Teaching point: A linear flake of bone at the posterolateral aspect of the distal fibula indicates avulsion of the superior peroneal retinaculum and warrants further investigation by dynamic ultrasound. A 22-year-old female presented with a persistent swelling at the lateral malleolus and limited range of motion after a sports injury two months earlier. Conventional radiography and computed tomography revealed a detached osseous fragment at the posterolateral cortex of the lateral malleolus associated with locoregional soft tissue swelling . In addiThe peroneal tendons both run in a common synovial sheath posteriorly to the lateral malleolus in the retro-malleolar groove where they are stabilized by the superior peroneal retinaculum. Injury of the peroneal retinaculum could lead to an increased friction of the tendons, tearing of the tendons and a higher risk of peroneal instability often resulting in spontaneous dislocation.Patients mostly present with ecchymosis, swelling, pain and focal tenderness along the lateral malleolus.In case of an avulsion fracture at the fibular insertion of the retinaculum, conventional radiographs show a flake of bone at the posterolateral distal fibula, designated as the ‘ankle fleck sign’.On MRI, in the acute setting, rupture associated with edema of the retinaculum is seen on FS T2-WI. Scarring of the retinaculum with secondary tethering of the peroneal tendons and/or sural nerve can be seen in the chronic stage. Subluxation of the peroneal tendons is not always visible on static MRI but is best demonstrated during dynamic ultrasound imaging during dorsiflexion, eversion and/or sonopalpation . The tre


Porphyromonas gingivalis (Pg) is one of the keystone pathogens involved in periodontitis. The present study aimed to observe the relationship among different infection forms of Pg, systemic inflammation, and acute myocardial infarction (AMI).Pg infection. Clinical characteristics, inflammatory parameters, and severity of coronary artery lesions of the patients were analyzed and compared.A total of 382 patients diagnosed with AMI and 78 patients without coronary heart disease (CHD) were included in the study. DNA from exfoliated oral cells, circulating cell-free DNA (cfDNA), and genomic DNA (gDNA) from blood samples were extracted. The qPCR method was employed to detect Pg correlated positively with systemic inflammation. Multivariate logistic regression analysis suggested that Pg positivity in gDNA was correlated with the risk of AMI . Pg positivity in cfDNA and gDNA was related to the severity of coronary artery lesions .Both the oral colonization and distant invasion of Pg were the risk factors of AMI. They also affected the severity of CHD, indicating that periodontitis severity and distant invasion of periodontal pathogens were related to CHD. The presence of Pg was likely able to drive systemic inflammation, suggesting that there was an inflammatory relationship between periodontitis and AMI.The distant invasion and colonization of  Cardiovascular disease (CVD) is the leading cause of death worldwide . AtherosPorphyromonas gingivalis (Pg) is the most important pathogen of PD. Based on animal experiments, it has been confirmed that Pg is closely related to the initiation and development of many systemic diseases, such as atherosclerosis, cancer, and Alzheimer’s disease . The positive rate of Pg in the blood samples was statistically different between the two groups , p < 0.05; Table There was no significant difference in Pg and systemic inflammatory factors  = 1.917, 95% confidence interval (CI) 1.108–3.315), Model 2 , and Model 3  (p < 0.05); Table Univariate and multivariable logistic regression were performed with the occurrence of AMI  was used as the dependent variable, and Pg positivity in the circulatory system was related to the severity of coronary artery. The same result was obtained when the confounding factors were adjusted (Table The severity of coronary artery lesions in AMI patients was divided into a mild (Syntax score < 23) and a moderate-severe (Syntax score ≥ 23) groups. In univariate logistic regression analysis, the results indicated that ed Table .Table 5CPg by detecting the presence of Pg DNA using the qPCR method and analyzed its relationship with AMI. The main study findings were as follows: (1) Pg correlated positively with systemic inflammation regardless of the Pg infection mode, and systemic inflammatory molecular levels increased significantly; (2) Pg positivity in the circulatory system (cfDNA and gDNA) was an independent risk factor for first-time AMI and was related to the severity of coronary artery, with a possible clinical significance for optimizing risk stratification in CHD patients; and (3) the study findings further strengthened the possibility of an independent relationship between PD and CVD manifestations.The present study for the first time evaluated the different infection forms of Pg positivity in cfDNA indicated that Pg invaded the circulatory system. In addition, Pg positivity in gDNA indicated that Pg colonized the circulatory system with persistent presence in the cells, further resulting in a lasting inflammatory state. The study results also showed a positive association between gDNA Pg positivity and AMI, which remained following adjustment for the differences in clinical characteristics between patients and controls. This reinforces the possibility of an independent relationship between PD and the risk for CVD presently expressed as AMI, which depends on whether the distant invasion and colonization of endothelial cells by periodontal pathogens were involved.The present study supported the idea that the main mechanism for PD affecting the development of atherosclerosis was the direct invasion of endothelial cells by periodontal pathogens . FurtherPg can leave oral epithelial cells via the endocytic recycling pathway and infect other cells or enter the circulatory system , which contradicted previous study results [There were some limitations in this study. First, this was a cross-sectional, single-center study with relatively small sample size. Therefore, it could not determine the causality between  results , 32. ThiPg positivity in the circulatory system, which may suggest a potential inflammatory link between PD and AMI. Two conclusions can be drawn from the present study. First, Pg positivity in the circulatory system was significantly and positively correlated with AMI. Second, Pg promoted systemic inflammation response. Future multicenter, prospective, and randomized clinical trials are necessary to determine whether the treatment of PD and removal of its pathogenic bacteria can help prevent the occurrence or recurrence of CVD.PD pathogen invasion and colonization in the circulatory system was one of the risk factors of first-time AMI and was related to the severity of coronary artery lesions. The systemic inflammation was more evident in AMI patients with


Nigronia), and the accessory gland substances are usually brown. In contrast, dobsonflies  lay a multi-layered hemispherical egg mass, and the accessory gland substances differ in color and chemical properties among genera and species. Egg masses of the dobsonfly genus Protohermes are coated with a sticky substance, while those of other dobsonflies are covered with hardened white powders, both of which contribute to the prevention of egg desiccation. The accessory gland substances of most species of Megaloptera also function to protect eggs from attack by oophagous predators, such as ladybird beetles and ants. The information on the parasitoids of Megaloptera egg masses are also discussed based on the present and previously reported observations.Egg masses of the insect order Megaloptera are coated with female accessory gland substances and are diverse in shape, color, and surface structure. Female alderflies  and fishflies  lay eggs in a single layer on the substrate  and avoid attack by egg-eating predators, egg parasites, and microbes. Females of Megaloptera lay their eggs as a single- or multi-layered egg mass, which is coated with chemical substances secreted from the female reproductive accessory glands. In this study, we observed the egg masses laid by females of two species of Sialidae , nine species of Chauliodinae (fishflies), and 23 species of Corydalinae (dobsonflies) belonging to the order Megaloptera and examined the functions of accessory gland substances coating the laid eggs. The female accessory gland is a single tube in alderflies and fishflies but a paired pouch in dobsonflies. The amount and color of the gland substances differ greatly among species. These substances prevent egg desiccation, inhibit egg feeding by ladybird beetles, and repel ants. Most characteristics of the egg mass structures and the effectiveness of accessory gland substances reflect the phylogeny of Megaloptera, although some differ among closely related taxa. Insect eggs are protected physically and chemically, to allow them to survive harsh environmental conditions and biological attacks. The chorion differs interspecifically in structure, reflecting different physiological needs and environmental hazards . DepositSialis, Protosialis, Ilyobius), fishflies , and dobsonflies  )bstances c. After t-test was used to detect difference in the mean amount of sucrose solution consumed by each ant when the solutions with and without female accessory gland substances were presented simultaneously. In the experiments of the ability of the accessory gland substances to prevent egg predation by the ladybird beetles, differences in frequencies of intact, broken, and lost (eaten) eggs were examined by the chi-square test.Values are shown as mean ± standard error (SE). Pearson’s correlation analysis was used to examine the log-log relationship between the mean female body size (head width) and the mean accessory gland weight among 29 species , and theNigronia, laid single-layered egg masses  dissected out of the female abdomen was positively correlated with the mean female head width (x mm) in the log-log relationship of 29 species . The mean residual accessory gland size calculated from this equation was larger in Protohermes dobsonflies  than Sialis alderflies , three genera of fishflies , and the other two genera dobsonflies .The female body size of Megaloptera varied greatly in head width and forewing length among genera and species . The meaProtohermes grandis were parasitized by the hymenopteran parasitoid Oooencyrtus yoshidai in the field; one in Niigata Prefecture and the other on Sado Island, central Japan; 16.2% and 28.1% of eggs were parasitized, respectively.Two egg masses of Parachauliodes continentalis and Neoneuromus coomani  and some fishflies  could not be examined because the gland substances sufficient to cover the whole nylon mesh of the tube opening could not be obtained from their small accessory glands.Female accessory gland substances prevented water loss from the 1% agarose gel, excluding  coomani . In thisN = 90, SE = 0.06) and 1.16 mm , respectively. The addition of the accessory gland substances to 10% sucrose solution decreased the feeding rate of large ants in two of 11 species tested in the experiment  and one dipteran parasitoid (Pseudogaurax idiogenes) have been reported to parasitize the eggs of Megaloptera  and Corydalus dobsonflies (with a hardened white cover). Interestingly, there have been no reports of parasitism on fishfly egg masses despite being laid in a single layer, as in alderflies. The egg masses are much larger than parasitoid ovipositors  have a smaller accessory gland. Although based on a small sample size, the accessory gland of Acanthacorydalis is relatively small. We must study the reasons why the relative size of female accessory glands varies among genera and species.The female accessory gland was a single pouch in alderflies , singleThe female accessory gland substances of Megaloptera are used for egg coating and show high diversity in color and other properties. The coloration of egg masses may play a role in crypsis on background substrates such as leaves, tree trunks and branches, and stones. We experimentally demonstrated that the accessory gland substances prevent severe desiccation of eggs during development and avoid predation by oophagous predators such as ladybird beetles and ants. Unfortunately, no information is available on the chemical compounds and synthesis of these egg-coating substances in Megaloptera. Further studies are required for chemical analysis of these substances and to examine other functions such as egg-parasitoid avoidance and antimicrobial activity to understand the evolution of insect egg structure and properties.


The purpose of this study was to verify whether pre-treatment digital setups can accurately predict the tooth positions after presurgical orthodontic treatment has been performed in a 3-dimensional way. Twenty-six patients who underwent a combined orthodontic-orthognathic surgical treatment were included. Pre-treatment digital dental models were merged with cone beam computed tomography (CBCT) scans. One operator fabricated virtual setups to simulate the tooth movements of the presurgical orthodontic treatment. Prior to surgery, digital dental models were merged with the CBCT scans. Differences between de virtual setups and the presurgical dental models were calculated using linear mixed model analyses. Differences in tooth displacements exceeding the boundaries of clinical acceptance (>2 degrees for rotations and >0.6 mm for translations) were found in 75% of the rotational and 52% of translational mean differences in the maxilla and in 74% of the rotational mean differences and 44% of the translational mean differences in the mandible. Significant differences were found for all tooth types and in all tooth displacement directions with significant effects of extractions and surgically assisted rapid maxillary expansion (SARME) procedures. The accuracy of the digital setup is still too limited to correctly simulate the presurgical orthodontic treatment. Diagnostic orthodontic setups have been used for decades to simulate different treatment options during orthodontic planning. Diagnostic setups aid decision making during treatment planning, for example considering the use of interproximal reduction (IPR), extraction therapy or anchorage management ,2. They Recently a new application of a diagnostic setup in orthognathic treatment planning was introduced . At the A study of Hou et al. investigated whether viewing of digital setups influenced orthodontic treatment planning decision or orthodontists’ confidence in their selected outcome . After vSeveral studies are available concerning the accuracy of therapeutic setups. Two studies looked into the predictability of a setup regarding lingual appliances ,11, anotAlthough digital setups in orthognathic treatment planning are regarded as useful tools and a potential advancement to establish a definitive treatment plan, questions remain regarding the accuracy and predictability of the pre-treatment diagnostic setup compared to the actual three-dimensional outcome of the presurgical orthodontic treatment just prior to surgery. The predictability of the presurgical orthodontic treatment stage has not attracted much attention so far. Therefore, the goal of this study is to verify whether pre-treatment digital setups can accurately predict the pre-surgical tooth positions in a 3-dimensional way.Twenty-six consecutive patients who underwent a combined orthodontic-orthognathic treatment at the Radboud University Medical Center, department of Dentistry, section of Orthodontics and Craniofacial Biology were selected for this retrospective study. The study was conducted between September 2020 and July 2021. Inclusion criteria were skeletally maturity based on cervical vertebral maturation , presencAll patients were treated orthodontically with labial fixed appliances including metal bidimensional self-ligating brackets with Roth prescription .The sample size was calculated using the formula described by Pandis , conside®, Copenhagen, Denmark).Two CBCT scans were acquired for each patient as part of the treatment protocol for orthognathic surgery cases. One CBCT scan was acquired before the start of the orthodontic treatment and the second CBCT scan was taken four weeks prior to orthognathic surgery. On both occasions, an extended-height CBCT scan was acquired . Directly after the acquisition of the CBCT scans plaster models of the dental arches were acquired after alginate impression taking. The plaster models were digitized with a laser scanner  software was used to produce a virtual orthodontic setup on the pre-treatment dental model. The orthodontist (OdW), who created the virtual setups, had access to all patient’s pretreatment records and the treatment plan, but was blinded to the outcome of the actual orthodontic treatment. Creating a virtual setup started with the determination of arch form and tooth axis. Each of the individual teeth were semi-automatically segmented using the OrthoAnalyzer software [OrthoAnalyzer . IPS CaseDesigner automatically aligns the STL files of the dental models with the CBCT scans after indicating the right and left condyle, mesial cusp of the first upper right and left molar and the middle of the two upper incisors. This step is validated and shows a high level of accuracy and agreement [Treatment evaluation was carried out by the method of Baan et al. , this megreement  (step 1)® software each individual tooth was rotated and translated from the pre-treatment model to the virtual setup and to the final outcome (step 3). All translations and rotations were recorded and saved for each individual tooth . Linear mixed model analyses were used to calculate the differences between the virtual setup and the actual outcome and the estimation of the fixed effects of SARME and extraction on the result per tooth taking individual patients into account. Linear mixed models were used because of data on tooth level being clustered within patients.Twenty-six patients were enrolled in this study, 17 females (65%) and 9 males (35%). The mean age at start was 27 (range 18–51) years. Seventeen patients had Class II/1 malocclusion, three patients had a Class II/2 malocclusion and six patients had Class III malocclusion. Fifteen patients were treated with surgically assisted rapid maxillary expansion (SARME) using a tooth-born Hyrax expansion appliance at the start of treatment to expand the maxillary arch. Twenty-five patients were prepared for bimaxillary osteotomy and one patient for a le-fort-1 osteotomy. In thirteen patients teeth were extracted in order to gain space for the correction of crowded or proclined teeth. Twelve of them had two premolar extractions in the lower arch and one patient had first molar extractions in the mandible and only four of those thirteen patients also had two premolars in the upper arch extracted. One patient had a SARME procedure and extraction therapy in the upper arch before orthodontic treatment. The mean pre-surgical orthodontic treatment time was 19 (range 7–32) months.The evaluate the accuracy of the orthodontic setup, the virtual setup and the actual outcome of the orthodontic surgical preparation of each patient were compared, based on the registration with the underlying CBCT scans. The differences between setup and outcome for each tooth type per parameter are listed in Roll is described as rotation around the sagittal axis. A positive value means lingual root rotation (torque) for lateral teeth and mesial root angulation for frontal teeth. Pitch is described as rotation around the transversal axis. A positive value means backward root rotation. Rotation around the vertical axis is described as Yaw. A positive value means mesial out rotation. X is described as lateral to medial displacement. A positive value means lateral movement, a negative value means medial movement. Y is described as anterior to posterior displacement. A positive value means posterior movement, a negative value means anterior movement. Cranial to caudal displacement is described as Z. A positive value means cranial movement, a negative value means caudal movement.n = 4).In this retrospective study, the accuracy of pre-treatment digital setups of twenty-six patients, planned for orthognathic surgery, was evaluated. The results reveal significant differences between the setups and the actual outcome for all tooth types and in all tooth displacement directions indicating a discrepancy between expected tooth movements and the outcome. Incisors, canines and premolars in the maxilla showed significantly more extrusion than expected in the setup. Upper and lower canines showed more mesial crown angulation, backward and distal crown rotation. Lower canines were more buccally positioned. Premolars and molars in the maxilla had a more posterior position in the actual outcome. Premolars showed more distal rotation in both jaws and more buccal and backward crown rotation in the maxilla. Lower premolars were more buccally positioned. Upper molars did not reach the expected expansion as planned in the setup and showed more mesial rotation. In the mandible more buccal crown rotation and more extrusion than expected in the setup were found for molars.The differences in this study between setups and outcomes were evaluated in relation to the patient’s facial skeleton due to integration of the dental model in the CBCT scans. This could explain the relatively large differences in vertical dimension in this study.For an assessment of the clinical relevance of the differences between setup and outcome tolerance levels are considered. Based on available tolerance levels in the literature ,18,19, lThere’s a lack of reliable data on this subject, which contrasts with the increasing use of digital setups in daily practice. There are some studies regarding the accuracy of setups in patients planned for clear aligner treatment ,13 and fThe error of the method in the present study can be regarded as a sum of errors related to the superimposition of the CBCT scans and dental models. The maximum mean error of the method ranged up to 0.36 mm for translational differences and 1.54° for rotational differences.Another possible explanation could be the use of customized preprogrammed appliances in the aforementioned studies. Although literature is ambiguous, customized lingual appliances could be more accurate in achieving the expected outcome . ConcernAdditional analyses were performed to investigate the role of extractions and the SARME procedure on the results. In general, we can conclude that in extraction cases ideal arch shape and torque of incisors were more difficult to maintain or achieve. Furthermore, we see difficulties in maintaining the right angulation of teeth neighboring the extraction diastema and more unwanted deepening of the curve of Spee. These are well known effects of premolar extractions on the orthodontic outcome and were confirmed by the results in this study .In addition, SARME may have played a role. Significant errors were seen for the pitch for all tooth types in the maxilla and incisors in the mandible, as a result more retroclined incisors and more distal tipping of (pre)molars were seen in the setups.Canines, premolars and molars were significantly more posterior positioned in the outcome than in the setup. Upper molars showed more extrusion than expected. An increased dental show and inferior movement of the maxilla after SARME has been described earlier . This agA limitation of this study is that only one operator fabricated the orthodontic setups. We did so, to remove the operator effect. Nevertheless, the method is subject to inter-operator variability. Previously, it was shown that inter-operator differences in producing set-ups were clinically acceptable for 74% to 90% of the differences . AlthougAlthough the results in this study indicate that the use of a digital orthodontic setup to predict the pre-surgical outcome of orthodontic treatment is not yet accurate enough, especially in extraction and SARME cases, more research can improve the accuracy. Method errors can be diminished by using more accurate algorithms and artificial intelligence and automatization of the procedure can reduce the operator susceptibility. Use of customized preprogrammed appliances based on the setups instead of the use of non-customized appliances might also lead to a more predictable outcome of the presurgical orthodontic treatment. For certain tooth movements, there are significant differences between the orthodontic setup and the actual outcome of the presurgical orthodontic treatment as part of an orthodontic-orthognathic treatment trajectory. The accuracy of the digital setup is still too limited to correctly simulate the outcome of presurgical orthodontic treatment.No patents resulted from the work reported in this manuscript.


Professionals in the inpatient care of burdened children and adolescents are confronted with high demands in their daily work. The job satisfaction can be affected negatively, if these professionals do not have the necessary resources to carry out their work.In a study as part of the accompanying research of an online course called “Trauma informed Care”, the connection between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction were investigated on a sample of N = 543 professionals working in the (inpatient) care of children and adolescents.In order to quantify the connections between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction, correlations and a multiple regression were calculated.Moderate to strong correlations were identified between personal resources and job satisfaction among the professionals. The regression model revealed self-efficacy to be the most important predictor of job satisfaction. Self-care was also identified as an important predictor. Less importance could be ascribed to emotional competence. Action competence showed no effects in the regression model.The results indicate the importance of personal resources for job satisfaction an their targeted promotion in order to increase job satisfaction and thus counteract the tendency of fluctuation and shortage of professionals in the area of child and youth welfare.No significant relationships.


This Research Topic aimed to promote the publication of new developments that could deepen our understanding of invertebrate parasitism, such as parasite physiology, reproduction, and microbiota interplay during host-parasite dynamics. Papers published on this topic highlighted the importance of studies on invertebrate parasite cell biology and physiology, and further evaluated the economic impacts caused by these organisms. Advances in molecular biology, biochemistry, and studies on drug discovery used to control invertebrates have not progressed at the same pace of basic research on these complex multicellular organisms . For example, the lack of known specific targets for drugs and pesticides deployed on a large scale worldwide leads to an enhanced exposure of local populations and reduced efficiency of deployed strategies. As a result, economic losses and emerging resistance to treatments have been observed. Crop losses due to pests and diseases are a major threat to the incomes of rural families and food security worldwide .Coptotermes formosanus, Wenhui Zeng et al. studied the impact of demography on the behavior and innate immunity of termites. They observed that infected workers would self-sacrifice to maintain soldier proportion of the group. Indeed, a high proportion of soldiers was demonstrated to be associated with sanitary care of the workers to the nestmate workers and soldiers.The social behavior of termites is an important obstacle to their biological control, as the dynamic mechanism that coordinates social immunological defense and caste distribution remains undefined. Studies of host-parasite interactions of entomopathogenic fungi in different caste members can improve our understanding of the mechanisms of functional adaptation between pathogen-driven social immunity and termite demographics, evidencing new alternatives for biological controls . Using CGwokyalya et al. showed that the cellular immune response of the fruit flies is a key regulator of host-parasitoid dynamics during exposure to the parasitc wasps. Bactrocera dorsalis exhibited a stronger cellular immunity, contributing to its successful invasion and establishment across several ecological zones. The authors showed that D. longicaudata markedly reduced the host immune defenses. This partly explains the high parasitism rates achieved by D. longicaudata, making it a good control agent for many tephritid fruit fly pests.Fruit flies are important vectors of pathogens driving food poisoning in several countries. Parasitoid wasps have been used as biocontrol pests against several pests with varying levels of success. Most studies investigating host-parasitoid models have focused on functional and evolutionary aspects, leaving a gap in knowledge about the physiological mechanisms of tephritid biocontrol agents. Cellular immune responses are central to the host-parasitoid interaction in specific fruit fly and wasp species, presenting greater potential as a biocontrol agent. Rehemah Viktoria E. Nikishchenko et al. demonstrated that the structures of the sensory, muscle and nervous systems of the larvae of Nodularia douglasiae differ from the larval systems of marine bivalve species. The authors found that the glochidia sensory system included four pairs of tubulin-lir multicilia hair cells and non-ciliar tubulin-lir cells. These cells synthesize the neuropeptide FMRFamide and were identified as afferent neurons collecting information from peripheral tubulin-lir hair sensory cells to nervous regulators. The authors concluded that the nervous system of N. douglasiae glochidia is drastically different from other mollusks and lophotrochozoans because of the absence of an apical organ and the location and composition of FMRFamide and 5-HT cells.The structural plan of unionids - freshwater bivalve mollusks with a parasitic larval stage—is generally conserved, sharing a morphological structure adapted to the parasite’s lifestyle and survival. However, little is known about the neurodevelopment of freshwater mussels (Unionoidea). Lin Cheng et al. described a total of 462 unigenes of Tessaratoma papillosa related to growth and development. 1,851 unigenes related to digestion and detoxification, and 70 unigenes related to olfaction. They showed that the T. papillosa major life activity genes are uniformly expressed across all developmental stages. However, adult midgut gene expression was utterly different from that of the nymphs. Similarly, female fat body genes exhibited distinct expression patterns compared to that of males and nymphs, providing reference information for putative genes targeting the control of this herbivorous insect.Stink bugs are the major pests of lychee trees. These insects’ secretions are not only harmful to plants, but also to humans. Omics data are useful for understanding the growth and development of insects and identifying pest control targets . UnderstLiping An et al. found that the microbial community composition of Rhipicephalus sanguineus changed significantly with starvation stress. The bacteria Coxiella spp. of R. sanguineus gradually decreased thorough the starvation. Nymphs were treated with ofloxacin and allowed to develop into adults. Adult blood-sucking rate, adult weight after a blood meal, fecundity, and feeding period of the newly hatched larvae were all affected to varying degrees. The control of microbial composition or diversity through antibiotics can have an impact on tick development and affect it to varying degrees.The Brown dog tick is the most widespread tick in the world and is a predominant vector of multiple pathogens affecting the wildlife, domestic animals, and humans. The One Health paradigm emphasizes the importance of studying invertebrate physiology, especially in parasitic arthropods with non-specific relationships with their vertebrate hosts (euryxene). Tick gut microbiota is influenced by several factors, including tick species, dietary blood supply, and physiological stress. Nevertheless, the composition of tick microbiota has remained largely understudied, especially when compared to insect’s. Overall, these articles explored different tools and techniques, from a wide range of experts that strongly contributed toward the advance in the physiology of invertebrate parasites. Advanced research in cell biology and a better understanding of invertebrate physiology associated with economic losses are essential to assess the effectiveness of parasite and pest protection strategies, enabling sustainable interventions with biological or pharmacological controls .


This studyexplores students' experiences of learning based on patients' written feedback,obtained through the Patient Feedback in Clinical Practice (PFCP)questionnaire.Fifty-nine medicalstudents evaluated their learning experience of receiving patients' writtenfeedback obtained from the PFCP questionnaire. Students (N = 57) evaluatedtheir experiences by applying a nine-question evaluation survey  and/or participated in a semi-structuredinterview (N = 6 students). Data were analyzed using descriptive statistics andqualitative content analysis.The analysis ofdata from the students' evaluation survey was performed using 4-point Likertscale questions presented in mean, SD and range; ability to applypatient-centred communication , guidance for further clinicaltraining of clinical skills  and visualization of thepedagogical assignment during an encounter . A content analysisof the free-text questions from the students' evaluation surveys and interviewsresulted in three themes: (1) confidence in clinical practice, (2) applicationof patient-centred communication and (3) identification of learning needs.The resultsindicate that patients' feedback facilitated a reflective self-directedlearning process with the identification of learning needs and increasedawareness of the patient as a collaborative partner during the encounter.Patients' written feedback adjacent to a patient encounter is identified as avaluable additional learning tool in medical students' workplace learning.Further studies are required to explore how patients' written feedback can beoperationalized in different clinical contexts, for example, in in-patientcare. In a previous study, we developed a questionnaire for patient's feedback to medical students, the patients' feedback in Clinical Practice (PFCP) questionnaire, for provision of feedback adjacent to a patient encounter.Therefore, the current study aims to explore medical students' learning experiences from patients' written feedback obtained through the PFCP questionnaire.This study was conducted at the undergraduate medical programme at Karolinska Institutet (KI) in Stockholm, Sweden. Data was collected during the students' workplace learning at eight primary health care (PHC) centres, including areas with different socioeconomic status in Region Stockholm. The study explores students' experiences of learning from patients' written feedback, obtained from the PFCP questionnaire,During the study period of two years, fifty-nine medical students  were included in the study and received written feedback from patients .All students in the included semesters  were invited by e-mail to participate. The students and patients received oral and written information at the PHC centres. Prior to including students and patients, written consent was obtained from the management and clinical supervisors at the PHC centres. The Regional Ethical Review Board approved the study in Stockholm (Dno: EPN 2017-1574-31-1). Written consent was obtained from all participants.,In alignment with the generic model for doctor-patient communication at Maastricht Medical School, communication skills and patient-centredness are taught at the medical programme at KI.The PFCP questionnaire is a validated questionnaire developed for patients' written feedback to medical students in PHC.The data included students' evaluation survey and additional semi-structured interviews with students. The students evaluated their learning experiences from patients' written feedback obtained from the PFCP questionnaire. Data was collected by one of the authors (KB) during the students' workplace learning at PHC centres, KB had no relation to the participants in the study.Prior to data collection, an evaluation survey was developed to explore the students' experiences of how the patients' feedback from the PFCP questionnaire facilitated their learning regarding communication and patient-centeredness. The questions were developed through discussions among the authors. The students' evaluation survey included both open and closed questions to ensure coverage of the predefined elements.The final evaluation survey contained nine questions see . Three qThe questions from the evaluation survey were also used as a semi-structured interview guide, with follow up questions added for in-depth information and examples. These questions included, for example, 'Can you further describe how you experienced receiving patients' written feedback from the PFCP questionnaire?' and 'Can you further describe how the patients' written feedback could be applied as a tool in your learning?' Areas for the follow-up questions were discussed among the authors during the process of developing the questions to the students' evaluation survey see .23Prior to data collection, patients gave written feedback to medical students through the PFCP questionnaire adjacent to an encounter. The patients assessed their perceived experiences with the student-led encounter regarding communication and patient-centeredness. The patients received and filled out the PFCP questionnaire in the waiting room after the student-led encounter at the PHC centre (distribution and collection of questionnaires by KB). The students were handed (by KB) the patients' feedback at the end of the workplace day during roundups with their clinical supervisor. After the students had fulfilled the clinical rotation, the PFCP questionnaires were collected, and the data was documented in an Excel spreadsheet by KB. The patients' written feedback of the perceived experience of the clinical encounter, as obtained from the PFCP questionnaire  and range) and free-text comments), is presented in Appendices 1 and 2.After receiving the patients' written feedback, obtained from the PFCP questionnaire, the students filled out an evaluation survey. In addition, to further explore the students' experiences of receiving patients' written feedback, six students participated in a semi-structured interview performed by KB. The interviews were audio-recorded and transcribed by KB. Evaluation surveys were collected and documented in an Excel spreadsheet by KB.Data from the students' evaluation survey  was analyzed using descriptive statistical methods The qualitative data from the free-text questions from the students' evaluation survey and interviews were analyzed using qualitative content analysis.The text from the transcribed interviews was read repeatedly for a global understanding by KB and CL, and notes were taken. The meaning units were identified. The units were condensed according to the perceived key content areas. The units were compared to ensure consistency. The meaning units were sorted into categories and established by KB and CL.Finally, the analyses of the students' evaluation surveys and interviews were merged, resulting in four themes. All of the authors identified the themes in the process of negotiated consensus.The results from the questions with a 4-point Likert scale in the students' evaluation survey  are presented in The qualitative analysis of the free-text answers in the students' evaluation survey and the interviews resulted in three major themes: (1) increased confidence in clinical practice, (2) application of patient-centered communication, and (3) identification of learning needs. Within each theme, two sub-themes were identified. The themes and sub-themes are illustrated in The major content in this theme included aspects of how the patients' feedback facilitated students' confidence in their own performance. The students described that being acknowledged by the patients in certain aspects provided an increased self-confidence in clinical practice and facilitated their ability to apply a self-directed and reflective learning process.The patients' feedback was believed to confirm the adequacy of the chosen strategy and performance during the encounter. This constructive confirmation boosted the overall self-confidence in clinical practice for the students and strengthened their confidence in their present level of competence."The positive feedback that strengthens my self-confidence". The student's own experiences of their performance in communication and clinical competencies during the encounter were supplemented through the patients' perspectives."A mini-confirmation that I can capture the patient's concerns, expectations and that they experience that I saw them". In addition to self-confidence, the students indicated that the patients' feedback provided tools to facilitate a self-directed and reflective learning process."I saw that I sometimes did not lift and alleviate the patient's concern/dissatisfaction and received a chance to see that when I put more focus on those aspects, the patients became more satisfied". "I can link it [feedback] directly to what I did in the room, in the situation it happened, how I thought and what I can develop further". The patients' feedback also contained valuable confirmation that the students were perceived as demonstrating empathy and respect for the patients during the encounter."They [patients] gave positive feedback regarding how my compassion was perceived, which is difficult to estimate on my own".  "Very interesting to both being confirmed what I thought went well and rewarding/educational to realize where I did not interpret 100% of the patient's expectations right". This theme includes perspectives of how the patients' feedback clarified the value and usability of patient-centered communication as a working method in the dialogue with the patient and in the importance of the patients as a collaborative partner during an encounter.The students described how the patients' feedback clarified the benefits of using and learning patient-centered communication techniques as a structure in a consultation."To continue using a patient-centered consultation and understand the value of bringing forth patients' ideas, concerns and expectations". "It was very useful to consider how my own conception of consultation was consistent with the patients'. Patients will immediately answer if they have been given the opportunity to express ideas, concerns, and expectations". For the students, the patients' feedback highlighted the importance of the patient as a collaborative partner during an encounter. Several students stated that the patients' feedback added a valuable perspective to better understand the power of integrating the patients' agenda, that is, the received information as a prerequisite for the provided information throughout the encounter. This also includes patient safety aspects in terms of communication techniques to secure mutual agreement and understanding. For a health provider, this emphasized the importance of having a respectful role as both the receiver and sender of information."Above all, getting patients' ideas, concerns, and expectations make my own work as clinician easier when I understand the patient's agenda". "A little surprising how different caregiver and patient can feel after a patient visit from a positive point of view". The theme includes different aspects of how the patients' subjective feedback facilitated the students' identification of specific areas and competencies for improvement.For the students, the patients' feedback identified areas of improvement for further clinical practice regarding patient-centred communication techniques. The patients' feedback also clarified that the students must adjust their own professional language to enhance the patients' ability to understand and participate in the dialogue during the encounter."Suggested several shortcomings, e.g., in patient's ability to express his concerns, etc.". "Do not forget ICE ! ...". "Need to remember to ask the patient if he/she is concerned about something". In addition, the patients' feedback provided the students with valuable information, highlighting the student's pedagogical assignment throughout an encounter to provide valuable and actionable information to the patient."Adapt my language according to the different patients need. Be clear and avoid using medical language during the dialogues with patients". "Provides insights on whether you, as a clinician also has a pedagogical approach…". The students experienced that the patients' feedback provided information regarding the level of clinical competences, that is, the areas for improvement of clinical knowledge and skills. The feedback also targeted the importance of the fact that to perform a patient-centred encounter, adequate theoretical and clinical knowledge is required. Many students described this as an eye-opener, stating that the combination of communication skills and medical expert knowledge is a prerequisite for a successful outcome in clinical practice."Clarifying warning flags for which the patient should seek medical care". "Reminded me of what I forgot to perform or ask during the medical history/clinical examination". "It becomes clear that when one feels the medical knowledge is lacking, communication becomes more restricted from my side". Our study explored students' learning experiences from patients' written feedback, obtained using the PFCP questionnaire, adjacent to a patient encounter.The results from the students' experiences of learning, obtained from the students' evaluation survey , indicated that the patients' written feedback visualized the students' ability to apply patient-centred communication and provided guidance for further clinical training. In addition, the patient's written feedback visualized the value of the student's pedagogical assignment during an encounter. The student's experience of their learning by use of the PFCP questionnaire was explored in an evaluation survey and through semi-structured interviews, which in thematic analysis resulted in three themes: (1) increased confidence in clinical practice, (2) application of patient-centered communication, and (3) identification of learning needs.,,,,,The students in our study described that they experienced enhanced self-confidence in clinical practice as a result of patients' written feedback, which also has been described by the previous authors.,The usefulness of a patient-centred communication model as a tool to structure the dialogue and increase the patient's participation in the dialogue was perceived to be clarified through the patients' written feedback. The students expressed an understanding of how lack of theoretical and/or practical competencies affected both their ability to communicate and apply patient-centredness throughout the encounter. The relationship between the necessity of solid knowledge and skills and the ability to communicate and apply patient-centeredness has been described in the studies by Finch and colleagues,,-Our results of students learning from patients' written feedback are consistent with the findings in previous work despite variations in the methodology and research.Hattie and colleagues,Some previous studies have indicated that students prefer feedback from clinical supervisors.The current study included students from several semesters at eight PHC centres representing different socioeconomic populations. The patients further represented different ages and genders with various problems and diseases. Data from the students' evaluation surveys were further elaborated with the addition of individual interviews to capture in-depth perspectives regarding the students' experiences of their own learning. The detailed description of the collection and analysis of the data aimed to increase the transferability of our findings. The cohesion of the results in the students' evaluation surveys and interviews and the results of the descriptive data indicated that a mixed-methods approach for data collection was appropriate.Although the findings in this study suggest that written feedback from patients obtained directly after an encounter can play a more significant role in medical education, there are some limitations to consider. One such limitation could be that the present study only considered students' experiences of patients' written feedback from a specific questionnaire, which could limit the generalisability of our findings. The questionnaire focused on communication skills and patient-centredness, hence potentially limiting the patients' opportunity to provide feedback from other perspectives. To compensate for an eventual lack of aspects that were not perceived to be covered by the items, the patients were offered to add free-text comments after each item and in a supplementary open-ended last question.During the present study, some questions were answered, and a number of questions remain to be explored within the field of patients' written feedback as a facilitator in students' workplace learning. Further studies are also required regarding the models for implementing the patients' written feedback in different educational or clinical contexts. In addition, further studies are required to explore how patients' scoring items in the PFCP questionnaire can be related to the fulfilment of the intended learning outcomes.The results indicate that patients' written feedback obtained from the PFCP questionnaire can be an important resource in students' workplace learning and an adequate educational tool facilitating communication and patient-centredness learning in medical education. Through the PFCP questionnaire application, which provided concrete feedback adjacent to a patient encounter, students' motivation for further clinical training, progressive development of communication skills and the application of patient-centredness could be facilitated. The patients' feedback was perceived as a useful resource for the students to identify the ability to communicate and apply patient-centredness during an encounter and to target areas for further clinical training during the students' workplace learning. The patients' feedback seemed to provide students with increased confidence in clinical practice, which facilitated a reflective, self-directed learning process. Furthermore, patient-centeredness was stressed as an important working method, and increased awareness of the patient as a collaborative partner throughout an entire encounter was visualized through the patients' feedback. The patients' written feedback adjacent to a patient encounter was identified as a valuable additional learning tool in medical students' workplace learning. Further studies are required to explore how patients' written feedback can be operationalized in different clinical contexts, for example, within in-patient care.We gratefully acknowledge the heads of the PHC centres, the clinical supervisors, and the staff at PHC centres and the medical students and the patients for their participation and for making this study and subsequent article possible.The authors declare that they have no conflict of interest.


Studies over the past decade have shown how stem cells representing embryonic and extra-embryonic tissues of the mouse can self-assemble in the culture dish to recapitulate an astonishing part of early embryonic development. A systematic analysis has demonstrated how pluripotent embryonic stem cells can be induced to behave like the implanting epiblast; how they can interact with trophectoderm stem cells to form a patterned structure resembling the implanting embryo prior to gastrulation; and how the third stem cell type—extra-embryonic endoderm cells—can be incorporated to generate structures that undergo the cell movements and gene expression patterns of gastrulation. Moreover, such stem cell-derived embryo models can proceed to neurulation and establish progenitors for all parts of the brain and neural tube, somites, beating heart structures and gut tube. They develop within extra-embryonic yolk sacs that initiate haematopoiesis. Here we trace this journey of discovery. At that time, Martin and Matthew Kaufman were in the process of establishing the first embryonic stem cell (ESC) lines, an achievement contemporaneous with similar work by Gail Martin at UCSF . ESCs argastruloids. These structures could break symmetry, specify the germ layers and develop axial organization including the appropriate expression of Hox gene clusters notably in the absence of any extra-embryonic tissues . T. Ta) [34. 7ex utero to the head-fold stages (0–5 somites) after nearly 4 days in culture [ex utero mouse embryos, Patrick Tam had tested a variety of media in the early 1980s and concluded that Dulbecco's modified Eagle's Medium (DMEM) with additional glucose and glutamine being critical together with correctly prepared mouse or rat serum present at greater than 50% to achieve development to the somite stage [Could the gastrulating embryoids formed using induced XEN cells develop further? With this question in mind, the Zernicka-Goetz lab revisited previous studies for post-implantation embryo culture. The laboratory had previously developed so-called IVC media that enabled both natural mouse and human embryos to develop from blastocysts through to gastrulation in the culture dish ,36. Othe culture ,38. To ate stage . In the te stage ,41 allowte stage ,43. Morete stage . It remate stage  to facil. 8It was May 2020 at the beginning of the Covid-19 lockdown when the Zernicka-Goetz group submitted their work showing gastrulation in ETiX embryoids incorporating extraembryonic endoderm from ESCs . They weThe most striking feature of the neurulating ETiX-embryoids, setting them apart from gastruloid systems was their ability to recapitulate development of all brain regions . At day Pax6 in the ESC line used to build the embryoids to test the consequences for neural tube patterning in embryoids. In line with the known mouse knock-out phenotype [In revising the manuscript, the group knocked out henotype , there whenotype . This va. 9The ETiX-embryoids also displayed the expected gene expression pattern of neuromesodermal precursors, which give rise to derivatives of the neural tube and paraxial mesoderm . As in n. It will be of considerable future interest to determine whether development of the stem cell-derived embryo models can be extended beyond this stage.Gene expression signatures also revealed the initiation of gut tube development from definitive endoderm and VE gut progenitor cells. Markers for the specific organs of the gut tube were not expressed in line with the developmental stage reached by the embryoids and the known onset of organ-specific identities in the gut tube at a later stage (E8.75)et al. [The primordial germ cells were another matter. These repositories of the genome for the next generation are set aside early in embryonic development. Indeed, it was already known from the study by Harrison et al.  that priet al. .. 10A really striking feature of the embryoids was that they developed inside membranes that resembled the amnion and yolk sac, whose natural role is to provide nourishment to the embryo until the foetal-maternal circulation becomes established. The presence of these structures reflects the participation of extra-embryonic tissues, specifically the extraembyonic endoderm, in the assembly of embryoids to give rise to both yolk sac and amnion cells. Not only did the ETiX embryoids develop a yolk sac but their extraembryonic portion supported haematopoiesis just as in natural development. This was evident from the formation of Runx1-positive blood islands in the mesoderm of the yolk sac and at the base of the allantois of neurulating embryoids at day 8 . In accoHowever, the parietal/visceral endoderm-derived lineages were not perfect in the embryoids as some of these cells were at an immature stage in their developmental programme. Such cells began to appear in the day 6 embryoids, but the vast majority of these potentially aberrant cells appeared at day 8. The lineages derived from trophectoderm were also not perfect. During natural development, the proximal portion of the ExE differentiates into the ectoplacental cone (ECP), precursor of trophoblast giant cells and spongiotrophoblasts and although markers of these cells could be detected, the ECP lineage was not fully developed even though development of the chorion lineages had largely taken place.A further indication of the importance of the correct specification of trophectoderm-derived tissue came from graduate student Kasey Lau in the Zernicka-Goetz lab, working in collaboration with Yonatan Stelzer's lab at the Weizmann Institute. Kasey had made embryoids from three stem cell components in which not only extraembryonic endoderm was generated from ESCs, but also TSC-like cells. In the latter case, ESCs were induced to develop into TE-like cells by expression of the TE-determining transcription factor, Cdx2. Strikingly these EiTiX embryoids also developed into structures at the head-fold stage with neural tubes, somites and beating hearts . UnknownCdx2 ESCs (97.26%) gave rise to chorion lineage and the small number that did not, appeared not to have been induced to differentiate [Cdx2 ESCs have restricted differentiation potential. In natural embryos, Sox2, Cdx2 and Eomes are downregulated in the distal part of the ExE, where the EPC and TGC subtypes are found [It seemed that the embryoids in which both extraembryonic lineages were derived from ESCs developed to the neurulation stages at a lower efficiency. Moreover, the Hanna group also found that their equivalent of ETiX embryos developed better than EiTiX embryos . Clues arentiate . The EPCre found  but in Dre found .. 11in utero; and partly because transcription factor-mediated induction biases iCdx2 ESCs to differentiate into chorionic cell types. To correctly represent TE-derived cells in development, it might be necessary either to induce expression of genes promoting ExE differentiation or to downregulate TSC-like genes to generate EPC and TGC subtypes in EiTiX embryo. Understanding of the precise roles of such cells in the developmental process needs future engineering.The lack of EPC and TGC cell types in EiTiX embryoids is a shortcoming of this particular system. It could arise partly because EiTiX-embryoids lack the interactions with the maternal environment that they would have The extra-embryonic tissues not only need to have correct interactions with the developing epiblast to promote correct development, but they must also develop to form the correct structures that interface with the mother. The current embryoid models built from embryonic and extra-embryonic stem cells take the embryoids to a stage at which, in natural development, the embryo would become reliant upon the developing placenta. One of the next challenges will be to develop ways of substituting for these placental functions to enable continued development. Extrapolating these systems to other mammals, particularly humans, will present a considerable challenge because of the diversity of placental structures. Moreover, the spatial organization of the implanting human embryo differs markedly from the mouse in that it is a disc-like structure, as opposed to a cylinder, and within this disc there is an additional cellular compartment, the amnion, which is derived from the pluripotent epiblast. Thus, we might anticipate distinct differences in the pathways of morphological remodelling and molecular signalling between these tissues throughout the post-implantation developmental stages of mouse and human that will be fascinating to unravel.


Emergency room nurses have a strong influence on the population of smokeless tobacco users. If healthcare providers address patient's tobacco use by using a brief intervention strategy (one minute or less), it increases the quit attempt rate threefold. The object of this study is to assess the effectiveness of asynchronous internet based brief tobacco intervention training with rural emergency room nurses.t-tests were used to compare the pre-and post-test results.A 1-h asynchronous training session on smokeless tobacco use and the 2-A and 1-R  brief tobacco intervention strategy were given to 13 emergency room nurses at a rural acute care hospital in West Virginia. Paired sample The 1-h training session produced significant and positive increases in all items measured: increased motivation to assist patients in quitting; increased knowledge of smokeless tobacco use, its dangers, and cessation processes; increased self-efficacy in implementing brief interventions; increased perception of tobacco cessation as important; increased perception of the effectiveness of tobacco cessation interventions; and increased acknowledgment of barriers and an awareness of how to deal with them.The results suggest that there is a significant potential benefit from training emergency room nurses. Brief tobacco interventions should be conducted by clinical staff during the medical history check, physical examination, or discharge phases of the emergency room visit. Although the consequences of illness, disease, and death from tobacco use are well identified and known, to the extent that it is considered to be a chronic disease , it remaIn a standardized review of over 14,000 emergency department admission screenings from across six states in the United States (including West Virginia), 47% of emergency room patients had used some form of tobacco within the past 30 days –7, whichWhen patients in emergency departments are educated on the dangers of tobacco use and are referred to a treatment source, they are more likely to initiate contact with a treatment provider . PatientHealthcare providers are more likely to conduct brief tobacco interventions that result in the client being referred to a national or state-level tobacco quit line . Quit liRural nurses are more likely to view tobacco cessation as part of their role than urban nurses . System-With nursing staff often unable to attend in-person training, the study aims to assess the effectiveness of asynchronous internet based brief tobacco intervention training with rural emergency room nurses.Most nurses leave the subject of tobacco cessation to the provider. Only a few currently use any CDC-recommended intervention or refer smokeless tobacco users to the West Virginian tobacco quit line.Emergency room nurses should feel that tobacco cessation is “very much” a part of their job duties. Nurses should typically spend 3–10 min with patients on tobacco cessation education, using CDC-recommended interventions. Furthermore, nurses should increase their knowledge and self-efficacy in the delivery of smokeless tobacco cessation interventions.This project was conducted in agreement with the West Virginian Division of Tobacco Prevention. The participants were 13 emergency room nurses at Welch Community Hospital in McDowell County, an acute care facility owned and managed by the West Virginian Department of Health and Human Resources and located in the rural coalfields of the state. The emergency room nurses included five licensed practical nurses, nine registered nurses, and one family nurse practitioner. Nurses from all work shifts participated–i.e., day shift, evening shift, and night shift. Participation was voluntary and participants acknowledge their own interest and willingness to be a part of the study, as shown by the informed consent. Nurses were recruited by a graduate student who also worked in the emergency room.(1) All nurses participated in the asynchronous internet based brief tobacco intervention training on how to implement smokeless tobacco and the brief tobacco interventions (2-As & 1-R) for brief smokeless cessation counseling with emergency room nurses. Nurses will have the option to complete the same training via webinar if their schedule does not permit participation in the face-to-face training.(2) Nurses used a guideline algorithm of the brief tobacco interventions, as provided by the CDC, with patients who use smokeless tobacco.(3) When encountering tobacco users motivated to quit, nurses used fax quit line referrals or direct patient referrals (quit line cards) to the state tobacco quit line for proactive telephone counseling.(4) Nurses received weekly support from a certified tobacco treatment specialist. This support was for nurses who have questions or encounter situations not covered in the training or the CDC algorithm.(5) The intervention phase lasted 30 days at the site.Effective Training Assessment Instrument: Tobacco use status; motivation to help patients stop using tobacco; knowledge of performing tobacco interventions; confidence in ability to help patients quit; the importance of tobacco use in preventive care; perceived effectiveness of tobacco interventions; importance of addressing barriers; preparedness to provide intervention; how often the nurse sees patients affected by tobacco use; reactiveness in addressing tobacco use; success in helping patients quit; and how often the 2-As and 1-R brief intervention is used. The post-training instrument measured the same items see . All iteKnowledge Assessment Instrument: The pre-training assessment instrument was a 20-item multiple choice questionnaire. The questionnaire tested nurse's knowledge of the following items: the difference in the level of harm between e-cigarettes and traditional cigarettes; levels of cravings with e-cigarettes; the effectiveness of nicotine patches with e-cigarettes; teen use of e-cigarettes; the role of the FDA oversight; the profile of an e-cigarette user; the use of an e-cigarette in tobacco cessation attempts; the level of nicotine in smokeless tobacco; prevalence data for West Virginia; the role of healthcare providers in tobacco cessation interventions; and the average number of cessation attempts before sustainable abstinence. The post-training instrument was measured by using the same items. Nurses had to achieve a score of at least 80% to pass the post-test and access the continuing education unit.This study was approved by the Institutional Review Board at both Capella University and West Virginia University. Informed consent was received from all participants in the study. The identity of the participants remains anonymous and all data are reported in the aggregate format. An error was made in coding the pre- and post-effective training assessment instrument, as they were not blind coded correctly. Therefore, assessments were randomly assigned codes for the analysis.n = 13). All nurses identified as white (100%) in race. Most reported never having used tobacco regularly (46.2%), although almost one-quarter (23.1%) were current tobacco users and 7.7% were former tobacco users. The mean age of participants was 38.66 years, ranging between 24 and 57 years. The emergency room nurses included five licensed practical nurses, nine registered nurses, and one family nurse practitioner. Nurses from all work shifts participated. The mean number of years of practice as a nurse was 13.86 years.For the analysis, the participants were grouped into one professional group: emergency room nurses  (see 020) see . The pos020) see .Proactive in addressing tobacco usage yields a statistically significant difference as a function of the independent variable  (see 023) see . The pos023) see .How often the 2-As & 1-R brief is used yields a statistically significant difference as a function of the independent variable  (see 000) see . The pre000) see . Note thPercentage of correct answers yields a statistically significant difference as a function of the independent variable  (see 007) see . The pos007) see .Emergency room nurses trained in smokeless tobacco knowledge and evidence-based brief tobacco interventions increase their knowledge of tobacco usage as well as develop positive attitudes toward tobacco intervention strategies such as the 2-As and 1-R method and the state tobacco quit line. These increases seem to suggest that training leads to higher rates of brief tobacco interventions with patients in the emergency room setting. The rates of cessation of the patients are not known.With shrinking tobacco cessation budgets in West Virginia and across the nation, using asynchronous webinars as training platforms and focusing on healthcare providers to deliver brief tobacco interventions are cost-effective tools. In this case, almost 90% of the sample hospital's emergency room nurses were trained and willingly implemented the brief tobacco intervention, all at minimal cost. The same asynchronous webinar is now being used in healthcare facilities across West Virginia.The project is sustainable without future funding. The webinar training and implementation by the nurses provide a skill set that need not be retaught, since the trained nurses can disseminate the knowledge they have acquired on how to conduct brief tobacco interventions to new nurses.A limitation of this project is that it is based upon the self-reporting from emergency room nurses. As such, there is no direct evidence that long-term tobacco abstinence occurs. Further data collection and investigation are needed to provide evidence that the following occur as a result of the training provided: (a) increased motivation to assist patients in quitting; (b) increased knowledge of smokeless tobacco use, its dangers, and cessation processes; (c) increased self-efficacy in implementing brief interventions; (d) increased perception of tobacco cessation as important; (e) increased perception of the effectiveness of tobacco cessation interventions; and (f) increased recognition of the importance of barriers and preparedness to deal with the barriers.The last limitation to note is that the participants were from one small acute care emergency room in West Virginia and not chosen at random. As such, generalizations from this data cannot be made due to the sample size.While it is understood that this study can not be used to generalize its finding, this study does sustenance and parallel with the findings in a larger study conducted in 2009 by researchers at the University of Arkansas .The nurses at this rural hospital emergency room initiated the project with different levels of knowledge and different attitudes, motivations, self-efficacy, and practices toward smokeless tobacco cessation. The 1-h webinar training session produced significant and positive increases in all items measured: increased motivation to assist patients in quitting; increased knowledge of smokeless tobacco use, its dangers, and cessation processes; increased self-efficacy in implementing brief interventions; increased awareness of tobacco cessation as important; increased perception of the effectiveness of tobacco cessation interventions; and increased recognition of the importance of barriers and preparedness to deal with the barriers than before the training. Most importantly, pre-and post-data reviews show a 100% increase in the frequency of using the brief intervention with patients.The results suggest large potential to benefit from training emergency room nurses. In the literature, these brief tobacco interventions should be conducted by clinical staff during the medical history check, physical examination, or discharge phases of the emergency room visit . The 2-AThe original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.The studies involving human participants were reviewed and approved by Capella University and West Virginia University. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.DR is the lead researcher and editor. KD was an assistant editor on this project and also part of the funding agency. Both authors contributed to the article and approved the submitted version.This project was funded by the West Virginia Division of Tobacco Prevention.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The assessment of heavy metal toxicity’s effects on plants will enable the evaluation of heavy metal-tolerant plant species and their use for the phytoremediation of contaminated soils.Although heavy metals are naturally present in the soil, geologic and anthropogenic activities increase the concentration of these elements to amounts that are harmful to plants. Some of these activities include the mining and smelting of metals, the burning of fossil fuels, the use of fertilizers and pesticides in agriculture, and the production of batteries and other metal products in industries, sewage sludge, and municipal waste disposal. Growth reduction as a result of changes in physiological and biochemical processes in plants growing on heavy metal-polluted soils has been recorded. Some of the heavy metal phytotoxic manifestations include the disturbance of nutrient uptake and translocation, photosynthetic reduction  and bacteria on rice plants that were grown in water polluted with heavy metals (HMs). First, Akhtar et al., 2021 [Myb), zinc-finger protein (Zat-12), and ascorbate peroxidase (Apx), while the combined effect revealed minimum expression as compared with individual treatments. Overall, the findings of this study demonstrated that the combined effect of ZnO NPs and bacteria lowered the stress-induced gene expression, while it increased the nitrogen protein content and protein expression in plant grown under HM stress. Next, the study by Akthar et al., 2022 [Bacillus subtilis-synthesized iron oxide nanoparticles (Fe3O4 NP) on rice growth under arsenic stress. The results revealed that a lower concentration of Fe3O4 NPs inhibits the arsenic level significantly and enhances plant growth, whereas a higher concentration fails to do so. It seemed that Fe2O3 NPs have different effects due to their dosage. Further research is needed to identify the basic intracellular mechanism of Bacillus subtilis to synthesize Fe3O4 NPs and subsequently increase their efficiency to remediate arsenic-contaminated water. This study suggests that Bacillus subtilus-synthesized iron oxide nanoparticles can be used as nano-adsorbents in reducing arsenic toxicity in rice plants and therefore, it is highly recommended to develop and subsequently commercialize them. As arsenic (As) contamination has emerged as a serious public health concern worldwide because of its accumulation and mobility through the food chain, the study by Khan et al., 2021  planned Since co-cropping is an eco-friendly strategy to improve the phytoremediation capacity of plants growing in soils contaminated with heavy metals such as cadmium (Cd), the study by Wang et al., 2021  aimed to−1 and favorable kinetic behavior. The results also showed that the application of liming decreased the mobility of Cd toward the seedlings, with the liming combined with charcoal leading to the absence of Cd in the cocoa seedlings. The findings, although limited to a small scale, demonstrated the possibility of applying low-cost and easy-to-handle amendments for the control of Cd in cocoa plantations.Next, a study that evaluated the use of commercial charcoal and lime in lowering the concentration of Cd in cacao grown in tropical soil  is incluLens culinaris Medik.) is an important legume crop cultivated worldwide as a source of dietary protein. This study evaluated the antioxidative and growth responses of two lentil varieties with differing seed Fe contents to Cd toxicity. It was revealed that Cd stress significantly affects lentil growth through oxidative damage. Cd stress tolerance in the biofortified genotype was attributed to strong antioxidant potential and improved growth in toxic environments due to the high seed Fe content. It is suggested that the biofortification of lentil varieties may help reduce malnutrition and improve Cd tolerance. Studies on Cd stress responses are available primarily in cereals, with minimal information reported in legumes . Lentil 2+ supply in Cd2+ uptake/translocation and toxicity in Salvia sclarea L. plants [S. sclarea plants exposed to Cd2+ toxicity accumulated a significant amount of Cd2+ in their tissues, with higher concentrations in the roots than in the leaves. The accumulated Cd2+ led to a substantial decrease in photosystem II (PSII) photochemistry and disrupted the chloroplast ultrastructure, which coincided with an increased lipid peroxidation. Zinc application decreased Cd2+ uptake and translocation to leaves, while it mitigated oxidative stress, restoring chloroplast ultrastructure and ameliorated the adverse effects of Cd2+ on PSII photochemistry. It was concluded that excess Zn2+ application eliminated the adverse effects of Cd2+ toxicity, and therefore it could be used as an important method for low Cd2+-accumulating crops, limiting Cd2+ entry into the food chain.The following paper included in this Special Issue evaluated the mitigative role of excess Zn. plants . It was 4+)-stressed salvia plants. Physiological disorders and typical NH4+ toxicity symptoms, as well as interrupted photosynthesis, were observed in the 100% NH4+-treated plants. Furthermore, cation uptake inhibition and oxidative damage were also imposed by the 100% NH4+ supply. In contrast, in the presence of Si, the NH4+ toxicity degree was attenuated and plant growth was ensured. Accordingly, the NH4+ toxicity appearance ratio decreased significantly. Furthermore, Si-treated plants showed an ameliorated photosynthetic ability, elevated internal K and Ca levels, and enhanced antioxidative capacity, as reflected by improved major antioxidant enzyme activities, as well as diminished accumulation of ROS (reactive oxygen species) and MDA . Those findings highlighted the agronomic importance of additional Si to nutrient solutions, especially pertaining to bedding plants at risk of NH4+ toxicity.The study by Song et al., 2022  evaluateLactuca sativa L. var. adela) [The aim of the following study was to investigate the ability of biochar amendment to reduce the availability of lead (Pb) in the soil and its uptake in lettuce (. adela) . Soils cMelilotus officinalis plant in the phytoremediation of soils contaminated with heavy metals  and coexisting petroleum hydrocarbons (TPH and PAH). Tests of the plant material showed that heavy metals taken up by Melilotus officinalis mainly accumulated in the root tissues, revealing a poor metal translocation from the roots to the shoots, which indicates that M. officinalis behaves as a phytostabilizer. Extensive toxicological monitoring, which is an element of novelty, carried out during the process of the biodegradation of petroleum pollutants (TPH and PAH) and phytoremediation with the use of M. officinalis allows one to track changes in toxicity that correlate with the reduction in pollutants  in the tested soils. The obtained research results confirm the correctness of the adopted concept of applying gradual soil treatment in biological processes  for the treatment of soil contaminated with heavy metals and coexisting petroleum hydrocarbons (TPH and PAH).The article by Steliga and Kluk, 2021  aimed toSasa argenteostriata to zinc (Zn) stress and combined lead (Pb)–Zn stress [S. argenteostriata were the primary organs accumulating Zn, and the absorption of Zn followed a trend of, when the concentration of Zn stress was low, the absorption of Zn by the roots increased with the increase in the concentration of Zn stress. Under combined Pb–Zn stress, the toxicity of heavy metals to S. argenteostriata was mainly caused by Pb. The roots were the main organs of S. argenteostriata that accumulated Pb. The presence of Zn could promote the absorption of Pb by the roots of S. argenteostriata, and the promotion was enhanced with increases in the Zn stress concentration. The results of this study can provide the basis for the application of S. argenteostriata in the remediation of the combined Pb–Zn contamination of soil. In the future, a long-term soil culture experiment should be conducted to further verify the toxicity of combined Pb–Zn stress on S. argenteostriata and the interaction between these elements.Finally, this Special Issue also includes a study that explored the tolerance of n stress . The rooIn summary, the eleven manuscripts included in the present Special Issue demonstrated small steps in our continued understanding of the heavy metal toxicity effects on plants. This area of research is far from complete, and greater efforts would be needed from the scientific community to enable the assessment of heavy metal-tolerant plant species and their role for the phytoremediation of polluted soils.


In immunocompetent animals, numerous factors including the immune system of the host regulate the survival of neuro-glial precursors transplanted into the cerebellum. We transplanted human neuro-glial precursors derived in vitro from partial differentiation of IPS cells into the developing cerebellum of mice and rats before maturation of the host immune system. These approaches should facilitate the development of immune-tolerance for the transplanted cells. However, we found that human cells survived the engraftment and integrated into the host cerebellum and brain stem up to about 1 month postnatally when they were rejected in both species. On the contrary, when we transplanted the same cells in NOD-SCID mice, they survived indefinitely. Our findings are consistent with the hypothesis that the slower pace of differentiation of human neural precursors compared to that of rodents restricts the induction of immune-tolerance to human antigens expressed before completion of the maturation of the immune system. As predicted by our hypothesis, when we engrafted the human neuro-glial precursor cells either in a more mature state or mixed with extracts from adult cerebellum, we prolonged the survival of the graft. The development of reproducible techniques to generate induced pluripotent stem cells obtained from mature somatic cells of patients with specific neurologic conditions permits the study in vitro and in vivo of neural and glial precursors at different degrees of differentiation up to their full maturity , 2.Despite the increasing use of organoids mimicking different areas of the brain and cerebellum , 4, orthThe barrier that the host immune system raises is commonly overcome by transplanting the hiPSdNP into immune-depressed hosts  or by chAn alternative that promotes survival and differentiation of xenogenic neural precursors is based on the seminal observation of Billingham et al.  showing Recently, we tried to replicate our successful xenotransplantation and long-term survival of mouse cerebellar precursors in rat cerebellum after intra-utero transplantation  with humBut, why does xenografting in utero cerebellar precursors from mice into the rat cerebellum induces complete and lifelong immune-tolerance  while thThese apparently contradictory results may be explained by considering that xenografted cerebellar precursors from both species differentiate in the host brain, following their species-specific developmental timing , 25. OurAutoimmune attack to both mature and fetal cerebellar antigens has been described in several autoimmune diseases that affect humans, such as autism spectrum disorder , 32 and There is an ongoing interest in modeling human neurological diseases by xenografting hiPSdNP into animal hosts , 5. Our


Hemispheric specialization of the human brain is a characteristic feature of functional cortical organization . MorpholBrain lateralization varies with the normal aging , but morJia et al.), two works explored the pathological asymmetry in Depressive disorders , one article investigated brain changes in patients with stroke  and another one studied patients with Crohn's disease and psychological disorders .The aim of the present Research Topic was to collect scientific works that explore brain hemispheric lateralization and asymmetry through Neuroimaging and Neuropsychology, as well as to bring light to their relationship with behavioral, cognitive, and symptomatic alterations in neurological and neurodegenerative diseases. A total of five articles were collected here: one was focused on the normal functioning of the human brain in language production and visuospatial attention  and visuospatial attention (right hemisphere), and specifically on their relationship in a cohort of right-handed healthy students. The authors acquired structural Magnetic Resonance Imaging (MRI) and functional near-infrared spectroscopy (firs) data of the participants to measure the cerebral lateralization while performing the picture-naming and the landmark tasks. In particular, the degree of hemispheric lateralization was quantified according to the fNIRS activation difference between the left and right hemispheres and by the lateralization index. The findings showed that the left hemisphere  was the predominant activated side by the picture-naming task, while the right hemisphere  was activated by the landmark task. Moreover, the absence of correlation between the laterality indices of these two tasks corroborated the hypothesis that different cognitive tasks may produce lateralized processing which are independent of each other .The work by Sun et al.; Zheng et al.). More in detail, Zheng et al. found that MDD patients had a decrease of the homotopic FC in the bilateral medial prefrontal cortex. Together with FC analysis, Zheng et al. found through Diffusion Tensor Imaging (DTI) that MDD patients had lower fractional anisotropy (FA)  and recurrent depressive episode patients . Interestingly, both articles  demonstrated that interhemispheric FC were associated with clinical severity in patients with depressive disorders.Two of the collected works investigated major depressive disorders (MDD), demonstrating an impairment of inter-hemispheric functional connectivity (FC) through resting-state functional MRI (rs-fMRI) analyses (opy (FA)  of the aPark et al. investigated the lateralized injury of the Parieto-Insular Vestibular Cortex (PIVC) by applying DTI analysis and explored the association between the PIVC projection pathways and the gait impairment assessed with the motricity index (MI) and the functional ambulatory category (FAC) scale. Probabilistic tractography was used for reconstructing the projection pathway to the PIVC and the diffusion metrics of both affected and unaffected side were extracted and compared. The correlation between diffusion metrics and motor function scores revealed a mild positive correlation between fractional anisotropy (FA) and motor function in the affected PIVC, while in the unaffected hemisphere, PIVC FA correlated negatively with MI. Importantly, the authors investigated the association of DTI parameters of the affected PIVC with the changes in the gait and motor function recovery process after rehabilitation. These correlations suggested that neuroplasticity may have compensated the affected PIVC by inducing the hyperactivation of the contralateral unaffected side without restoration of motor function .Huang et al. studied patients affected by Crohn's disease (CD) with psychological disorders, by analyzing brain regional homogeneity (ReHo) data extracted from rs-fMRI. The CD patients had widespread cerebral alterations compared to healthy controls, and these alterations were correlated with obsessive-compulsive scores and depression scale. These results demonstrated that CD patients could present both clinical intestinal symptoms and psychological disorders, which can affect each other .In the fifth collected article, Jia et al.), in depression disorders, , in stroke  and in CD . Moreover, we demonstrated that regional deviations from normal asymmetry are often correlated with clinical, motor and psychological scores, thus providing a valuable support in the clinical evaluation, diagnosis and prognosis of patients.In conclusion, this Research Topic highlighted the importance to investigate the brain hemispheric lateralization in the normal functioning (AS produced the first draft. AQ, MJ, and MGV revised the draft. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.