关键词： Curriculum   Medical Education   Training  

摘要： Drastic and rapid changes to medical education are uncommon because of regulations and restrictions designed to ensure consistency among medical school curriculums and to safeguard student well-being. As a consequence of the COVID-19 pandemic, medical education had to break away from its conventions and transition from time-honored teaching methods to innovative solutions. This article explores the anticipated and actual efficacy of the swift conversion of a specialty elective from a traditional in-person format to a fully virtual clerkship. In addition, it includes a noninferiority study to determine where a virtual classroom may excel or fall short in comparison with conventional clinical rotations.

关键词： GWP   Alternative refrigerant   R-448A   R-449A   R-455A   R-454C   R-404A   Condensation   Muitiport   Mini-channel  

摘要： The literature survey reveals that condensation or evaporation studies on R-404A alternative refrigerants are very limited. Especially for the multiport tube, no prior investigation exists. In this study, four R-404A alternative refrigerants (GWP100 <2500: R-448A, R-449A and GWP100 <150: R-455A, R-454C) -including R-404A (GWP100 = 3922) were tested in a multiport tube having 0.80 mm hydraulic diameter. The tests were conducted changing the mass flux from 380 to 760 kg/m2s, vapor quality from 0.2 to 0.8. During the tests, the saturation temperature and the heat flux were maintained at 45 degrees C and at 6 kW/m2. The results showed that the heat transfer coefficients of the alternative refrigerants were higher than those of R-404A. The reason was attributed to the better thermo-physical properties of the alternative refrig-erants. Especially, at a high mass flux of this study, the gas core and the liquid film became turbulent, which mitigated the malign effect of temperature glide by strong mixing. Hence, the alternative refrig-erants yielded higher heat transfer coefficients than R-404A. Some correlations with mixture correction predicted the heat transfer coefficient reasonably well with RMSE of approximately 0.20. An interest-ing finding is that even better predictions (RMSE of 0.13) were obtained when the correlation was not mixture corrected. The pressure drops were generally in the reverse order to the value of vapor density. Pressure drops of alternative refrigerants were larger than those of R-404A. The pressure drop correlations generally underpredicted the data. (c) 2021 Elsevier Ltd. All rights reserved.

关键词： parathyroid adenoma   calcium sensing   primary hyperparathyroidism  

摘要： Context: The biochemical basis for clinical variability in primary hyperparathyroidism (PHPT) is poorly understood. Objective: This study aimed to define parathyroid tumor biochemical properties associated with calcium-sensing failure in PHPT patients, and to relate differences in these profiles to variations in clinical presentation. Methods: Preoperative clinical data from a sequential series of 39 patients undergoing surgery for PHPT at an endocrine surgery referral center in a large, public university hospital were evaluated for correlation to parathyroid tumor biochemical behavior. An intact tissue, ex vivo interrogative assay was employed to evaluate the calcium-sensing capacity of parathyroid adenomas relative to normal donor glands. Tumors were functionally classified based on calcium dose-response curve profiles, and clinical parameters were compared among the respective classes. Changes in the relative expression of 3 key components in the calcium/parathyroid hormone (PTH) signaling axis-CASR, RGS5, and RCAN1-were evaluated as potential mechanisms for calcium-sensing failure. Results: Parathyroid adenomas grouped into 3 distinct functional classes. Tumors with diminished calcium sensitivity were the most common (18 of 39) and were strongly associated with reduced bone mineral density (P = 0.0009). Tumors with no calcium-sensing deficit (11 of 39) were associated with higher preoperative PTH (P = 0.036). A third group (6/39) displayed a nonsigmoid calcium/PTH response curve;4 of these 6 tumors expressed elevated RCAN1. Conclusion: Calcium-sensing capacity varies among parathyroid tumors but downregulation of the calcium-sensing receptor (CASR) is not an obligate underlying mechanism. Differences in tumor calcium responsiveness may contribute to variations in PHPT clinical presentation.

关键词： Agribusiness   Cattle feeding   Feeding conversion efficiency   Nutrition evaluation   Ruminant nutrition  

摘要： Glycerine a co-product from the biodiesel industry and cashew and clove oils could be an alternative food for replacing corn as an energy source and synthetic additives commonly used in feedlot diets. This work was realized to study the effects of replacing corn grain with glycerine and vegetal oils (nut shell liquid and castor oils) on animal performance, feed intake, feed efficiency and apparent digestibility of Puruna similar to bulls finished in feedlot. A total of 32 Puruna similar to bulls (1/4 Aberdeen Angus + 1/4 Caracu + 1/4 Charolaise + 1/4 Canchim) with a mean age of 32 +/- 2.0 months and a mean body weight 206.1 +/- 20.0 kg were distributed in a completely randomized design with four diets and eight replications per diet. The four experimental diets were as follows: CONT - basal diet;VOIL -basal diet and addition of vegetable oils (3 g/animal/day);GLYC - basal diet and addition of glycerine (20.1% glycerine on a DM basis);GLVO - basal diet and addition of glycerol (20.1% glycerine in DM basis) and vegetal oils (3 g/animal/day). Final body weight and average daily gain were similar (P 0.05) the DM intake and other nutrients in comparison to CONT diet. DM efficiency was similar (P 0.04) among the four diets. The GLYC and VOIL diets reduced (P < 0.05) the NDF intake (10.0 and 18.9%) in comparison to the CONT and GLVO diets, respectively. However, bulls fed GLYC and GLVO diets had a high (P < 0.05) intake of metabolizable energy when compared to bulls fed diets without glycerin. The apparent digestibility of DM, OM, CP, TC, NFC, and NDF was higher (P < 0.05) when glycerin was added to the diets;whereas no change was observed in the apparent digestibility of EE, ADF, and CF. In conclusion, diets containing glycerine and vegetal oils did not change average daily gain;however, they improved the carcass weight, the feed intake, and the apparent digestibility.

关键词： Concatenation   exons   introns   phylogenomics   species-tree methods   target capture  

摘要： The use of high-throughput sequencing technologies to produce genome-scale data sets was expected to settle some long-standing controversies across the Tree of Life, particularly in areas where short branches occur at deep timescales. Instead, these data sets have often yielded many well-supported but conflicting topologies, and highly variable genetree distributions. A variety of branch-support metrics beyond the nonparametric bootstrap are now available to assess how robust a phylogenetic hypothesis may be, as well as new methods to quantify gene-tree discordance. We applied multiple branch-support metrics to a study of an ancient group of marine fishes (Teleostei: Pelagiaria) whose interfamilial relationships have proven difficult to resolve due to a rapid accumulation of lineages very early in its history. We analyzed hundreds of loci including published ultraconserved elements and newly generated exonic data along with their flanking regions to represent all 16 extant families for more than 150 out of 284 valid species in the group. Branch support was typically lower at inter- than intra-familial relationships regardless of the type of marker used. Several nodes that were highly supported with bootstrap had a very low site and gene-tree concordance, revealing underlying conflict. Despite this conflict, we were able to identify four consistent interfamilial clades, each comprised of two or three families. Combining exons with their flanking regions also produced increased branch lengths at the deep branches of the pelagiarian tree. Our results demonstrate the limitations of employing current metrics of branch support and species-tree estimation when assessing the confidence of ancient evolutionary radiations and emphasize the necessity to embrace alternative measurements to explore phylogenetic uncertainty and discordance in phylogenomic data sets.

关键词： Alternative splicing   Arabidopsis   Cold stress   DNA-methylation   epiRILs   Nucleosome occupancy  

摘要： How stable and temperature-dependent variations in DNA methylation and nucleosome occupancy influence alternative splicing (AS) remains poorly understood in plants. To answer this, we generated transcriptome, whole-genome bisulfite, and MNase sequencing data for an epigenetic Recombinant Inbred Line (epiRIL) of A. thaliana at normal and cold temperature. For comparative analysis, the same data sets for the parental ecotype Columbia (Col-0) were also generated, whereas for DNA methylation, previously published high confidence methylation profiles of Col-0 were used. Significant epigenetic differences in an identical genetic background were observed between Col-0 and epiRIL lines under normal and cold temperatures. Our transcriptome data revealed that differential DNA methylation and nucleosome occupancy modulate expression levels of many genes and AS in response to cold. Collectively, DNA methylation and nucleosome levels exhibit characteristic patterns around intron-exon boundaries at normal and cold conditions, and any perturbation in them, in an identical genetic background is sufficient to modulate AS in Arabidopsis.

摘要： Objective The aim of this systematic review was to analyse current literature and reported cases of multisystem inflammatory syndrome in children (MISC), concerning its clinical spectrum, complications associated, therapeutic strategies and distinguishing features of other clinical syndromes. Methods Extensive literature research was performed in MEDLINE (through PubMed), Scopus and Web of Science from December 2019 to December 2020. First analysis included all article titles and abstracts screening to identify relevant studies, and second analysis included a full-text screening of previously selected studies. Eligibility was assessed independently by two authors, and disagreements were resolved by discussion and consensus. Data were extracted on MISC definition, demographic data, clinical features, diagnostic tests, laboratory analysis and imaging, therapeutical approach and outcomes. Results Common symptoms included gastrointestinal (70%), rash (57%) and cardiovascular (52% with shock). Notable differences with Kawasaki disease were identified including age, clinical presentation and cardiac involvement. Thirty per cent presented positive severe acute respiratory syndrome coronavirus-2 reverse transcription polymerase chain reaction and 51% positive serologies. Sixty-two per cent received intravenous immunoglobulin and 42% glucocorticoids. Sixty-two per cent required intensive care and 21 children died (<2%). Severe presentations were associated with neurological symptoms, hepatitis and acute kidney injury. Conclusions MISC raises concern on its severe cardiac involvement at presentation, with frequent intensive care and immunomodulatory therapy need. Short-term outcomes seem to be favourable, with cardiac dysfunction recovery and low mortality rates.

关键词： SARS-CoV-2   Viral infection   Biomedicine   general   Immunology   Infectious Diseases  

摘要： There is limited understanding of the viral antibody fingerprint following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children. Herein, SARS-CoV-2 proteome-wide immunoprofiling of children with mild/moderate or severe coronavirus disease 2019 (COVID-19) versus multisystem inflammatory syndrome in children versus hospitalized control patients revealed differential cytokine responses, IgM/IgG/IgA epitope diversity, antibody binding and avidity. Apart from spike and nucleocapsid, IgG/IgA recognized epitopes in nonstructural protein (NSP) 2, NSP3, NSP12-NSP14 and open reading frame (ORF) 3a-ORF9. Peptides representing epitopes in NSP12, ORF3a and ORF8 demonstrated SARS-CoV-2 serodiagnosis. Antibody-binding kinetics with 24 SARS-CoV-2 proteins revealed antibody parameters that distinguish children with mild/moderate versus severe COVID-19 or multisystem inflammatory syndrome in children. Antibody avidity to prefusion spike correlated with decreased illness severity and served as a clinical disease indicator. The fusion peptide and heptad repeat 2 region induced SARS-CoV-2-neutralizing antibodies in rabbits. Thus, we identified SARS-CoV-2 antibody signatures in children associated with disease severity and delineate promising serodiagnostic and virus neutralization targets. These findings might guide the design of serodiagnostic assays, prognostic algorithms, therapeutics and vaccines in this important but understudied population. Pediatric COVID-19 can be associated with subsequent multisystem inflammatory syndrome in children (MIS-C), but how these pathologies are related or differ is unclear. Here the authors compare and contrast pediatric COVID-19 and MIS-C immunophenotypes using SARS-CoV-2 antibody fingerprinting proteomics.

关键词： apalutamide   applesauce   food vehicles   swallowing   tea   water  

摘要： Patients may have difficulty swallowing a whole daily dose of 240 mg (4 x 60-mg tablets) of apalutamide. One of the unique properties of apalutamide tablets is easy disintegration and dispersion when mixed into aqueous vehicles, avoiding the need to crush/split the tablets. To evaluate whether this method of apalutamide tablet administration would be conducive in a patient setting, different variations in preparation were evaluated, and one preparation was tested in humans. In vitro compatibility studies evaluated purity, dose, or stability of different variations of apalutamide in applesauce/yogurt/orange juice/green tea. An open-label, randomized, crossover phase 1 study in healthy men determined the bioavailability of an apalutamide-applesauce mixture versus whole tablets based on maximum plasma analyte concentration (C-max), area under the plasma analyte concentration-time curve: AUC(0-72h) and AUC(0-168h). Different amounts of applesauce/yogurt/orange juice/green tea as well as durations (up to 6 hours) did not affect the total apalutamide content available. The phase 1 study (n = 12) showed increased total exposure of 5% and peak exposure of 27.6% when comparing the apalutamide-applesauce mixture with whole-tablet administration. Variations in preparation times and total content for applesauce/yogurt/orange juice/green tea did not affect the purity, dose, or stability of apalutamide. An apalutamide-applesauce mixture is a suitable alternative administration method to whole tablets.