Medicine and Health Sciences Commons^™

Leptin Decreases Gluconeogenesis And Gluconeogenic Substrate Availability In Patients With Lipodystrophy, Emmanuel Quaye, Shaji Chacko, Megan Startzell, Rebecca J Brown

Children’s Nutrition Research Center Staff Publications

Context: The effects of leptin, an adipocyte-derived hormone that signals overall energy sufficiency, can only be studied in leptin-deficient conditions. In patients with lipodystrophy, a rare disease and unique model of leptin deficiency, treatment with recombinant leptin (metreleptin) improves glycemia and decreases energy expenditure. We hypothesized that these improvements might be mediated by reduced gluconeogenesis (GNG), an energy-requiring process.

Objective: To determine the effects of metreleptin on GNG and GNG substrates.

Methods: This was a single-arm prospective study of metreleptin administration in 15 patients with lipodystrophy, 9 of whom had data on GNG (NIH, 2013-2018). We analyzed total GNG, insulin-mediated …

Ints6 And The Integrator Phosphatase Module Tune The Efficiency Of Select Premature Transcription Termination Events, Rina Fujiwara, Si-Nan Zhai, Dongming Liang, Aayushi P Shah, Matthew Tracey, Xu-Kai Ma, Christopher J Fields, María Saraí Mendoza-Figueroa, Michele C Meline, Deirdre C Tatomer, Li Yang, Jeremy E Wilusz

Children’s Nutrition Research Center Staff Publications

The metazoan-specific Integrator complex catalyzes 3' end processing of small nuclear RNAs (snRNAs) and premature termination that attenuates the transcription of many protein-coding genes. Integrator has RNA endonuclease and protein phosphatase activities, but it remains unclear if both are required for complex function. Here, we show IntS6 (Integrator subunit 6) over-expression blocks Integrator function at a subset of Drosophila protein-coding genes, although having no effect on snRNAs or attenuation of other loci. Over-expressed IntS6 titrates protein phosphatase 2A (PP2A) subunits, thereby only affecting gene loci where phosphatase activity is necessary for Integrator function. IntS6 functions analogous to a PP2A regulatory …

Introduction To The Special Issue On Artificial Intelligence In Counselor Education And Supervision, Russell Fulmer, Wendell Callahan, Olivia Uwamahoro Williams

Journal of Technology in Counselor Education and Supervision

No abstract provided.

Immunosequencing Applications In Cutaneous T-Cell Lymphoma, Jenna Mandel, Laura Gleason, Daniel Joffe, Safiyyah Bhatti, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

Immunosequencing has emerged as a newer clinical test for assessment of T-cell clonality in the blood and skin of cutaneous T-cell lymphoma (CTCL) patients. Utilization of immunosequencing, also known as high-throughput sequencing of the T-cell receptor (HTS-TCR), enables identification and quantification of the precise genetic signature of dominant T-cell clones. Although immunosequencing is more sensitive than commonly used methods such as polymerase chain reaction (PCR) paired with capillary electrophoresis or flow cytometry, it remains underutilized for CTCL management. Nonetheless, incorporation of HTS-TCR in clinical practice offers distinct advantages compared to other molecular analyses that may improve diagnostic evaluation, prognostication, and …

Parallel Neural Pathways Control Sodium Consumption And Taste Valence, Yameng Zhang, Allan-Hermann Pool, Tongtong Wang, Lu Liu, Elin Kang, Bei Zhang, Liang Ding, Kirsten Frieda, Richard Palmiter, Yuki Oka

Faculty, Staff and Student Publications

The hedonic value of salt fundamentally changes depending on the internal state. High concentrations of salt induce innate aversion under sated states, whereas such aversive stimuli transform into appetitive ones under sodium depletion. Neural mechanisms underlying this state-dependent salt valence switch are poorly understood. Using transcriptomics state-to-cell-type mapping and neural manipulations, we show that positive and negative valences of salt are controlled by anatomically distinct neural circuits in the mammalian brain. The hindbrain interoceptive circuit regulates sodium-specific appetitive drive , whereas behavioral tolerance of aversive salts is encoded by a dedicated class of neurons in the forebrain lamina terminalis (LT) …

Folate Deficiency Modifies The Risk Of Cin3+ Associated With Dna Methylation Levels: A Nested Case–Control Study From The Ascus-Col Trial, María C. Agudelo, Samuel Agudelo, Attila Lorincz, Arianis Tatiana Ramírez, Kelly Melisa Castañeda, Isabel Garcés-Palacio, Arnold H. Zea, Chandrika Piyathilake, Gloria Ines Sanchez

School of Medicine Faculty Publications

Purpose: To our knowledge, there are very few studies evaluating if the levels of folate modify the risk of cervical intraepithelial neoplasia grade 2 and higher (CIN2+ and CIN3+) associated with the levels of HPV genome methylation, two cofactors related to single carbon metabolism and independently associated with cervical cancer in previous studies. We conducted a case–control study nested in a three-arm randomized clinical pragmatic trial (ASCUS-COL trial) to evaluate the risk of CIN3+ associated with methylation levels according to serum folate concentrations. Methods: Cases (n = 155) were women with histologically confirmed CIN2+ (113 CIN2, 38 CIN3, and 4 …

Metalloproteomic Investigation Of Hg-Binding Proteins In Renal Tissue Of Rats Exposed To Mercury Chloride, Emerson Carlos De Almeida, Victor Diego Faria, Felipe Dalmazzo Cirinêu, Maria G.A. Santiago, Beatriz Miotto, José C.S. Vieira, Camila Pereira Braga, Jiri Adamec, Ana A.H. Fernandes, Marília A.R. Buzalaf, Pedro De Magalhães Padilha

School of Medicine Faculty Publications

Results obtained from rat studies indicate that, even at low concentrations, mercurial species cause harmful effects on the kidneys, by inducing the nephrotic oxidative stress response. In the present work, Hg-associated proteins were identified as possible mercury-exposure biomarkers in rat kidneys exposed to low mercury chloride concentrations for 30 days (Hg-30) and 60 days (Hg-60), using metalloproteomic strategies. The renal proteomic profile was fractioned by two-dimensional electrophoresis and the mercury determinations in kidney samples, protein pellets and protein spots were performed using graphite furnace atomic absorption spectrometry. The characterization of Hg-associated protein spots and the analysis of differentially expressed proteins …

Using Ai-Supported Supervision In A University Telemental Health Training Clinic, Donna Sheperis, Shiri Sadeh-Sharvit

Journal of Technology in Counselor Education and Supervision

Artificial Intelligence (AI) technologies have the potential of transforming clinical education and supervision in university-based telemental health training clinics. AI can improve the accuracy of diagnoses, automate routine tasks, and personalize treatment plans, potentially enhancing the accessibility and quality of mental health care. In this paper, we describe why training clinics serve as an optimal setting to adopt innovation and share lessons from the field to inform future integrations of AI in clinical supervision. The lessons include support for case conceptualization, feedback on session quality, and automation of routine tasks such as sending standardized assessments and writing progress notes. However, …

Artificial Intelligence, Virtual Reality, And Augmented Reality In Counseling: Distinctions, Evidence, And Research Considerations, Sidney Shaw, Sophie Oswin, Yue Xi, Fallon Calandriello, Russell Fulmer

Journal of Technology in Counselor Education and Supervision

Technology is experiencing a growing presence in counseling and mental health, attracting attention from counselors, researchers, and the general public. This growth has the potential to change counseling practice, counselor education, and how users access mental health services. In this article we provide definitions of and distinctions between three common technologies that are used in the counseling field—Artificial Intelligence, Virtual Reality, and Augmented Reality. We also provide examples of the use of each technology, ethical implications, research support, and recommendations for future research.

Artificial Intelligence For Mental Health Support During Covid-19: Experiences Of Graduate Counseling Students, Russell Fulmer, Eric T. Beeson, Carl Sheperis, Daniel Rosello, Rebecca Edelman

Journal of Technology in Counselor Education and Supervision

The purpose of this study was to examine how an AI chatbot could provide mental health support to counselors-in-training during the COVID-19 pandemic. The chatbot “Tess” was available to participants for two weeks. Participants responded to questions about their experience and the content of this qualitative data was analyzed. Themes emerged that focused on mental health during the pandemic, utility of the AI chatbot during the pandemic, and potential therapeutic use in general. Findings were mixed and suggest some skepticism among counseling students towards the use of an AI chatbot.

Abdominal Volume Index, Waist-To-Height Ratio, And Waist Circumference Are Optimal Predictors Of Cardiometabolic Abnormalities In A Sample Of Lebanese Adults: A Cross-Sectional Study, Myriam Abboud, Suzan Haidar, Nadine Mahboub, Dimitrios Papandreou, Rana Rizk

All Works

The prevalence of cardiometabolic abnormalities is high globally. This is concerning since these abnormalities increase the risk of morbidity and mortality. Using noninvasive, low-cost, and ethnic-specific anthropometric indices is crucial for widespread screening and early detection of cardiometabolic abnormalities. In this cross-sectional study, we enrolled 221 Lebanese participants (62.9% females; mean age: 43.36 ± 16.05 years; mean body mass index (BMI): 28.43 ± 6.10 Kg/m2). The main outcome measure was cardiometabolic abnormality (CMA), defined as the presence of at least two or more non-anthropometric components of the Metabolic Syndrome. Several anthropometric indices: Total body fat percent, Conicity index, Abdominal volume …

Combination Of Thymoquinone And Intermittent Fasting As A Treatment For Breast Cancer Implanted In Mice, Shatha Khaled Haif, Lina T. Al Kury, Wamidh H. Talib

All Works

Breast cancer stands out as a particularly challenging form of cancer to treat among various types. Traditional treatment methods have been longstanding approaches, yet their efficacy has diminished over time owing to heightened toxicity, adverse effects, and the emergence of multi-drug resistance. Nevertheless, a viable solution has emerged through the adoption of a complementary treatment strategy utilizing natural substances and the incorporation of intermittent fasting to enhance therapeutic outcomes. This study aimed to assess the anticancer activity of thymoquinone (TQ), intermittent fasting, and their combination using in vivo and in vitro methods. The anti-proliferative activity of TQ and fasting (glucose/serum …

Comparative Analysis Of Rectum Delineation: Inter-Observer Agreement Among Treatment Planners Versus Auto Segmentation In A Single Institution, Haley Douglas

Masters Projects

Abstract

Introduction

The past 20 years have seen a continuous rise in the cancer patient population, resulting in staffing shortages, longer wait times for patients, and potentially lower-quality care. Artificial intelligence has been incorporated into the healthcare system and has provided ease with understaffing. Using AI technology to delineate structures can reduce planning time and variation between planners. The objective of this research is to assess the level of consistency in the rectum boundary delineation performed by different dosimetrists working at a single institution, as compared to the performance of the AutoContour software. This analysis will help determine the efficacy …

The Involvement Of Hepatic Cytochrome P450s In The Cytotoxicity Of Lapatinib, Si Chen, Xilin Li, Yuxi Li, Xiaobo He, Matthew Bryant, Xuan Qin, Feng Li, Ji-Eun Seo, Xiaoqing Guo, Nan Mei, Lei Guo

Faculty, Staff and Students Publications

Lapatinib, an oral tyrosine kinase inhibitor used as a first-line treatment for HER2-positive breast cancer, has been reported to be associated with hepatotoxicity; however, the underlying mechanisms remain unclear. In this study, we report that lapatinib causes cytotoxicity in multiple types of hepatic cells, including primary human hepatocytes, HepaRG cells, and HepG2 cells. A 24-h treatment with lapatinib induced cell cycle disturbances, apoptosis, and DNA damage, and decreased the protein levels of topoisomerase in HepG2 cells. We investigated the role of cytochrome P450 (CYP)-mediated metabolism in lapatinib-induced cytotoxicity using our previously established HepG2 cell lines, which express each of 14 …

Current Biomedical Applications Of 3d-Printed Hydrogels, Allan John R Barcena, Kashish Dhal, Parimal Patel, Prashanth Ravi, Suprateek Kundu, Karthik Tappa

Faculty, Staff and Student Publications

Three-dimensional (3D) printing, also known as additive manufacturing, has revolutionized the production of physical 3D objects by transforming computer-aided design models into layered structures, eliminating the need for traditional molding or machining techniques. In recent years, hydrogels have emerged as an ideal 3D printing feedstock material for the fabrication of hydrated constructs that replicate the extracellular matrix found in endogenous tissues. Hydrogels have seen significant advancements since their first use as contact lenses in the biomedical field. These advancements have led to the development of complex 3D-printed structures that include a wide variety of organic and inorganic materials, cells, and …

Mir-410 Is A Key Regulator Of Epithelial-To-Mesenchymal Transition With Biphasic Role In Prostate Cancer, Diana M Asante, Amritha Sreekumar, Sandip Nathani, Tae Jin Lee, Ashok Sharma, Nikhil Patel, Matthew N Simmons, Sharanjot Saini

Faculty, Staff and Student Publications

The molecular basis of prostate cancer (PCa) progression from the primary disease to metastatic castration-resistant prostate cancer (CRPC) followed by therapy-induced neuroendocrine prostate cancer is not fully understood. In this study, we elucidate the role of miR-410, a little-studied microRNA located on chromosome 14q32.31 within the DLK1-DIO3 cluster, in PCa. miR-410 expression analyses in primary and metastatic PCa tissues and cell lines show that its levels are decreased in initial stages and increased in advanced PCa. Functional studies were performed in a series of PCa cell lines. In LNCaP cells, miR-410 overexpression led to decreases in cellular viability, proliferation, invasiveness, …

Olanzapine Pharmacokinetics: A Clinical Review Of Current Insights And Remaining Questions, Priyanka Kolli, Grace Kelley, Marianela Rosales, Justin Faden, Ryan Serdenes

Department of Psychiatry and Human Behavior Faculty Papers

Olanzapine is one of the most widely used antipsychotics since its initial approval by the US Food and Drug Administration in 1996 and has undergone extensive pharmacokinetic study. Despite being utilized in clinical psychiatry for decades, there remain questions regarding the variety of available formulations, the utility of therapeutic drug monitoring, altered kinetic properties in special populations/medical illnesses, the use of high-dose olanzapine, and drug interactions, among many others. We performed a narrative literature review of olanzapine pharmacokinetics in June 2023 using the US National Library of Medicine's PubMed.gov resource (https://www.ncbi.nlm.nih.gov/pubmed) and Google Scholar. Herein, we review clinically relevant aspects …

Distinct Gene Expression Signatures Comparing Latent Tuberculosis Infection With Different Routes Of Bacillus Calmette-Guérin Vaccination, Richard F Silver, Mei Xia, Chad E Storer, Jessica R Jarvela, Michelle C Moyer, Azra Blazevic, David A Stoeckel, Erin K Rakey, Jan M Tennant, Johannes B Goll, Richard D Head, Daniel F Hoft

2020-Current year OA Pubs

Tuberculosis remains an international health threat partly because of limited protection from pulmonary tuberculosis provided by standard intradermal vaccination with Bacillus of Calmette and Guérin (BCG); this may reflect the inability of intradermal vaccination to optimally induce pulmonary immunity. In contrast, respiratory Mycobacterium tuberculosis infection usually results in the immune-mediated bacillary containment of latent tuberculosis infection (LTBI). Here we present RNA-Seq-based assessments of systemic and pulmonary immune cells from LTBI participants and recipients of intradermal and oral BCG. LTBI individuals uniquely display ongoing immune activation and robust CD4 T cell recall responses in blood and lung. Intradermal BCG is associated …

Assessment Of Deficits In Specific Cognitive Domains In Older Adults Living With Hiv., Andrea Reyes-Vega, Harideep Samanapally, Rishikesh Rijal, Stephen P. Furmanek, Christopher B. Shields, Brandon C. Dennis, Smita Ghare, Shirish Barve

Faculty and Staff Scholarship

A significant proportion of people living with HIV (PLWH) have cognitive impairment. Moreover, approximately 70% of PLWH in the United States will be ≥50 years old by 2030, raising concerns of a higher incidence of dementia as they age. Accordingly, there is a clinical need to monitor their cognitive status. The aim of this study was to delineate specific cognition areas impacted in OALWH with a clinical diagnosis of neurocognitive impairment. We used a comprehensive set of tests (paper and NIH Toolbox Cognition Battery), to assess different cognitive domains in a total of 25 OALWH ≥ 50 years. 64% were …

Comparative Genomics Reveals The Correlations Of Stress Response Genes And Bacteriophages In Developing Antibiotic Resistance Of Staphylococcus Saprophyticus, Kailun Zhang, Robert F Potter, Jamie Marino, Carol E Muenks, Matthew G Lammers, Jennifer Dien Bard, Tanis C Dingle, Romney Humphries, Lars F Westblade, Carey-Ann D Burnham, Gautam Dantas

2020-Current year OA Pubs

No abstract provided.

Dsm-5 Conduct Disorder And Symptoms In Youths At High Risk Of Psychosis In Kenya With Dsm-5 Mental Disorders And Substance Use: Towards Integrated Management, David M Ndetei, Victoria Mutiso, Christine Musyimi, Reinpeter Momanyi, Pascalyne Nyamai, Peter Tyrer, Daniel Mamah

2020-Current year OA Pubs

Little is known about the prevalence of Conduct Disorder (CD) and symptoms of CD in high risk psychosis persons at both clinical and community populations in LMICs and in particular Kenya. This study aimed to document (1) the prevalence of CD diagnosis and symptoms in youth who screened positive for psychosis and (2) the associated mental disorders and substance use in the same cohort in LMIC. The sample size was 536 students who had screened positive on the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) from a population of 9,742 high school, college and university students, but had not …

Efficacy And Safety Of Teprotumumab In Patients With Thyroid Eye Disease Of Long Duration And Low Disease Activity, Raymond S Douglas, Steven Couch, Sara T Wester, Brian T Fowler, Catherine Y Liu, Prem S Subramanian, Rosa Tang, Quang T Nguyen, Robi N Maamari, Shoaib Ugradar, Kate Hsu, Michael Karon, Marius N Stan

2020-Current year OA Pubs

CONTEXT: Early inflammatory thyroid eye disease (TED) can lead to symptomatic chronic disease, including disabling proptosis. Teprotumumab, an insulin-like growth factor-1 receptor (IGF-1R) inhibitor, previously demonstrated efficacy in acute, high-inflammation TED trials.

OBJECTIVE: We present data from the first placebo-controlled trial with teprotumumab in chronic/low disease activity TED.

METHODS: This randomized double-masked, placebo-controlled trial, conducted at 11 US centers, enrolled adult participants with TED duration of 2 to 10 years, Clinical Activity Score (CAS) ≤ 1 or no additional inflammation or progression in proptosis/diplopia for ≥1 year, proptosis ≥3 mm from before TED and/or from normal, euthyroid/mildly hypo/hyperthyroid, no prior …

Pharmacokinetics Of Dacarbazine And Unesbulin And Cyp1a2-Mediated Drug Interactions In Patients With Leiomyosarcoma, Lan Gao, Diksha Kaushik, Brian A Van Tine, Matthew A Ingham, Steven Attia, Christian F Meyer, Gary K Schwartz, Pius Maliakal, John D Baird, Jiyuan Ma, Rosemary Barrett, Dhiren D'Silva, Kylie O'Keefe, Ronald Kong

2020-Current year OA Pubs

Unesbulin is being investigated in combination with dacarbazine (DTIC) as a potential therapeutic agent in patients with advanced leiomyosarcoma (LMS). This paper reports the pharmacokinetics (PK) of unesbulin, DTIC, and its unreactive surrogate metabolite 5-aminoimidazole-4-carboxamide (AIC) in 29 patients with advanced LMS. Drug interactions between DTIC (and AIC) and unesbulin were evaluated. DTIC (1000 mg/m

Perceived Importance Of Ultrasound Vascular Access Education Among Residents, Raquel Lamarche, Jared Marx, Jihyun Ma, Stephanie Claudy

Graduate Medical Education Research Journal

Background: Peripheral intravenous catheter (PIVC) failure and difficult intravenous access (DIVA) are pervasive issues causing patient suffering and increased costs. Despite their prevalence, there is a gap in internal medicine and pediatric resident training to manage these challenges effectively.

Objective: This study aimed to assess the value of ultrasound-guided-PIVC (USGPIVC) education for internal medicine and pediatric residents and the impact of a 1-hour multidisciplinary workshop on their knowledge and confidence.

Methods: A cross-sectional survey study was conducted at an academic medical center in 2022 to assess residents’ perceptions of USG-PIVC education. This was followed by a USG-PIVC simulation-based workshop with …

Getting Off On The Right Foot: Addressing Severe Lymphedema Through A Novel Shoe Design, Carl R. Russell Iii, Anjollie M. Ramakrishna, Christopher H. Johns Iii, Alana V. Van Wijnen

Purdue Journal of Service-Learning and International Engagement

Engineering Projects in Community Service (EPICS) is a service-learning design program run by the College of Engineering at Purdue University. EPICS teaches students design skills by providing solutions for individuals, communities, and organizations in the surrounding area while mirroring engineering industry standards. Biomedical Engineering is a team within EPICS that strives to serve community partners through biomedical applications. HR is a patient who suffers from severe lymphedema. This condition results in her foot swelling three times its original size and requires her to utilize weekly leg compression therapy. Prescription shoes are slightly adequate. However, they lead to sores and pain …

Ham-Tmc Facts And Figures 2022-2023, Houston Academy Of Medicine-Texas Medical Center Library, Houston Academy Of Medicine - Texas Medical Center Library

Library Statistics

No abstract provided.

Some Biological Markers In Diabetic Patients, Ahmed Malk Hassan, Hasan Ali Hussein, Radhwan Mohmmed Hussein, Maryam Hiyder Kadhum

Al-Esraa University College Journal for Medical Sciences

Endstage renal disease (ESRD) usually comes on by diabetic nephropathy (DN) and is one of the most dreaded chronic microvascular complications of diabetes. The objective of this study is to provide an overview of the DN-biomarker landscape with a particular emphasis on new approaches that improve the sensitivity of biomarkers for identifying patients who will develop DN or who are at risk of developing ESRD. This study was designed as a case-control study. 120 individuals were involved, divided into three groups: a control group diabetic without nephropathy, Early stage and end stage of nephropathy, 40 patients were taken for each …

A Computational Exploration: Docking Analysis Of Compounds From Foeniculum Vulgare As Potential Aromatase Inhibitors For Endometriosis Candidate Therapy, Dwi Anita Suryandari, Puji Sari, Hadi Sunaryo, Khaerunissa Anbar Istiadi

Indonesian Journal of Medical Chemistry and Bioinformatics

Aromatase inhibitors (AI) have controlling symptoms and size of endometriotic implants, making them a promising second-line therapy for endometriosis treatment.pretreatment with letrozole, an AI, combined with leuprolide acetate and resveratrol has been found to improve in vitro fertilization (IVF) outcomes in women mild endometriosis.in this study we screening and analysis of ten phenolic compounds from Foeniculum vulgare using molecular docking with Mcole server.from this results showed that three phenolic trans resveratrol (TR), caempherol coumaril (CC) have low gibbs energy compare with resveratrol (R). The binding modalities of compound TR and compound R were hydrogen-bonding between the hydroxyl and oxygen atom …

Comparing The Effectiveness Of Mother-Focused Interventions To That Of Mother-Child Focused Interventions In Improving Maternal Postpartum Depression Outcomes: A Systematic Review, Divya Kumar, Waqas Hameed, Bilal Iqbal Avan

Community Health Sciences

Background: Most empirically researched interventions for postpartum depression (PPD) tend to target mothers' depression alone. Harmful effects of PPD on physical and mental health of both mother and child has led researchers to investigate the impact of interventions on PPD and child outcomes together. So far, the evidence is limited regarding how these interventions compare with those focusing only on mothers' depression. This review compares the effectiveness of PPD-improving interventions focusing only on mothers with those focusing on mother and child together.
Methods: Nine electronic databases were searched. Thirty-seven studies evaluating mother-focused (n = 30) and mother-child focused interventions (n …

Développement D’Un Système De Mesure Pour La Caractérisation Des Traitements Absorbants En Laboratoire, Alain Berry, Olivier Robin, Thomas Dupont, Franck Sgard

Rapports de recherche scientifique

Le bruit constitue une préoccupation de plus en plus importante et généralisée dans le monde. Selon l’Organisation mondiale de la Santé, environ une personne sur quatre dans le monde souffrira de déficience auditive à des degrés divers d’ici à 2050. Dans de nombreux pays et régions du globe, le bruit représente le second facteur environnemental provoquant le plus de dommages sanitaires, et ce derrière la pollution atmosphérique. Sur un volet cognitif ou perceptif, le bruit environnemental peut par exemple perturber le sommeil et gêner l’apprentissage en milieu scolaire. Dans un milieu de travail, il peut perturber la bonne compréhension/perception de …