-expansion 3h after warming. These results demonstrate that ABC before vitrification does not alter mRNA or protein expression of Na+/K+-ATPase, or mRNA levels of ER stress genes Atf4 and Hsp90α. Activity of the pump may be increased in ABC embryos, with potential compensation by AQP3 when it is compromised.