Assessment of hair loss and skin changes during treatment in Asian breast cancer patients: A prospective cohort study.

With the increasing number of young breast cancer (BC) patients worldwide, concerns about hair loss and skin change persist among BC survivors. This study aimed to evaluate the hair loss and skin changes in Asian BC patients and to compare them according to the treatment regimens. This study enrolled 322 patients scheduled to undergo BC surgery. Hair loss and skin changes were assessed at the following two time points: one day before surgery and 6 months after surgery. Patients who had received systemic anticancer treatment before surgery were assigned to the neoadjuvant treatment group, while patients who were scheduled to receive systemic anticancer treatment were assigned to the adjuvant treatment group. In the adjuvant treatment group, patients with taxane-based chemotherapy had significantly higher odds of increased hair loss, a higher melanin index, and an increased volume of wrinkles (p < 0.0001, p = 0.0110, and p = 0.0371, respectively). In the neoadjuvant treatment group, hair loss was reversed in most patients at 6 months after surgery. Clinicians should inform BC patients about the potential for hair loss and skin changes and provide supportive care to mitigate the effects on the patients' quality of life.

A novel approach of kinship determination based on the physical length of genetically shared regions of chromosomes.

BACKGROUND: Determination of genetic relatedness between individuals plays a crucial role in resolving numerous civil cases involving familial relationships and in forensic investigation concerning missing persons. Short tandem repeats (STRs), known for their high degree of DNA polymorphism, have traditionally been the primary choice of DNA markers in genetic testing, but their application for kinships testing is limited to cases involving close kinship. SNPs have emerged as promising supplementary markers for kinship determination. Nevertheless, the challenging remains in discriminating between third-degree or more distant relatives, such as first cousins, using SNPs. OBJECTIVE: To investigate a kinship analysis method for distant degree of familial relationships using high-density SNP data. METHODS: A high-density SNP data from 337 individuals of Korean families using Affymetrix Axiom KORV1.0-96 Array was obtained for this study. SNPs were aligned by chromosomal positions, and identity-by-state (IBS) was determined, and then shared regions as consecutive SNPs with IBS of 1 or 2 were investigated. The physical lengths of these IBS segments were measured and summed them to create an Index, as a measure of kinship. RESULTS: The kinship was determined by the physical length of shared chromosomal regions that are distinguished by each kinship. Using this method, the relationship was able be distinguished up to the fourth degree of kinship, and non-relatives were clearly distinguished from true relatives. We also found a potential for this approach to be used universally, regardless of microarray platforms for SNP genotyping and populations. CONCLUSION: This method has a potential to determine the different degree of kinship between individuals and to distinguish non-relatives from true relatives, which can be of great help for practical applications in kinship determination.

Identifying subgroups of eating behavior traits unrelated to obesity using functional connectivity and feature representation learning.

Eating behavior is highly heterogeneous across individuals and cannot be fully explained using only the degree of obesity. We utilized unsupervised machine learning and functional connectivity measures to explore the heterogeneity of eating behaviors measured by a self-assessment instrument using 424 healthy adults (mean ± standard deviation [SD] age = 47.07 ± 18.89 years; 67% female). We generated low-dimensional representations of functional connectivity using resting-state functional magnetic resonance imaging and estimated latent features using the feature representation capabilities of an autoencoder by nonlinearly compressing the functional connectivity information. The clustering approaches applied to latent features identified three distinct subgroups. The subgroups exhibited different levels of hunger traits, while their body mass indices were comparable. The results were replicated in an independent dataset consisting of 212 participants (mean ± SD age = 38.97 ± 19.80 years; 35% female). The model interpretation technique of integrated gradients revealed that the between-group differences in the integrated gradient maps were associated with functional reorganization in heteromodal association and limbic cortices and reward-related subcortical structures such as the accumbens, amygdala, and caudate. The cognitive decoding analysis revealed that these systems are associated with reward- and emotion-related systems. Our findings provide insights into the macroscopic brain organization of eating behavior-related subgroups independent of obesity.

Tracking antigen-specific TCR clonotypes in SARS-CoV-2 infection reveals distinct severity trajectories.

Despite the importance of antigen-specific T cells in infectious disease, characterizing and tracking clonally amplified T cells during the progression of a patient's symptoms remain unclear. Here, we performed a longitudinal, in-depth single-cell multiomics analysis of samples from asymptomatic, mild, usual severe, and delayed severe patients of SARS-CoV-2 infection. Our in-depth analysis revealed that hyperactive or improper T-cell responses were more aggressive in delayed severe patients. Interestingly, tracking of antigen-specific T-cell receptor (TCR) clonotypes along the developmental trajectory indicated an attenuation in functional T cells upon severity. In addition, increased glycolysis and interleukin-6 signaling in the cytotoxic T cells were markedly distinct in delayed severe patients compared to usual severe patients, particularly in the middle and late stages of infection. Tracking B-cell receptor clonotypes also revealed distinct transitions and somatic hypermutations within B cells across different levels of disease severity. Our results suggest that single-cell TCR clonotype tracking can distinguish the severity of patients through immunological hallmarks, leading to a better understanding of the severity differences in and improving the management of infectious diseases by analyzing the dynamics of immune responses over time.

Experiences of Caring for Cohort-Isolated Patients among Nurses in Locked Psychiatric Units.

The aim of this study was to gain an understanding of the experiences of caring for cohorts of patients isolated due to coronavirus disease (COVID-19) among nurses in locked psychiatric units. A phenomenological approach was used to analyze data collected from 10 nurses with a minimum of one year of experience as a mental health nurse working in locked psychiatric units that were cohort-isolated due to COVID-19. Data collected using semi-structured one-to-one in-depth interviews were analyzed based on steps outlined by Colaizzi. Five themes and thirteen subthemes emerged. The five themes were as follows: "Challenges intensified by the nature of mental disorders", "Concerns regarding limited mental health care", "Escalating stress", "Bolstered identity as a mental health nurse", "Witnessing changes that have begun". Environmental and institutional measures need to be implemented to identify the potential phenomena that may affect locked psychiatric units during an infectious disease epidemic and ensure the safety of health care professionals and patients from the infectious disease.

FLT4 as a marker for predicting prognostic risk of refractory acute myeloid leukemia.

Treating patients with refractory acute myeloid leukemia (AML) remains challenging. Currently there is no effective treatment for refractory AML. Increasing evidence has demonstrated that refractory/relapsed AML is associated with leukemic blasts which can confer resistance to anticancer drugs. We have previously reported that high expression of Fms-related tyrosine kinase 4 (FLT4) is associated with increased cancer activity in AML. However, the functional role of FLT4 in leukemic blasts remains unknown. Here, we explored the significance of FLT4 expression in leukemic blasts of refractory patients and mechanisms involved in the survival of AML blasts. Inhibition or absence of FLT4 in AML blasts suppressed homing to bone marrow of immunocompromised mice and blocked engraftment of AML blasts. Moreover, FLT4 inhibition by MAZ51, an antagonist, effectively reduced the number of leukemic cell-derived colony-forming units and increased apoptosis of blasts derived from refractory patients when it was co-treated with cytosine arabinoside under vascular endothelial growth factor C, its ligand. AML patients who expressed high cytosolic FLT4 were linked to an AML-refractory status by internalization mechanism. In conclusion, FLT4 has a biological function in leukemogenesis and refractoriness. This novel insight will be useful for targeted therapy and prognostic stratification of AML.

Workplace Violence Experienced by Community Mental Health Workers.

A cross-sectional online survey was conducted to 1) investigate the prevalence of workplace violence and workers' emotional distress, 2) explore factors associated with workplace violence, and 3) assess workers' needs for preventive measures. A total of 763 community mental health workers participated in Korea. Among them, 85.85% of workers experienced workplace violence, including verbal (74.31%), emotional (66.45%), infectious (47.44%), informational (42.60%), sexual (32.50%), and physical (23.72%) abuse. Binary logistic regression analysis indicated that sex, occupation, certification, and working institution were significantly associated with workplace violence. Workplace violence affects workers' depression, anger, and anxiety negatively. The most-needed preventive measure is a two-person home visit.

A Case of Cowden Syndrome Presenting with Diverse Cutaneous Manifestations.

Cowden syndrome is caused by mutations in the phosphatase and tensin homolog (PTEN) gene and is part of the PTEN hamartoma tumor syndrome. Skin lesions including trichilemmomas, acral keratosis, mucocunateous neuromas and oral paillomas are the most prevalent feature found in patients with Cowden syndrome. It also possesses an increased risk of developing malignancies including breast, thyroid, endometrial, and colorectal cancers. Due to the increased risk of cancer, early diagnosis and regular surveillance are important for Cowden syndrome patients. Herein, we report a case of Cowden syndrome with diverse cutaneous manifestations and thyroid cancer.

Factors Affecting COVID-19 Preventive Behaviors of Young Adults based on eHealth Literacy and the Health Belief Model: A Cross-Sectional Study.

Following the COVID-19 pandemic, disease prevention and preventive behaviors have become crucial for public health. In young adults, the internet is a popular source of health information. However, research that explores the factors associated with disease preventive behaviors based on the eHealth literacy (eHL) and the Health Belief Model (HBM) in young adults is lacking. A cross-sectional study design was used. Snowball sampling was used to recruit the participants through social network services. Proportionate stratified sampling was applied according to age, sex, and education level to mitigate sampling bias. The URL link for the online survey was provided via their mobile phones. A total of 324 participants, aged 20 to 39, completed the structured questionnaires (response rate = 98.2%). Frequency and descriptive statistical analyses, independent t-tests, one-way analyses of variance, Pearson's correlation coefficients, and multiple linear regression analyses were performed. Factors associated with COVID-19 preventive behaviors were COVID-19-related eHL (ß = .376, P < .001) and self-efficacy (ß = .221, P < .001), which were positively associated with COVID-19 preventive behaviors. Boosting self-efficacy and the ability to find, evaluate, and apply health information with sufficient evidence from the Internet can improve COVID-19 preventive behaviors. The government and healthcare personnel should consider psychological factors such as self-efficacy when developing COVID-19 disease prevention behavioral guidelines for the Internet.

Corrigendum: A Double-Blind, Split-Face, Randomized Study on the Effects and Safety of Intradermal Injection of Botulinum Toxin Type A 150 kD Neurotoxin in the Cheek.

This corrects the article on p. 442 in vol. 34, PMID: 36478426.

Virtual simulation and problem-based learning enhance perceived clinical and cultural competence of nursing students in Asia: A randomized controlled cross-over study.

BACKGROUND: Both clinical and cultural competencies are of paramount importance in ensuring patients' safety and high-quality care. While problem-based learning (PBL) is a widely applied pedagogy in nursing education, an emerging technology-based pedagogy, virtual simulation provides a realistic clinical learning experience for students. It can be an effective solution for continuing clinical and cultural learning across countries in the era of the pandemic. OBJECTIVES: This study aimed to compare the effectiveness of virtual simulation and PBL on the perceived clinical and cultural competence for nursing students. DESIGN: A randomized controlled cross-over study design was used. SETTINGS AND PARTICIPANTS: Sixty-one undergraduate and postgraduate nursing students from five Asian regions were selected for participation. METHODS: Participants were randomized to receive either virtual simulation (group A) or PBL (group B) for one day, followed by another intervention on the second day. Three self-reported questionnaires were used: Clinical Competence Questionnaire (CCQ), Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Student Version (IAPCC-SV), and demographic questionnaire. RESULTS: The results revealed that students in both arms had significant improvements in CCQ total score (A: d = 21.500, P < 0.001; B: d = 16.710, P = 0.001), nursing professional behavior (A: d = 8.233, P < 0.001; B: d = 6.323, P < 0.001), and advanced nursing skills (A: d = 2.533, P = 0.008; B: d = 2.129, P = 0.029) after two interventions. In addition, both arms demonstrated significant improvements in IAPCC-SV total score (A: d = 3.467, P = 0.037; B: d = 4.032, P = 0.010) and cultural skills (A: d = 0.767, P = 0.012; B: d = 1.000, P = 0.001). No significant differences were observed between the two arms. CONCLUSIONS: The findings indicated that both virtual simulation and PBL were effective in promoting students' perceived clinical and cultural competence. As both education modes have their own uniqueness and effectiveness in both outcomes, the combination of both could enhance the variability of learning modalities. Notably, the use of virtual simulation first could engage students better in learning and achieve better educational outcomes.

Effects of Emotional Regulation, Resilience, and Distress Disclosure on Post-Traumatic Growth in Nursing Students.

Nursing students, who need to reflect on self, secure their identity, and be prepared as would-be nurses, can make a good use of post-traumatic growth (PTG) that can function as a catalyst for positive change even amidst this COVID-19 crisis. Emotional regulation strategies in traumatic events are key factors for successful growth, resilience is positively associated with PTG, and distress disclosure is an important factor for stress reduction. In this context, this study is a descriptive research study to identify factors influencing the PTG of nursing students, using emotional regulation, resilience, and distress disclosure as the main variables. Data were collected from 231 junior and senior students of the nursing departments of two universities, and the collected data were analyzed using the t-test, the Mann-Whitney U test, ANOVA, the Scheffé test, Pearson's correlation coefficients, and stepwise multiple regression in SPSS/WIN 26.0. Analysis of the PTG scores of the nursing students by general characteristics revealed significant differences in PTG according to the transfer status, perceived health status, and levels of satisfaction with major, hybrid-learning class, interpersonal relationship satisfaction, and clinical practice. Factors influencing PTG were identified to be resilience, reappraisal among emotional regulation strategies, satisfaction with clinical practice, and transfer, with the overall explanatory power calculated at 44%. Based on the results of this study, it is necessary to consider resilience and reappraisal, which is a sub-variable of emotional regulation strategies, in order to develop programs designed to promote PTG of nursing students in the future.

A Double-Blind, Split-Face, Randomized Study on the Effects and Safety of Intradermal Injection of Botulinum Toxin A (Incobotulinum Toxin A) in the Cheek.

BACKGROUND: Intradermal injection of botulinum toxin A (BTXA) is used for cosmetic purposes without strong evidence for clinical use, as opposed to intramuscular injection. OBJECTIVE: To evaluate the efficacy and safety of intradermal injection of incobotulinum toxin A (iBTXA) in the cheeks. METHODS: We conducted a study with 18 volunteers who received intradermal injection of iBTXA into one cheek and normal saline into the contralateral side as a control. Volunteers visited the clinic at weeks 2, 4, 8, and 12 after injection. At each visit, pores and wrinkles were evaluated by a facial analyzer, sebum secretion by a sebumeter, skin texture by both volunteers and clinicians, and wrinkles of the nasolabial fold were graded with photographic reviews. RESULTS: There were no significant effects on the wrinkles of the infraorbital area and sebum secretion. However, there were significant improvements in the wrinkles of the nasolabial fold and skin texture on the iBTXA injected side. The effects on the wrinkles of the nasolabial fold lasted 12 weeks, and those on skin texture lasted 8 weeks. Improvement in the pore size was observed only at week 2. No serious adverse events were reported except one volunteer who complained of facial palsy after the injection of 30 units of iBTXA in one cheek. However, injection of 20 units of iBTXA in one cheek was not associated with any adverse events. CONCLUSION: Intradermal injection of iBTXA, could provide clinical benefits for skin texture and wrinkles overcoming the skin prick effect without obvious side effects.

The contribution of common and rare genetic variants to variation in metabolic traits in 288,137 East Asians.

Metabolic traits are heritable phenotypes widely-used in assessing the risk of various diseases. We conduct a genome-wide association analysis (GWAS) of nine metabolic traits (including glycemic, lipid, liver enzyme levels) in 125,872 Korean subjects genotyped with the Korea Biobank Array. Following meta-analysis with GWAS from Biobank Japan identify 144 novel signals (MAF ≥ 1%), of which 57.0% are replicated in UK Biobank. Additionally, we discover 66 rare (MAF < 1%) variants, 94.4% of them co-incident to common loci, adding to allelic series. Although rare variants have limited contribution to overall trait variance, these lead, in carriers, substantial loss of predictive accuracy from polygenic predictions of disease risk from common variant alone. We capture groups with up to 16-fold variation in type 2 diabetes (T2D) prevalence by integration of genetic risk scores of fasting plasma glucose and T2D and the I349F rare protective variant. This study highlights the need to consider the joint contribution of both common and rare variants on inherited risk of metabolic traits and related diseases.

Clinical Field and Alternative Clinical Practice Experience in a Pandemic Situation of Nursing Students Who Have Experienced Clinical Practice before COVID-19.

This study aimed to understand the experiences of nursing students who experienced clinical practice before the outbreak of COVID-19 on clinical field practice and alternative clinical practice adopted during the COVID-19 pandemic. A phenomenological study was conducted on 14 graduates who experienced clinical field practice and alternative clinical practice during a pandemic. Data were collected using individual in-depth interviews that were semi-structured. Data were analyzed according to Colaizzi's procedure. As a result of data analysis, five themes and 17 sub-themes were selected. The five themes were: alienation during the process of clinical practice change, regret caused by alternative clinical practice, alternative clinical practice as a supplementary measure, difficulties due to COVID-19, non-replaceable clinical field practice. It is necessary to consider using alternative clinical practices to complement the clinical setting and improve the quality of clinical practice in the post-corona era. To this end, it is necessary to supplement the disadvantages of alternative clinical practice, such as reduced concentration and lack of sense of presence, by applying integrated education using Edutech.

The MARCHF6 E3 ubiquitin ligase acts as an NADPH sensor for the regulation of ferroptosis.

Ferroptosis is a unique form of cell death caused by excessive iron-dependent lipid peroxidation. The level of the anabolic reductant NADPH is a biomarker of ferroptosis sensitivity. However, specific regulators that detect cellular NADPH levels, thereby modulating downstream ferroptosis cascades, are largely unknown. We show here that the transmembrane endoplasmic reticulum MARCHF6 E3 ubiquitin ligase recognizes NADPH through its C-terminal regulatory region. This interaction upregulates the E3 ligase activity of MARCHF6, thus downregulating ferroptosis. We also found that MARCHF6 mediates the degradation of the key ferroptosis effectors ACSL4 and p53. Furthermore, inhibiting ferroptosis rescued the growth of MARCHF6-deficient tumours and peri-natal lethality of Marchf6-/- mice. Together, these findings identify MARCHF6 as a previously unknown NADPH sensor in the ubiquitin system and a crucial regulator of ferroptosis.

COVID-19 Related Fear, Risk Perceptions, and Behavioral Changes According to Level of Depression among Nursing Students.

Depression may have a negative impact on health behaviors during crisis situations, such as the COVID-19 pandemic. Accordingly, the present study aimed to investigate the effects of depression felt by nursing students on their infectious disease response. A total of 241 nursing students from two nursing colleges in Chungcheong Province was convenience sampled between 2 and 12 December 2020. The tools used in the study were the Patient Health Questionnaire-9 Korean version, Fear of COVID-19 Scale, COVID-19-related risk perceptions, and COVID-19 behavior changes. The depression group showed higher fear scores and lower behavioral change scores than the non-depression group. Such findings indicated that the depression group did not actively perform COVID-19-related preventive behaviors. With respect to the influencing factors of depression, depression scores were 2.28 times higher among sophomores than seniors; fear scores were 1.09 times higher in the depression group than the non-depression group; and behavioral change scores were 0.87 times lower in the depression group than the non-depression group. Based on the findings in the present study, it is necessary to screen nursing students with depression during disaster crisis situations, such as the COVID-19 pandemic, and provide active psychological support to such students for their mental health care.

Diagnosis-informed connectivity subtyping discovers subgroups of autism with reproducible symptom profiles.

Clinical heterogeneity has been one of the main barriers to develop effective biomarkers and therapeutic strategies in autism spectrum disorder (ASD). Recognizing this challenge, much effort has been made in recent neuroimaging studies to find biologically more homogeneous subgroups (called 'neurosubtypes') in autism. However, most approaches have rarely evaluated how much the employed features in subtyping represent the core anomalies of ASD, obscuring its utility in actual clinical diagnosis. To address this, we combined two data-driven methods, 'connectome-based gradient' and 'functional random forest', collectively allowing to discover reproducible neurosubtypes based on resting-state functional connectivity profiles that are specific to ASD. Indeed, the former technique provides the features (as input for subtyping) that effectively summarize whole-brain connectome variations in both normal and ASD conditions, while the latter leverages a supervised random forest algorithm to inform diagnostic labels to clustering, which makes neurosubtyping driven by the features of ASD core anomalies. Applying this framework to the open-sharing Autism Brain Imaging Data Exchange repository data (discovery, n = 103/108 for ASD/typically developing [TD]; replication, n = 44/42 for ASD/TD), we found three dominant subtypes of functional gradients in ASD and three subtypes in TD. The subtypes in ASD revealed distinct connectome profiles in multiple brain areas, which are associated with different Neurosynth-derived cognitive functions previously implicated in autism studies. Moreover, these subtypes showed different symptom severity, which degree co-varies with the extent of functional gradient changes observed across the groups. The subtypes in the discovery and replication datasets showed similar symptom profiles in social interaction and communication domains, confirming a largely reproducible brain-behavior relationship. Finally, the connectome gradients in ASD subtypes present both common and distinct patterns compared to those in TD, reflecting their potential overlap and divergence in terms of developmental mechanisms involved in the manifestation of large-scale functional networks. Our study demonstrated a potential of the diagnosis-informed subtyping approach in developing a clinically useful brain-based classification system for future ASD research.

Corrigendum: Genetic Determinants of Visit-to-Visit Lipid Variability: Genome-Wide Association Study in Statin-Naïve Korean Population.

[This corrects the article DOI: 10.3389/fcvm.2022.811657.].