bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Addition of Torso Flexion to the LIFFT Analysis Tool
Authors: Capanoglu M. Fehmi , Barim Menekse S. , Sesek Richard F. , Sesek Robert M. , Schall Mark C. , Gallagher Sean
Published: October 2023

The Lifting Fatigue Failure Tool (LiFFT) is an ergonomic assessment tool based on fatigue failure theory that uses the lower back load moment to evaluate the risk associated with multi-task jobs involving manual lifting. The current LiFFT tool does not account for the moment associated with flexing the lifter's torso. This study explores the incorporation of torso flexion into the LiFFT model while maintaining the relative simplicity of the original LiFFT tool. Automotive manufacturing workers (n=607) performing various tasks were included in the study. Non-manual material handling (MMH) tasks with no MMH load moment were considered "zero" risk. The moment associated with trunk flexion was considered if a worker flexed at the torso during non-MMH assembly tasks. The torso moment from bending was computed using the "average" worker height and weight for the data set used in this study. The proposed model yielded higher odds ratios than the original model.
Key Constructs, Measures, and Considerations for Human Factors Researchers in the Advanced Air Mobility Domain
Authors: Namukasa Maureen , Carroll Meredith , Chauhan Bhoomin B , Sharma Vivek , Carmody Kendall , Wilt Donna
Published: October 2023

The emergence of Advanced Air Mobility (AAM) has seen the design of new electric vertical takeoff and landing (eVTOL) aircraft that will be utilized to serve the AAM market and associated use cases. Before operations commence, aircraft manufacturers must obtain a government-issued type certificate proving that the new aircraft meets prescribed safety levels. Human factors is an important aspect of AAM certification as the proposed designs have significant changes to how pilots will interact with the aircraft. Published certification standards create an opportunity for human factors researchers to generate meaningful ties between the research being conducted in their laboratories and the work being conducted in the industry to prove the effectiveness and safety of AAM systems. To facilitate this, the current effort identified human factors language used in the certification documents that is related to information processing on the flight deck and relevant to AAM aircraft. This language was then mapped to constructs and associated measures studied in the literature. This mapping can serve as a guide for human factors researchers to ensure the relevancy of the research being conducted for this emerging domain.
Adaptation and Validation of the Falls Efficacy Scale-International (FES-I) in Community-Dwelling Older Mexican Adults
Authors: Medina-Jiménez Erick Alberto , Acosta-Quiroz Christian Oswaldo , García-Flores Raquel
Published: October 2023

The objective of this study was to evaluate the reliability and validity of the FES-I scale in community-dwelling older Mexican adults. Participants were 222 older adults, with a mean age of 70 years; 75% were women who completed a sociodemographic data sheet, a Spanish version of the FES-I scale, intended to explore measures of depression, quality of life, and instrumental activities of daily living. Discriminant validity was demonstrated for all items on the FES-I scale and when groups of older adults were compared according to age. Evidence of internal consistency was found in all the items of the FES-I scale (α = .91) and convergent and divergent validity of the FES-I scale with measures of depression and quality of life, except instrumental activities of daily living. The Confirmatory Factor Analysis shows that the FES-I scale partially retains its two-factor measurement properties since five items were removed from the model to fit the data. The FES-I scale is a valid and reliable measure for clinical evaluations of fear of falls in older Mexican adults in the community.
Clinical Reasoning Curricula in Health Professions Education: A Scoping Review
Authors: Elvén Maria , Welin Elisabet , Wiegleb Edström Desiree , Petreski Tadej , Szopa Magdalena , Durning Steven J. , Edelbring Samuel
Published: October 2023

OBJECTIVES

This scoping review aimed to explore and synthesize current literature to advance the understanding of how to design clinical reasoning (CR) curricula for students in health professions education.

METHODS

Arksey and O’Malley's 6-stage framework was applied. Peer-reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies.

RESULTS

Twenty-six articles were included on CR in medical, nursing, physical therapy, occupational therapy, midwifery, dentistry, and speech language therapy education. The results describe: features of CR curriculum design; CR theories, models, and frameworks that inform curricula; and teaching content, methods, and assessments that inform CR curricula.

CONCLUSIONS

Several CR theories, teaching, and assessment methods are integrated into CR curricula, reflecting the multidimensionality of CR among professions. Specific CR elements are addressed in several curricula; however, no all-encompassing CR curriculum design has been identified. These findings offer useful insights for educators into how CR can be taught and assessed, but they also suggest the need for further guidance on educational strategies and assessments while learners progress through an educational program.
Optimizing compressive mechanical properties and water absorption of polycaprolactone/nano-hydroxyapatite composite scaffolds by 3D printing based on fused deposition modeling
Authors: Akhoundi Behnam , Taghipour Lahijani Yasser , Modanloo Vahid
Published: October 2023

This research examines the mechanical properties and water absorption of polycaprolactone (PCL) scaffolds reinforced with nano-hydroxyapatite (N-HA) particles, printed using a 3D printer based on fused deposition modeling (FDM) technology. Fabricating this composite material aims to replicate a tissue similar to bone tissue. Biocompatible N-HA (50% by weight) was utilized to fortify the matrix phase and enhance the mechanical properties. The compression test results showed that the addition of N-HA augmented the compressive strength and modulus of the scaffolds (with a nominal porosity of 60% and a filling pattern of 0/60/120) by 240% and 150%, respectively. Moreover, the water absorption increased by 600%.
Case report: Primary stabbing headache treated with melatonin in Saethre-Chotzen syndrome
Authors: Frank Florian , Filippi Vera , Kaltseis Katharina , Broessner Gregor
Published: October 2023

Background:

Primary stabbing headache (PSH) is a rare primary headache presenting with short, stabbing pain sensations of unknown etiology. Owed to the rare prevalence of the disease, only limited data exists on possible treatment options. The most cumulative expertise exists for indomethacin as a potential treatment in PSH. However, known side effects and long-term tolerability issues have urged the FDA to restrict the use of indomethacin as long-term medication. In about 35% of the cases indomethacin does not provide sufficient relieve, demanding for efficacious and well tolerable alternatives.

Case:

Herewith we report a case of a young female adult presenting with PSH treated with melatonin resulting in an outstanding and long-lasting response. The patient has a rare underlying genetic disorder leading to facial dysmorphia, which according to the scarce literature, is not associated with PSH so far, but requires extensive exclusion of secondary causes of headaches.

Conclusion:

Given the exceptional tolerability of melatonin with low concern even on a long-term use, we discuss an indomethacin trial in PSH might be a diagnostic approach rather than a therapeutic one in the future.
Meeting the Mental Health and Behavioral Needs of Children and Youth in Rural Foster Care: The Role of Schools
Authors: Sears Julie A. , Barton Alison L. , Blevins Melody , Chambers Cynthia R.
Published: October 2023

Children and youth in foster care and their caregivers often experience mental health challenges. Rural settings introduce barriers that prevent these youth from accessing such services. Nevertheless, rural area school personnel, and particularly special educators, are positioned to help improve access to mental health services for foster care students, who often qualify for special education services. In this article, we explore ways U.S. school personnel can support this vulnerable population through psychoeducation, mental health screenings and referrals, evidence-based therapies (EBTs), and supportive infrastructure to help students and their foster families access mental health services through schools. With such services, school personnel can help these students improve stability within home life, increase positive life-long outcomes for school performance, decrease incarceration, and reduce drug and alcohol abuse.
PF4 activates the c-Mpl–Jak2 pathway in platelets
Authors: Buka Richard J. , Montague Samantha J. , Moran Luis A. , Martin Eleyna M. , Slater Alexandre , Watson Steve P. , Nicolson Phillip L. R.
Published: October 2023

Platelet factor 4 (PF4) is an abundant chemokine that is released from platelet α-granules on activation. PF4 is central to the pathophysiology of vaccine-induced immune thrombocytopenia and thrombosis (VITT) in which antibodies to PF4 form immune complexes with PF4, which activate platelets and neutrophils through Fc receptors. In this study, we show that PF4 binds and activates the thrombopoietin receptor, cellular myeloproliferative leukemia protein (c-Mpl), on platelets. This leads to the activation of Janus kinase 2 (JAK2) and phosphorylation of signal transducer and activator of transcription (STAT) 3 and STAT5, leading to platelet aggregation. Inhibition of the c-Mpl–JAK2 pathway inhibits platelet aggregation to PF4, VITT sera, and the combination of PF4 and IgG isolated from VITT patient plasma. The results support a model in which PF4-based immune complexes activate platelets through binding of the Fc domain to FcγRIIA and PF4 to c-Mpl.
Anti-PF4 immunothrombosis without proximate heparin or adenovirus vector vaccine exposure
Authors: Schönborn Linda , Esteban Olga , Wesche Jan , Dobosz Paulina , Broto Marta , Puig Sara Rovira , Fuhrmann Jessica , Torres Raquel , Serra Josep , Llevadot Roser , Palicio Marta , Wang Jing Jing , Gordon Tom Paul , Lindhoff-Last Edelgard , Hoffmann Till , Alberio Lorenzo , Langer Florian , Boehme Christian , Biguzzi Eugenia , Grosse Leonie , Endres Matthias , Liman Thomas , Thiele Thomas , Warkentin Theodore E. , Greinacher Andreas
Published: October 2023

Platelet-activating anti-platelet factor 4 (PF4)/heparin antibodies and anti-PF4 antibodies cause heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombocytopenia and thrombosis (VITT), respectively. Diagnostic and treatment considerations differ somewhat between HIT and VITT. We identified patients with thrombocytopenia and thrombosis without proximate heparin exposure or adenovirus-based vaccination who tested strongly positive by PF4/polyanion enzyme-immunoassays and negative/weakly positive by heparin-induced platelet activation (HIPA) test but strongly positive by PF4-induced platelet activation (PIPA) test (ie, VITT-like profile). We tested these patients by a standard chemiluminescence assay that detects anti-PF4/heparin antibodies found in HIT (HemosIL AcuStar HIT-IgG(PF4-H)) as well as a novel chemiluminescence assay for anti-PF4 antibodies found in VITT. Representative control sera included an exploratory anti-PF4 antibody-positive but HIPA-negative/weak cohort obtained before 2020 (n = 188). We identified 9 patients with a clinical-pathological profile of a VITT-like disorder in the absence of proximate heparin or vaccination, with a high frequency of stroke (arterial, n = 3; cerebral venous sinus thrombosis, n = 4), thrombocytopenia (median platelet count nadir, 49 × 109/L), and hypercoagulability (greatly elevated D-dimer levels). VITT-like serological features included strong reactivity by PIPA (aggregation <10 minutes in 9/9 sera) and positive testing in the novel anti-PF4 chemiluminescence assay (3/9 also tested positive in the anti-PF4/heparin chemiluminescence assay). Our exploratory cohort identified 13 additional patient sera obtained before 2020 with VITT-like anti-PF4 antibodies. Platelet-activating VITT-like anti-PF4 antibodies should be considered in patients with thrombocytopenia, thrombosis, and very high D-dimer levels, even without a proximate exposure to heparin or adenovirus vector vaccines.
CRTC2 activates the epithelial–mesenchymal transition of diabetic kidney disease through the CREB-Smad2/3 pathway
Authors: Li Yujie , Zhang Yufeng , Shi Hongshuo , Liu Xuemei , Li Zifa , Zhang Jiayi , Wang Xiuge , Wang Wenbo , Tong Xiaolin
Published: October 2023

Background

Epithelial–mesenchymal transition (EMT) plays a key role in tubulointerstitial fibrosis, which is a hallmark of diabetic kidney disease (DKD). Our previous studies showed that CRTC2 can simultaneously regulate glucose metabolism and lipid metabolism. However, it is still unclear whether CRTC2 participates in the EMT process in DKD.

Methods

We used protein‒protein network (PPI) analysis to identify genes that were differentially expressed during DKD and EMT. Then, we constructed a diabetic mouse model by administering STZ plus a high-fat diet, and we used HK-2 cells that were verified to confirm the bioinformatics research results. The effects that were exerted by CRTC2 on epithelial-mesenchymal transition in diabetic kidney disease through the CREB-Smad2/3 signaling pathway were investigated in vivo and in vitro by real-time PCR, WB, IHC and double luciferase reporter gene experiments.

Results

First, bioinformatics research showed that CRTC2 may promote EMT in diabetic renal tubules through the CREB-Smad2/3 signaling pathway. Furthermore, the Western blotting and real-time PCR results showed that CRTC2 overexpression reduced the expression of E-cadherin in HK-2 cells. The CRTC2 and α-SMA levels were increased in STZ-treated mouse kidneys, and the E-cadherin level was reduced. The luciferase activity of α-SMA, which is the key protein in EMT, was sharply increased in response to the overexpression of CRTC2 and decreased after the silencing of CREB and Smad2/3. However, the expression of E-cadherin showed the opposite trends. In the real-time PCR experiment, the mRNA expression of α-SMA increased significantly when CRTC2 was overexpressed but partially decreased when CREB and Smad2/3 were silenced. However, E-cadherin expression showed the opposite result.

Conclusion

This study demonstrated that CRTC2 activates the EMT process via the CREB-Smad2/3 signaling pathway in diabetic renal tubules.
Hypovitaminosis D in persons with Down syndrome and autism spectrum disorder
Authors: Boyd Natalie K. , Nguyen Julia , Khoshnood Mellad M. , Jiang Timothy , Nguyen Lina , Mendez Lorena , Spinazzi Noemi A. , Manning Melanie A. , Rafii Michael S. , Santoro Jonathan D.
Published: October 2023

Background

Plasma levels of vitamin D have been reported to be low in persons with Down syndrome (DS) and existing data is limited to small and homogenous cohorts. This is of particular importance in persons with DS given the high rates of autoimmune disease in this population and the known relationship between vitamin D and immune function. This study sought to investigate vitamin D status in a multi-center cohort of individuals with DS and compare them to individuals with autism spectrum disorder (ASD) and neurotypical (NT) controls.

Methods

A retrospective, multi-center review was performed. The three sites were located at latitudes of 42.361145, 37.44466, and 34.05349. Patients were identified by the International Classification of Diseases (ICD)-9 or ICD-10 codes for DS, ASD, or well-child check visits for NT individuals. The first vitamin D 25-OH level recorded in the electronic medical record (EMR) was used in this study as it was felt to be the most reflective of a natural and non-supplemented state. Vitamin D 25-OH levels below 30 ng/mL were considered deficient.

Results

In total, 1624 individuals with DS, 5208 with ASD, and 30,775 NT controls were identified. Individuals with DS had the lowest mean level of vitamin D 25-OH at 20.67 ng/mL, compared to those with ASD (23.48 ng/mL) and NT controls (29.20 ng/mL) (p < 0.001, 95% CI: −8.97 to −6.44). A total of 399 (24.6%) individuals with DS were considered vitamin D deficient compared to 1472 (28.3%) with ASD and 12,397 (40.3%) NT controls (p < 0.001, 95% CI: −5.43 to −2.36). Individuals with DS with higher body mass index (BMI) were found to be more likely to have lower levels of vitamin D (p < 0.001, 95% CI: −0.3849 to −0.1509). Additionally, having both DS and a neurologic diagnosis increased the likelihood of having lower vitamin D levels (p < 0.001, 95% CI: −5.02 to −1.28). Individuals with DS and autoimmune disease were much more likely to have lower vitamin D levels (p < 0.001, 95% CI: −6.22 to −1.55). Similarly, a history of autoimmunity in a first-degree relative also increased the likelihood of having lower levels of vitamin D in persons with DS (p = 0.01, 95% CI: −2.45 to −0.63).

Conclusions

Individuals with DS were noted to have hypovitaminosis D in comparison to individuals with ASD and NT controls. Associations between vitamin D deficiency and high BMI, personal autoimmunity, and familial autoimmunity were present in individuals with DS.
The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova - results from the PRICOV-19 survey
Authors: Delvento Giulia , Curteanu Ala , Rotaru Cristina , Van Poel Esther , Willems Sara , Prytherch Helen , Curocichin Ghenadie
Published: October 2023

Background

The COVID-19 pandemic has had an enormous impact on health systems in Europe and has generated unprecedented challenges for tertiary care. Less is known about the effects on the activities of local family doctors (FDs), who have shifted tasks and adapted their practice to accommodate the new services brought by the pandemic. The PRICOV-19 study was a multi-country survey aiming to understand the challenges posed by the pandemic in primary health care (PHC) practices around Europe. Within the framework of this study, we assessed the impact of the pandemic on PHC facilities in urban, rural, and mixed urban/rural areas in the Republic of Moldova.

Methods

We present the results from the PRICOV-19 questionnaire designed at Ghent University (Belgium) and distributed between January and March 2021 to PHC facilities from the 35 districts of the Republic of Moldova. This analysis presents descriptive data on limitations to service delivery, staff role changes, implementation and acceptance of COVID-19 guidelines, and incidents reported on staff and patient safety during the pandemic.

Results

Results highlighted the differences between facilities located in urban, rural, and mixed areas in several dimensions of PHC. Nearly half of the surveyed facilities experienced limitations in the building or infrastructure when delivering services during the pandemic. 95% of respondents reported an increase in time spent giving information to patients by phone, and 88% reported an increase in responsibilities. Few practices reported errors in clinical assessments, though a slightly higher number of incidents were reported in urban areas. Half of the respondents reported difficulties delivering routine care to patients with chronic conditions and a delay in treatment-seeking.

Conclusions

During the pandemic, the workload of PHC staff saw a significant increase, and practices met important structural and organizational limitations. Consequently, these limitations may have also affected care delivery for vulnerable patients with chronic conditions. Adjustments and bottlenecks need to be addressed, considering the different needs of PHC facilities in urban, rural, and mixed areas.
The role of geriatric syndromes in predicting unplanned hospitalizations: a population-based study using Minimum Data Set for Home Care
Authors: Rönneikkö Jukka , Huhtala Heini , Finne-Soveri Harriet , Valvanne Jaakko , Jämsen Esa
Published: October 2023

Background

The predictive accuracies of screening instruments for identifying home-dwelling old people at risk of hospitalization have ranged from poor to moderate, particularly among the oldest persons. This study aimed to identify variables that could improve the accuracy of a Minimum Data Set for Home Care (MDS-HC) based algorithm, the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale, in classifying home care clients’ risk for unplanned hospitalization.

Methods

In this register-based retrospective study, factors associated with hospitalization among home care clients aged ≥ 80 years in the City of Tampere, Finland, were analyzed by linking MDS-HC assessments with hospital discharge records. MDS-HC determinants associated with hospitalization within 180 days after the assessment were analyzed for clients at low (DIVERT 1), moderate (DIVERT 2–3) and high (DIVERT 4–6) risk of hospitalization. Then, two new variables were selected to supplement the DIVERT algorithm. Finally, area under curve (AUC) values of the original and modified DIVERT scales were determined using the data of MDS-HC assessments of all home care clients in the City of Tampere to examine if addition of the variables related to the oldest age groups improved the accuracy of DIVERT.

Results

Of home care clients aged ≥ 80 years, 1,291 (65.4%) were hospitalized at least once during the two-year study period. Unplanned hospitalization occurred following 15.9%, 22.8%, and 33.9% MDS-HC assessments with DIVERT group 1, 2–3 and 4–6, respectively. Infectious diseases were the most common diagnosis within each DIVERT groups.

Many MDS-HC variables not included in the DIVERT algorithm were associated with hospitalization, including e.g. poor self-rated health and old fracture (other than hip fracture) (p 0.001) in DIVERT 1; impaired cognition and decision-making, urinary incontinence, unstable walking and fear of falling (p < 0.001) in DIVERT 2–3; and urinary incontinence, poor self-rated health (p < 0.001), and decreased social interaction (p 0.001) in DIVERT 4–6. Adding impaired cognition and urinary incontinence to the DIVERT algorithm improved sensitivity but not accuracy (AUC 0.64 (95% CI 0.62–0.65) vs. 0.62 (0.60–0.64) of the original DIVERT). More admissions occurred among the clients with higher scores in the modified than in the original DIVERT scale.

Conclusions

Certain geriatric syndromes and diagnosis groups were associated with unplanned hospitalization among home care clients at low or moderate risk level of hospitalization. However, the predictive accuracy of the DIVERT could not be improved. In a complex clinical context of home care clients, more important than existence of a set of risk factors related to an algorithm may be the various individual combinations of risk factors.
Comparative study of biomarkers for the early identification of Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis in infectious mononucleosis
Authors: Cai Lisha , Xing Yuan , Xia Yahong , Zhang Zihan , Luo Zebin , Tang Yongmin , Chen Yan , Xu Xiaojun
Published: October 2023

Background and aim

Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) and infectious mononucleosis (EBV-IM) share mimic symptoms in the early stages of childhood development. We aimed to examine the clinical features and laboratory indices of these two diseases in children and uncover unique indicators to assist pediatricians in identifying these diseases early.

Methods

We collected clinical data from 791 pediatric patients diagnosed with EBV-IM or EBV-HLH, compared the clinical traits and laboratory biomarkers presented in the two groups, and constructed predictive models based on them.

Results

Patients with EBV-IM had greater ratios of cervical lymphadenopathy, eyelid edema, and tonsillitis, whereas individuals with EBV-HLH were more likely to have hepatomegaly and splenomegaly. When using the criteria of interleukin (IL)-10 > 89.6 pg/mL, interferon (IFN)-γ > 45.6 pg/mL, ferritin > 429 μg/L, D-dimer > 3.15 mg/L and triglycerides > 2.1 mmol/L, the sensitivity was 87.9%, 90.7%, 98.1%, 91.1% and 81.5% to predict EBV-HLH, while the specificity was 98.4%, 96.3%, 96.5%, 94.1% and 80.6%, respectively. A logistic regression model based on four parameters (IL-10, ferritin, D-dimer, and triglycerides) was established to distinguish EBV-HLH patients from EBV-IM patients, with a sensitivity of 98.0% and a specificity of 98.2%.

Conclusions

IL-10, IFN-γ, ferritin and D-dimer levels are significantly different between EBV-HLH and EBV-IM. Predictive models based on clinical signs and laboratory findings provide simple tools to distinguish the two situations.
Identification of microorganisms by a rapid PCR panel from positive blood cultures leads to faster optimal antimicrobial therapy – a before-after study
Authors: Agnetti Jessica , Büchler Andrea C. , Osthoff Michael , Helfenstein Fabrice , Weisser Maja , Siegemund Martin , Bassetti Stefano , Bingisser Roland , Schaefer Dirk J. , Clauss Martin , Hinic Vladimira , Tschudin-Sutter Sarah , Bättig Veronika , Khanna Nina , Egli Adrian
Published: October 2023

Background

The BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) detects microorganisms with high accuracy in positive blood cultures (BC) – a key step in the management of patients with suspected bacteraemia. We aimed to compare the time to optimal antimicrobial therapy (OAT) for the BF-FA-BCIP vs. standard culture-based identification.

Methods

In this retrospective single-centre study with a before-after design, 386 positive BC cases with identification by BF-FA-BCIP were compared to 414 controls with culture-based identification. The primary endpoint was the time from BC sampling to OAT. Secondary endpoints were time to effective therapy, length of stay, (re-)admission to ICU, in-hospital and 30-day mortality. Outcomes were assessed using Cox proportional hazard models and logistic regressions.

Results

Baseline characteristics of included adult inpatients were comparable. Main sources of bacteraemia were urinary tract and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7%, for cases and controls, respectively). Median (95%CI) time to OAT was 25.5 (21.0–31.2) hours with BF-FA-BCIP compared to 45.7 (37.7–51.4) hours with culture-based identification. We observed no significant difference for secondary outcomes.

Conclusions

Rapid microorganism identification by BF-FA-BCIP was associated with a median 20-h earlier initiation of OAT in patients with positive BC. No impact on length of stay and mortality was noted.

Trial registration

Clinicaltrials.gov, NCT04156633, registered on November 5, 2019.
Alterations of the expression of TET2 and DNA 5-hmC predict poor prognosis in Myelodysplastic Neoplasms
Authors: Seethy Ashikh A. , Pethusamy Karthikeyan , Kushwaha Tushar , Kumar Gaurav , Talukdar Joyeeta , Chaubey Rekha , Sundaram Udayakumar Dharmalingam , Mahapatra Manoranjan , Saxena Renu , Dhar Ruby , Inampudi Krishna K. , Karmakar Subhradip
Published: October 2023

Background

Myelodysplastic Neoplasms (MDS) are clonal stem cell disorders characterized by ineffective hematopoiesis and progression to acute myeloid leukemia, myelodysplasia-related (AML-MR). A major mechanism of pathogenesis of MDS is the aberration of the epigenetic landscape of the hematopoietic stem cells and/or progenitor cells, especially DNA cytosine methylation, and demethylation. Data on TET2, the predominant DNA demethylator of the hematopoietic system, is limited, particularly in the MDS patients from India, whose biology may differ since these patients present at a relatively younger age. We studied the expression and the variants of TET2 in Indian MDS and AML-MR patients and their effects on 5-hydroxymethyl cytosine (5-hmC, a product of TET2 catalysis) and on the prognosis of MDS patients.

Results

Of the 42 MDS patients, cytogenetics was available for 31 sub-categorized according to the Revised International Prognostic Scoring System (IPSS-R). Their age resembled that of the previous studies from India. Bone marrow nucleated cells (BMNCs) were also obtained from 13 patients with AML-MR, 26 patients with de-novo AML, and 11 subjects with morphologically normal bone marrow. The patients had a significantly lower TET2 expression which was more pronounced in AML-MR and the IPSS-R higher-risk MDS categories. The 5-hmC levels in higher-risk MDS and AML-MR correlated with TET2 expression, suggesting a possible mechanistic role in the loss of TET2 expression. The findings on TET2 and 5-hmC were also confirmed at the tissue level using immunohistochemistry. Pathogenic variants of TET2 were found in 7 of 24 patient samples (29%), spanning across the IPSS-R prognostic categories. One of the variants – H1778R – was found to affect local and global TET2 structure when studied using structural predictions and molecular dynamics simulations. Thus, it is plausible that some pathogenic variants in TET2 can compromise the structure of TET2 and hence in the formation of 5-hmC.

Conclusions

IPSS-R higher-risk MDS categories and AML-MR showed a reduction in TET2 expression, which was not apparent in lower-risk MDS. DNA 5-hmC levels followed a similar pattern. Overall, a decreased TET2 expression and a low DNA 5-hmC level are predictors of advanced disease and adverse outcome in MDS in the population studied, i.e., MDS patients from India.
Proteomic study of aqueous humour in diabetic patients with cataracts by TMT combined with HPLC-MS/MS
Authors: Xu Weihai , Liang Ya , Zhu Yunxia , Sun Tong , Yuan Zhilan , Han Xiao
Published: October 2023

Background

The purpose of this study is to identify the proteomic differences between the aqueous humour of diabetes patients with cataracts and that of non-diabetic sufferers of cataracts in a clinical setting.

Methods

Patients were divided into the diabetic experimental group and the non-diabetic control group. Aqueous humour specimens were obtained via cataract surgery. Sample proteins were treated with a TMT reagent, separated using a cation chromatography column, and analysed using a C18 desalting column. Proteins were identified using HPLC-MS/MS. The differential proteins were identified using both a p value of < 0.05 and a fold change of > 1.2. GO classification enrichment analysis, KEGG pathway enrichment analysis, protein interaction network analysis, and ingenuity pathway analysis were all carried out. The expression level of four differential proteins were verified by Western blot, and GC and TTR expressions were further examined using an expanded sample pool.

Results

The postprandial glucose levels between the experimental group (9.40 ± 1.35 mmol/L) and the control group (6.56 ± 0.81 mmol/L) were significantly different, with a p value of 1.16E-06. It is important to note, however, that the baseline levels of the parameters showed no statistical differences. In total, 397 aqueous humour proteins were identified; of these, 137 showed significant differences, with 63 upregulated ones and 74 down-regulated ones. The differential proteins play important roles in numerous biological processes and pathways, such as complement and coagulation cascades (p = 1.71E-09). Some of these differential proteins are associated with diabetic retinal degeneration and other diabetic complications. Differential proteins, such as HP, GC, and TTR, have high node degree in the protein interaction network. Western blot results further confirmed that GC were down-regulated while TTR was up-regulated in aqueous humour under diabetic condition.

Conclusion

A list of differential proteins in the human aqueous humour of diabetic patients was established. Proteins with high interaction scores as per protein interaction analysis, such as GC and TTR, were further verified and could potentially be used as early diagnostic markers for diabetic eye complications in clinical practice.
Impact of early-onset fetal growth restriction on the neurodevelopmental outcome of very preterm infants at 24 months: a retrospective cohort study
Authors: Cortez Ferreira Mariana , Mafra Joana , Dias Ana , Santos Silva Isabel , Taborda Adelaide
Published: October 2023

Background

The association between fetal growth restriction (FGR) and childhood neurodevelopmental delay is unclear and the evidence available to the present date shows conflicting results. Our aim was to analyse the impact of early-onset FGR on the neurodevelopmental outcome at 24 months of corrected age in very preterm infants.

Methods

Retrospective cohort study of very preterm infants (≤ 32 weeks’ gestation) admitted to a neonatal intensive care unit between 1 January 2013–31 December 2019. The control group comprised appropriate for gestational age (AGA) newborns. Griffiths III Mental Development Scale was performed at 24 months of corrected age.

Results

132 infants were included: 44 FGR and 88 AGA. Mean Global Development Quotient (GDQ) was lower for FGR infants (p = 0.004) even after adjusting for maternal and perinatal factors (βadjusted -16.703; p = 0.009). The average scores for the neurodevelopmental domains were highest for personal-social-emotional skills (107.02 ± 16.34), followed by eye/hand coordination (105.61 ± 14.20) and foundation of learning skills (102.23 ± 13.74) and were lowest for gross motor (97.90 ± 11.88) and language/communication skills (96.39 ± 18.88). FGR had a significant negative impact on all domains except for gross motor skills. After adjustment, FGR continued to have a significant adverse impact on language/communication (βadjusted -21.924; p = 0.013), eye/hand coordination (βadjusted -15.446; p = 0.015) and foundation of learning skills (βadjusted -15.211; p = 0.013).

Conclusions

In very preterm infants, FGR was associated with a significantly increased risk of poor neurodevelopmental outcome at 24 months of corrected age compared to age-matched AGA infants.
The impact of COVID-19 on the lives of Canadians with and without non-communicable chronic diseases: results from the iCARE Study
Authors: Deslauriers Frédérique , Gosselin-Boucher Vincent , Léger Camille , Vieira Ariany Marques , Bacon Simon L. , Lavoie Kim L.
Published: October 2023

Background

The COVID-19 pandemic and its prevention policies have taken a toll on Canadians, and certain subgroups may have been disproportionately affected, including those with non-communicable diseases (NCDs; e.g., heart and lung disease) due to their risk of COVID-19 complications and women due to excess domestic workload associated with traditional caregiver roles during the pandemic.

Aims/Objectives

We investigated the impacts of COVID-19 on mental health, lifestyle habits, and access to healthcare among Canadians with NCDs compared to those without, and the extent to which women with NCDs were disproportionately affected.

Methods

As part of the iCARE study (www.icarestudy.com), data from eight cross-sectional Canadian representative samples (total n = 24,028) was collected via online surveys between June 4, 2020 to February 2, 2022 and analyzed using general linear models.

Results

A total of 45.6% (n = 10,570) of survey respondents indicated having at least one physician-diagnosed NCD, the most common of which were hypertension (24.3%), chronic lung disease (13.3%) and diabetes (12.0%). In fully adjusted models, those with NCDs were 1.18–1.24 times more likely to report feeling lonely, irritable/frustrated, and angry ‘to a great extent’ compared to those without (p’s < 0.001). Similarly, those with NCDs were 1.22–1.24 times more likely to report worse eating and drinking habits and cancelling medical appointments/avoiding the emergency department compared to those without (p’s < 0.001). Moreover, although there were no sex differences in access to medical care, women with NCDs were more likely to report feeling anxious and depressed, and report drinking less alcohol, compared to men with NCDs (p’s < 0.01).

Conclusion

Results suggest that people with NCDs in general and women in general have been disproportionately more impacted by the pandemic, and that women with NCDs have suffered greater psychological distress (i.e., feeling anxious, depressed) compared to men, and men with NCDs reported having increased their alcohol consumption more since the start of COVID-19 compared to women. Findings point to potential intervention targets among people with NCDs (e.g., prioritizing access to medical care during a pandemic, increasing social support for this population and mental health support).
Automatic classification of 3D positional relationship between mandibular third molar and inferior alveolar canal using a distance-aware network
Authors: Chun So-Young , Kang Yun-Hui , Yang Su , Kang Se-Ryong , Lee Sang-Jeong , Kim Jun-Min , Kim Jo-Eun , Huh Kyung-Hoe , Lee Sam-Sun , Heo Min-Suk , Yi Won-Jin
Published: October 2023

The purpose of this study was to automatically classify the three-dimensional (3D) positional relationship between an impacted mandibular third molar (M3) and the inferior alveolar canal (MC) using a distance-aware network in cone-beam CT (CBCT) images. We developed a network consisting of cascaded stages of segmentation and classification for the buccal-lingual relationship between the M3 and the MC. The M3 and the MC were simultaneously segmented using Dense121 U-Net in the segmentation stage, and their buccal-lingual relationship was automatically classified using a 3D distance-aware network with the multichannel inputs of the original CBCT image and the signed distance map (SDM) generated from the segmentation in the classification stage. The Dense121 U-Net achieved the highest average precision of 0.87, 0.96, and 0.94 in the segmentation of the M3, the MC, and both together, respectively. The 3D distance-aware classification network of the Dense121 U-Net with the input of both the CBCT image and the SDM showed the highest performance of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve, each of which had a value of 1.00. The SDM generated from the segmentation mask significantly contributed to increasing the accuracy of the classification network. The proposed distance-aware network demonstrated high accuracy in the automatic classification of the 3D positional relationship between the M3 and the MC by learning anatomical and geometrical information from the CBCT images.
Modified interproximal tunneling technique with customized sub-epithelial connective tissue graft for gingival papilla reconstruction: report of three cases with a cutback incision on the palatal side
Authors: Dong Jia-chen , Liao Yue , Sun Meng-jun , Gong Yin , Chen Hui-wen , Song Zhong-chen
Published: October 2023

Background

Gingival papilla defects, which cause an unpleasant appearance and involve the upper anterior teeth, may be triggered by several factors. Several noninvasive and invasive techniques have been proposed for gingival papilla reconstruction. The combination of interproximal tunneling and customized connective tissue grafts (CTGs) has shown promise in papilla augmentation. However, due to the narrowness and limited blood supply of the gingival papilla, the long-term outcomes of these techniques remain unpredictable. Therefore, achieving tension-free coronal advancement of the interdental papilla and proper placement of the CTG is crucial for successful long-term outcomes and could provide widely applicable methods for papilla augmentation.

Case report

In this study, we enrolled three patients with gingival papilla defects in the maxillary anterior teeth. For reconstruction, we proposed a modified interproximal tunneling (MIPT) technique combined with a CTG. A crucial modification based on previous studies involved adding a cutback incision to the base of the palatal vertical incision, resulting in tension-free healing. Additionally, the CTG was sutured upright to further enhance the height of the gingiva papilla. To evaluate the efficacy of the MIPT technique, the clinical parameters—including the Jemt papilla index and the distance from the tip of the papilla to the interproximal contact point—were examined using a periodontal probe (UNC15, Hu-friedy) at baseline and 12 months after surgery. All three patients achieved satisfactory papilla reconstruction 12 months after the surgery. These three cases were used to evaluate the efficacy of the MIPT technique combined with the customized CTG. An average increase in the Jemt papilla score from 1.6 to 2.8 and a reduction in the distance from the papilla tip to the contact point of adjacent teeth from 2 mm to 0.08 mm were observed 12 months after surgery.

Conclusion

The preliminary results confirmed that this technique holds promise for gingival papilla augmentation between tooth/tooth or tooth/implant.
Attitudes toward the integration of nutritional assessment and counseling in the framework of physical therapy: a cross-sectional survey
Authors: Netzer Roy , Elboim-Gabyzon Michal
Published: October 2023

Background

As the field of physical therapy increasingly acknowledges the integral role of nutritional assessment and counseling, revisiting this subject is essential due to limited updated information regarding this topic. Furthermore, it is crucial to investigate the factors that may influence physical therapists’ attitudes toward integrating nutritional assessment and counseling into their physical therapy practice. The study’s primary aim was to explore the attitudes of registered physical therapists in Israel toward incorporating nutritional assessment and counseling into their clinical practice. We also explored the relation between personal and professional characteristics of physical therapists and their attitudes.

Methods

An anonymous nationwide online self-report survey was conducted. It included three sections: personal and professional background characteristics, self-reported level of nutritional knowledge and sources of nutritional knowledge, and attitudes toward incorporating nutritional assessment and counseling into practice. Descriptive statistics were calculated for all outcome measures. The total score of the attitude statements was compared between different groups of participants. Multiple linear regression analysis was used to predict positive attitudes.

Results

The study included 409 physical therapists. The attitude score was 19.78 (2.53) of 25, indicating a positive attitude. A majority (67%) reported that they did not acquire knowledge regarding nutrition during their entry-level studies or in other formal settings (63%). The three primary sources of nutritional information for the participants reported were the Internet (87.0%), registered dietitian (70.0%), and professional, scientific journals (36.0%). Prior knowledge acquired during entry-level physical therapist studies and clinical experience of ≥ 13 years significantly predicted positive attitudes (β = 0.17, β = −0.13, respectively).

Conclusion

Registered physical therapists held a positive attitude toward incorporating nutritional assessment and counseling into their clinical practice. Two background professional characteristics were predictors of positive attitudes. Accordingly, there is need to appropriate formal education regarding nutritional issues. Further studies are required to explore the actual integration of nutrition into the physical therapy framework.
Using video-based examiner score comparison and adjustment (VESCA) to compare the influence of examiners at different sites in a distributed objective structured clinical exam (OSCE)
Authors: Yeates Peter , Maluf Adriano , Cope Natalie , McCray Gareth , McBain Stuart , Beardow Dominic , Fuller Richard , McKinley Robert Bob
Published: October 2023

Purpose

Ensuring equivalence of examiners’ judgements within distributed objective structured clinical exams (OSCEs) is key to both fairness and validity but is hampered by lack of cross-over in the performances which different groups of examiners observe. This study develops a novel method called Video-based Examiner Score Comparison and Adjustment (VESCA) using it to compare examiners scoring from different OSCE sites for the first time.

Materials/ methods

Within a summative 16 station OSCE, volunteer students were videoed on each station and all examiners invited to score station-specific comparator videos in addition to usual student scoring. Linkage provided through the video-scores enabled use of Many Facet Rasch Modelling (MFRM) to compare 1/ examiner-cohort and 2/ site effects on students’ scores.

Results

Examiner-cohorts varied by 6.9% in the overall score allocated to students of the same ability. Whilst only a tiny difference was apparent between sites, examiner-cohort variability was greater in one site than the other. Adjusting student scores produced a median change in rank position of 6 places (0.48 deciles), however 26.9% of students changed their rank position by at least 1 decile. By contrast, only 1 student’s pass/fail classification was altered by score adjustment.

Conclusions

Whilst comparatively limited examiner participation rates may limit interpretation of score adjustment in this instance, this study demonstrates the feasibility of using VESCA for quality assurance purposes in large scale distributed OSCEs.
Assessment of needs and gaps in public health cadre in India - a situational analysis
Authors: Priyadarshi Manish , Mishra Sidharth Sekhar , Singh Abha , Singhal Aanchal , Hashmi Moammar , Neogi Sutapa B.
Published: October 2023

Background

A structured and organized public health set up with systematically trained personnel to manage and deliver public health services from grassroot levels to higher administrative levels with separate public health directorate is the need of the hour. The objective of this study was to conduct a situational analysis of public health cadre in select states in India to gain an in-depth understanding of the progress and explore the gaps and challenges in its implementation.

Methods

Four states from the country were selected based on stages of implementation of the cadre. The WHO health systems framework was the basis of assessment. In-depth interviews of 78 stakeholders from public health system across various categories and levels were conducted.

Results

Every state has a dedicated cadre for public health in the form of a separate hierarchical structure and Directorate. There are deficits in human resources skilled enough to manage and implement public health across all levels. Its penetration below districts level is limited. There are limited opportunities available for contractual staffs in terms of remuneration and job progression. The respondents strongly emphasized on having personnel with training in public health, especially at leadership positions. Funding was not reported to be a problem although some challenges in the timeliness of release of funds were reported. Under the existing Health Management Information System, duplication of data exists and there is underutilization of data for policy making.

Conclusion

A dedicated public health cadre is under evolution in India. The main challenge is inadequate workforce skilled in public health management. States are committed to finding solutions to overcome these barriers.