Role of Perifacial Lymph Node in Nodal Metastasis in Oral Squamous Cell Carcinoma: A Prospective Study.

Nodal involvement in oral squamous cell carcinoma is common due to its lymphatic spread. First echelon group of lymph nodes are to be removed in such scenarios. Perifacial lymph nodes are one of the suspected groups to be affected in metastasis and also missed in dissection due to position. So separate evaluation of this group is important surgically.

Chemical Tailoring Assisted non-TADF to TADF Switching in Carbazole-Benzophenone Emitter - An In-silico Investigation.

Organic light-emitting diodes (OLEDs) have become one of the most popular lighting technologies since they offer several advantages over conventional devices. In carbazole-benzophenone (CzBP) OLED devices, the polymeric form of the compound is previously reported to be Thermally Activated Delayed Fluorescence (TADF)-active (ΔEST ≈0.12 eV), while the monomer (CzBP) (ΔEST ≈0.39 eV) does not. The present study examines the effect of chemical tailoring on the optical and photophysical properties of CzBP using DFT and TDDFT methods. The introduction of a single -NO2 group or di-substitution (-NO2 , -COOH or -CN) in the selected LUMO region of the reference CzBP monomer significantly reduces ΔEST ≈0.01 eV, projecting these systems as potential TADF-active emitters. Furthermore, the chemical modification of CzBP-LUMO alters the two-step TADF mechanism (T1 →T2 →S1 ) in CzBP (ES1 >ET2 >ET1 ) to the Direct Singlet Harvesting (T1 →S1 ) mechanism (ET2 >ES1 >ET1 ), which has recently been identified in the fourth-generation OLED materials.

Titanium particles incorporated polymer monolith microcolumn for phosphoprotein enrichment from biological samples.

In proteomic studies, selective enrichment of target phosphoproteins from biological samples is of importance. Of various enrichment methods, affinity chromatography is widely preferred method. Development of micro-affinity columns with simple strategies are in constant demand. Here in this report, for the first time, we have embedded TiO2 particles within the monolith structure in a single step. Fourier transform infrared spectroscopy and scanning electron microscope analysis has confirmed the successful incorporation of TiO2 particles within the polymer monolith. Incorporation of 3-(trimethoxy silyl) propyl methacrylate within the poly(hydroxyethyl methacrylate) based monolith composition has enhanced its rigidity and one fold phosphoprotein (α-casein) adsorption capacity. Presence of only 66.6 µg of TiO2 particles within the monolith has displayed a four-fold higher affinity to α-casein over the non-phosphoprotein i.e. bovine serum albumin. Under optimized conditions (TiO2 particle and acrylate silane), the affinity monolith has a maximum adsorption capacity of ∼ 72 mg per gram monolith. Translation of TiO2 particles-monolith into a microcolumn of 3 cm long and 19 µL volume was successful. α-casein was selectively separated from an artificial protein mixture of α-casein and BSA, α-casein spiked human plasma, and cow milk within 7 min.

Recent Progress in Development and Application of DNA, Protein, Peptide, Glycan, Antibody, and Aptamer Microarrays.

Microarrays are one of the trailblazing technologies of the last two decades and have displayed their importance in all the associated fields of biology. They are widely explored to screen, identify, and gain insights on the characteristics traits of biomolecules (individually or in complex solutions). A wide variety of biomolecule-based microarrays (DNA microarrays, protein microarrays, glycan microarrays, antibody microarrays, peptide microarrays, and aptamer microarrays) are either commercially available or fabricated in-house by researchers to explore diverse substrates, surface coating, immobilization techniques, and detection strategies. The aim of this review is to explore the development of biomolecule-based microarray applications since 2018 onwards. Here, we have covered a different array of printing strategies, substrate surface modification, biomolecule immobilization strategies, detection techniques, and biomolecule-based microarray applications. The period of 2018-2022 focused on using biomolecule-based microarrays for the identification of biomarkers, detection of viruses, differentiation of multiple pathogens, etc. A few potential future applications of microarrays could be for personalized medicine, vaccine candidate screening, toxin screening, pathogen identification, and posttranslational modifications.

Facilitators and Barriers to Care Coordination Between Medicaid Accountable Care Organizations and Community Partners: Early Lessons From Massachusetts.

Care coordination is central to health care delivery system reform efforts to control costs, improve quality, and enhance patient outcomes, especially for individuals with complex medical and social needs. The potential impact of addressing health-related social needs further illustrates the importance of coordinating health care services with community-based organizations that provide social services and support. This study offers early findings from a unique approach to care coordination delivered by 17 Medicaid Accountable Care Organizations and 27 partnering community-based organizations for individuals with behavioral health conditions and/or those needing long-term services and supports. Interview data from 54 key informants were qualitatively analyzed to understand factors affecting cross-sector integrated care. Key themes emerged, essential to implementing the new model statewide: clarifying roles and responsibilities; promoting communication; facilitating information exchange; developing workforce capacity; building essential relationships; and responsive, supportive program management through real-time feedback, financial incentives, technical assistance, and flexibility from the state Medicaid program.

Multifaceted folding-unfolding landscape of the TrpZip2 ß-hairpin and the role of external sub-piconewton mechanical tensions.

Proteins can experience uneven tensions of the order of tens of piconewtons when exposed to different solvent environment due to the thermal motion of the solvent. It is also true that biomolecules, especially proteins, are subjected to a variety of mechanical tensions generated by several factors, including mechanically assisted translocation and pressure gradients within living systems. Here, we use metadynamics simulations to revisit the folding-unfolding of the TrpZip2 ß-hairpin and redefine it from the perspective of an external force of a sub-piconewton magnitude acting on the ends of the hairpin. The chosen forces, while preserving the morphology of the ß-hairpin chain when it is pulled, are capable of influencing the conformational behavior of the chain during folding and unfolding. Our investigations confirm that the TrpZip2 ß-hairpin exhibits a zipper (zip-out) mechanism for folding-unfolding in both mechanically unbiased and biased (with a 30 pN end force) situations. However, it is important to note that they present marked differences in their folding and unfolding paths, with the mechanically biased system capable of becoming trapped in various intermediate states. Both unbiased and biased scenarios of the hairpin indicate that the hairpin turn is highly stable during the folding-unfolding event and initiates folding. More importantly we confirm that the existing heterogeneity in the TrpZip2 ß-hairpin folding-unfolding is a consequence of the wide range of conformations observed, owing to the different trapped intermediates caused by the uneven forces it may experience in solution.

Measles Vaccination Immunogenicity and Association with Caste in Chandigarh, India.

Measles affects those of lower socioeconomic status disproportionately. This study evaluated the impact of measles vaccination on antibody titers 3 months after vaccination across different socioeconomic groups, with a focus on caste. In total, 169 infants in Chandigarh, India, had serum samples collected immediately prior to vaccination at 9 months of age and 3 months later. Overall, 126 infants (76%) were seropositive (antibody titers > 12 mIU/mL), 26 (16%) were borderline (8-12 mIU/mL), and 14 (8%) were seronegative (< 8 mIU/mL). Seropositivity (versus borderline/seronegative infants) was 0.78 times as high among individuals from the historically marginalized scheduled castes/scheduled tribes compared with the others caste grouping (95% CI, 0.62-0.98). Antibody response was not tied to anthropometric measures but was attenuated among scheduled castes/scheduled tribes with higher incomes. This study provides observational evidence that social structures can be associated with individual immune responses.

Disulfide Isomerization in nDsbD-DsbC Complex - Exploring an Internal Nucleophile Mediated Reaction Pathway.

The disulfide bond redox chemistry of proteins is believed to be mostly governed by the proton motive force. The nucleophilic and α-elimination mechanisms are also found to supplement the formation and scission of the S-S bonds. On these grounds, the possibility for an internal nucleophile assisted disulfide bond formation in the nDsbD-DsbC complex was proposed way back. Using QM/MM MD metadynamics simulations, we explore the feasibility of the proposed mechanism. Our simulations highlight the formation of the internal nucleophile Tyr42 O- and Tyr40 O- which further generates Cys103 S- necessary for the disulfide bond formation in nDsbD. Our results illustrate how the isomerase DsbC is functionally activated by nDsbD in gram-negative bacteria. Also, we foresee that the results will be important for modelling anti-bacterial compounds based on nDsbD.

The association of religion with maternal and child health outcomes in South Asian countries.

OBJECTIVE: Theological beliefs play an important role in cultural norms and could impact women's prenatal and postpartum decisions in South Asia, which has a high burden of disease in children and pregnant women. The aim of this study is to identify any associations religion may have in affecting a woman's decision-making ability, and how that in turn affects maternal and child health, at a group level in multiple South Asian countries. STUDY DESIGN: Cross-sectional study utilizing secondary data analysis. METHODS: We used Demographic and Health Surveys (DHS) between 2014 and 2018 in Afghanistan, Bangladesh, India, Maldives, Myanmar, Nepal, and Pakistan. Not every country's survey asked about religion, so we imputed these results based on Census data. We assessed maternal and child health through a composite coverage index (CCI), which accounts for family planning, attendance of a skilled attendant at birth, antenatal care, BCG vaccinations, 3 doses of diphtheria-tetanus-pertussis vaccine, measles vaccine, oral rehydration therapy, and seeking care if the child has pneumonia. The relationship between religion, women's empowerment, and CCI was assessed through linear regression models. RESULTS: The sample included 57,972 mothers who had children aged 12-23 months. CCI is observed to be affected by family income, in addition to religion and country. CCI was higher in Hindus (2.8%, 95% CI: 2.4%, 3.1%) and Buddhists (2.0%, 95% CI: 1.2%, 2.9%) than Muslims. Mother's age, education, income, decision-making autonomy, and attitude towards beatings were all related to CCI. In a model stratified by religion, age, education, and income were significant predictors of CCI for both Muslims and non-Muslims, but were more impactful among Muslims. CONCLUSION: Though multiple imputation had to be used to fill in gaps in religion data, this study demonstrates that maternal and child health outcomes continue to be a concern in South Asia, especially for Muslim women. Given the importance of religious beliefs, utilizing a simple indicator, such as the CCI could be helpful for monitoring these outcomes and provides a tangible first step for communities to address gaps in care resulting from disparities in maternal empowerment.

Towards solvent regulated self-activation of N-terminal disulfide bond oxidoreductase-D.

N-terminal disulfide bond oxidoreductase-D (nDsbD), an essential redox enzyme in Gram-negative bacteria, consists of a single disulfide bond (Cys103-Cys109) in its active site. The enzymatic functions are believed to be regulated by an electron transfer mediated redox switching of the disulfide bond, which is vital in controlling bacterial virulence factors. In light of the disulfide bond's inclination towards nucleophilic cleavage, it is also plausible that an internal nucleophile could second the existing electron transfer mechanism in nDsbD. Using QM/MM MD metadynamics simulations, we explore different possibilities of generating an internal nucleophile near the nDsbD active site, which could serve as a fail-over mechanism in cleaving the disulfide bond. The simulations show the formation of the internal nucleophile Tyr42O- (F ≈ 9 kcal mol-1) and its stabilization through the solvent medium. The static gas-phase calculations show that Tyr42O- could be a potential nucleophile for cleaving the S-S bond. Most strikingly, it is also seen that Tyr42O- and Asp68OH communicate with each other through a proton-hole like water wire (F ≈ 12 kcal mol-1), thus modulating the nucleophile formation. Accordingly, we propose the role of a solvent in regulating the internal nucleophilic reactions and the subsequent self-activation of nDsbD. We believe that this could be deterministic while designing enzyme-targeted inhibitor compounds.

Temporary obturator using high-density polyurethane foam following maxillectomy during the coronavirus disease 2019 pandemic.

BACKGROUND: Rhino-orbital mucormycosis was seen in epidemic proportions during the second wave of the coronavirus disease 2019 pandemic. Many of these post-coronavirus rhino-orbital mucormycosis patients underwent maxillectomy for disease clearance. Rehabilitating such a large number of patients with surgical obturators as an emergency in a low-income setting was challenging. METHODS: High-density polyurethane foam was used to make a temporary obturator for patients who underwent maxillectomy. These obturators helped alleviate functional problems like dysphagia and nasal regurgitation, improving nutritional outcomes and shortening the hospital stay. CONCLUSION: The coronavirus disease 2019 pandemic gave physicians time-sensitive challenges, for which immediate alternatives to established care were required. A maxillary obturator made of high-density polyurethane foam is an innovative solution to rehabilitate maxillectomy patients in the immediate post-operative period.

2.5% EMLA Versus 2% Lignocaine with Adrenaline Injection in Small Oral Mucosal Biopsies: A Parallel Group Randomized Controlled Trial.

TRIAL DESIGN: The study was designed as an open label randomized comparative parallel group design with a 1:1 allocation ratio. METHODS: All consecutive patients reporting for small biopsies (incisional or excisional) who gave written informed consent were included in the study between October 2018 and October 2019. They were randomized into two groups, Group A and Group B both receiving intervention in the form of 2.5% EMLA cream and 2% Lignocaine with 1:80,000 Adrenaline injection respectively, to anaesthetise tissue for small mucosal biopsies in the oral cavity. RESULTS: EMLA was found to be as effective as lignocaine infiltration with a completely painless application and higher satisfaction for overall comfort during procedure. The duration required to achieve anaesthesia was however more. A particular subgroup of pathology was found to be completely resistant to anaesthesia by EMLA. CONCLUSION: We recommend the use of EMLA as a sole anaesthetic in small mucosal biopsies and shavings in all patients. We suggest it as a higher and first line recommendation for anaesthesia in needle phobic patients and children.

Barriers and Facilitators to Implementation of Value-Based Care Models in New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol.

Introduction: Massachusetts established 17 new Medicaid accountable care organizations (ACOs) and 24 affiliated Community Partners (CPs) in 2018 as part of a large-scale healthcare reform effort to improve care value. The new ACOs will receive $1.8 billion dollars in state and federal funding over 5 years through the Delivery System Reform Incentive Program (DSRIP). The multi-faceted study described in this protocol aims to address gaps in knowledge about Medicaid ACOs' impact on healthcare value by identifying barriers and facilitators to implementation and sustainment of the DSRIP-funded programs. Methods and analysis: The study's four components are: (1) Document Review to characterize the ACOs and CPs; (2) Semi-structured Key Informant Interviews (KII) with ACO and CP leadership, state-level Medicaid administrators, and patients; (3) Site visits with selected ACOs and CPs; and (4) Surveys of ACO clinical teams and CP staff. The Consolidated Framework for Implementation Research's (CFIR) serves as the study's conceptual framework; its versatile menu of constructs, arranged across five domains (Intervention Characteristics, Inner Setting, Outer Setting, Characteristics of Individuals, and Processes) guides identification of barriers and facilitators across multiple organizational contexts. For example, KII interview guides focus on understanding how Inner and Outer Setting factors may impact implementation. Document Review analysis includes extraction and synthesis of ACO-specific DSRIP-funded programs (i.e., Intervention Characteristics); KIIs and site visit data will be qualitatively analyzed using thematic analytic techniques; surveys will be analyzed using descriptive statistics (e.g., counts, frequencies, means, and standard deviations). Discussion: Understanding barriers and facilitators to implementing and sustaining Medicaid ACOs with varied organizational structures will provide critical context for understanding the overall impact of the Medicaid ACO experiment in Massachusetts. It will also provide important insights for other states considering the ACO model for their Medicaid programs. Ethics and dissemination: IRB determinations were that the overall study did not constitute human subjects research and that each phase of primary data collection should be submitted for IRB review and approval. Study results will be disseminated through traditional channels such as peer reviewed journals, through publicly available reports on the mass.gov website; and directly to key stakeholders in ACO and CP leadership.

Religion and Measles Vaccination in Indonesia, 1991-2017.

INTRODUCTION: Some Muslim religious councils in Indonesia have ruled that measles vaccines contain haram (i.e., forbidden materials). This study evaluates the changes in measles vaccination coverage between 1991 and 2017 and compares vaccination coverage between Muslims and non-Muslims in Indonesia. METHODS: A total of 7 cross-sectional in-person surveys of mothers in 1991-2017 in Indonesia were analyzed in 2019. Participants were asked about religion in 1991-2007, and 100 data sets of religion were imputed for 2012 and 2017. In this multiple imputation analysis, binomial regression models output prevalence differences adjusted for wealth, education, child's sex, and mother's age. A quadratic term for year (year X year) and an interaction term between year and religion evaluated changes in vaccination over time by religion. RESULTS: The 7 data sets included 23,106 children aged 12-23 months, with the proportion of those who were Muslims ranging between 85% and 89% across the survey years. Between 1991 and 2017, measles vaccination coverage increased from 57% to 79% among non-Muslims and from 59% to 79% among Muslims. In the multivariable regression model, measles vaccination coverage increased by 1.6% each year (with a quadratic term of -0.05%, indicating some leveling over time). At baseline in 1991, non-Muslims had a vaccination coverage of 6.2% higher than that of Muslims, but this disparity decreased by -0.2% each year. CONCLUSIONS: Measles vaccination increased in both Muslims and non-Muslims in Indonesia but has stagnated in recent years. Because of increased attention among Muslim groups on haram materials in vaccines since 2017, future studies should continue to examine the relationship between religion and vaccine uptake in Indonesia. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.

Is child undernutrition associated with antenatal care attendance in Madhya Pradesh, India?

CONTEXT: There is a paucity of research investigating the association between antenatal care (ANC) attendance and child undernutrition in Madhya Pradesh, India. AIM: To determine whether body weight status in children under the age of 5 years is associated with ANC attendance in Madhya Pradesh. METHODS: A cross-sectional study was carried out using data from India's National Family Health Survey (2005-2006). Bodyweight status (an indicator of undernutrition) was determined using weight-for-age. Descriptive statistics and logistic regression were used to estimate prevalence and obtain adjusted odds ratios (AOR) to investigate associations between ANC indicators and weight-for-age. RESULTS: Majority of children were underweight (55.1%). ANC attendance was inadequate, with only 36.8% of women having four or more visits. None of the ANC indicators were associated with body weight status. Increased child age especially an age of 2 years (AOR 2.29; 1.66-3.15), belonging to a scheduled tribe [ST] (AOR 2.36; CI 1.64-3.39), scheduled caste [SC] (AOR 1.75; CI 1.25-2.45) or other backward caste [OBC] (AOR 1.43; CI 1.08-1.89) were associated with being underweight; a birth weight of ≥2.5 kg was associated with lower relative odds of being underweight (AOR 0.43; CI 0.29-0.64). Mothers who had a normal BMI (AOR 0.66; CI 0.53-0.82) or were overweight (AOR 0.42; CI 0.25-0.69) were less likely to have underweight children. CONCLUSIONS: ANC attendance was not associated with body weight status. Increased child age, low birth weight, poor maternal nutrition status and belonging to SCs, STs or OBCs increased the odds of child undernutrition.

Dermatoses Occurring after Parlor Procedures.

BACKGROUND: Cosmetic procedures are on the rise and practiced by all age groups, especially by teenagers. These procedures enhance the individual appearance and confidence levels, but they are not without side effects. AIMS AND OBJECTIVES: The aim of this study was to evaluate the side effects occurring after various parlor procedures such as facials, threading, waxing, and laser hair reduction. SETTING AND DESIGN: A prospective study for 12 months in a tertiary hospital. MATERIALS AND METHODS: Patients attending the department of dermatology at a tertiary care hospital for 12 months (July 2018-June 2019) were evaluated for any skin lesions, developed after one of the above parlor procedures. Detailed history, clinical examination, and correlation with the parlor procedure were noted. RESULTS: A total of 102 patients were found to have dermatoses after various parlor procedures during the 1-year study period (81 F and 21 M). Acneiform eruptions 26 (25.4%), followed by post-waxing folliculitis 17(16.7%), and hyperpigmentation of face 15 (14.7%) were the most common dermatoses. Molluscum contagiosum, verrucae plana, and tinea faciei were observed in 11, 6, and 3 patients, respectively. CONCLUSION: Side effects are not uncommon after parlor procedures. Awareness of these is necessary and educating the patients is extremely important to avoid these unwanted complications.

Genetic variants in post myocardial infarction patients presenting with electrical storm of unstable ventricular tachycardia.

Electrical storm (ES) is a life threatening clinical situation. Though a few clinical pointers exist, the occurrence of ES in a patient with remote myocardial infarction (MI) is generally unpredictable. Genetic markers for this entity have not been studied. In the present study, we carried out genetic screening in patients with remote myocardial infarction presenting with ES by next generation sequencing and identified 25 rare variants in 19 genes predominantly in RYR2, SCN5A, KCNJ11, KCNE1 and KCNH2, CACNA1B, CACNA1C, CACNA1D and desmosomal genes - DSP and DSG2 that could potentially be implicated in electrical storm. These genes have been previously reported to be associated with inherited syndromes of Sudden Cardiac Death. The present study suggests that the genetic architecture in patients with remote MI and ES of unstable ventricular tachycardia may be similar to that of Ion channelopathies. Identification of these variants may identify post MI patients who are predisposed to develop electrical storm and help in risk stratification.

Leg to leg bioelectrical impedance analysis of percentage fat mass in obese patients-Can it tell us more than we already know?

BACKGROUND: Bioelectrical impedance analysis (BIA) is well tolerated, inexpensive, and readily available, but can it be used to detect with clinical precision aberrant changes in the proportion of fat mass to fat-free mass during weight loss? OBJECTIVES: To assess the variance in percentage body fat mass explained by the readily available inputs and assess residual variance provided by leg-to-leg BIA scales. METHODS: Using cross-sectional data from a cohort of 665 patients of Indian ethnicity presenting for bariatric surgery, we examine the determinants of percentage body fat as provided by leg-to-leg output from Tanita SC-330 BIA scales. RESULTS: Four input factors-sex, weight, height, and age-contributed to provide 92% and 95% explanation in output variance for percentage fat mass (%FM) and actual fat mass, respectively, in 665 patients. Body mass index alone explained 89% and 81% of variance in %FM output for women and men, respectively. Neither weight distribution, as indicated by waist and hip circumference or waist to hip ratio, nor plasma lipids or markers of glucose metabolism contributed additional variance in %FM when controlled for the 4 key inputs. CONCLUSIONS: Simple, known input variables dominate the leg-to-leg BIA output of %FM, and this may compromise the detection of aberrant changes in %FM and fat-free mass with substantial weight loss. For clinical research, validated methods not largely dependent on known inputs should be used for evaluating changes in body composition after substantial weight loss.