bluuebunny/crossref_metadata_2025 huggingface dataset:
Autologous Protein Solution Effect on Chondrogenic Differentiation of Mesenchymal Stem Cells from Adipose Tissue and Bone Marrow in an Osteoarthritic Environment
Authors: Pagani Stefania , Veronesi Francesca , Giavaresi Gianluca , Filardo Giuseppe , Papio Tiziana , Romandini Iacopo , Fini Milena
Published: February 2021

Objective

Osteoarthritis (OA) is an inflammatory and degenerative disease, and the numerous treatments currently used are not fully effective. Mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) are proposed for OA treatment as biologic therapies. The aim of the study was to observe the role of autologous protein solution (APS), a type of PRP, on chondrogenic differentiation of 2 types of MSCs, from bone marrow (BMSCs) and adipose tissue (ADSCs), in an in vitro osteoarthritic microenvironment.

Design

Inflammatory culture conditions, mimicking OA, were obtained by adding interleukin-1β (IL-1β) and tumor necrosis factor α (TNFα), or synovial fluid from patient osteoarthritic knees (OSF), to the culture medium. MSCs were then treated with APS.

Results

After 1 month of culture, both cell types formed mature micromasses, partially altered in the presence of IL-1β and TNFα but quite preserved with OSF. Inflammatory conditions hindered differentiation in terms of gene expression, not counterbalanced by APS. APS triggered type I collagen deposition and above all contributed to decrease the expression of metalloproteinases in the most aggressive conditions (IL-1β and TNFα in the culture medium). ADSCs originated micromasses more mature and less prone toward osteogenic lineage than BMSCs, thus showing to better adapt in an aggressive environment than BMSC.

Conclusions

APS seems to act better on inflammation front and, between cell types, ADSCs respond better to the inflammatory microenvironment of OA and to the treatment with APS than BMSCs.
Impact of a change in rostering practices on absenteeism: An observational descriptive study
Authors: Fan Esther Monica Peijin , Aloweni Fazila , Lim Mei Ling , Woh Kelly Chai Yuen , Ang Shin Yuh
Published: February 2021

Background:

There was a change in rostering practice from a regular three-shift system to an irregular three-shift system.

Objective:

This study observed the trend of absenteeism before and after a change in rostering practice.

Methods:

An observational design was used to collect sick-leave data from six months before the change in rostering practice to 12 months after. The average number of sick-leave days per month before and after the change were compared. Data for nursing hours per patient day (NHPPD) were also collected.

Results:

An increase in the number of sick-leave days was seen in three out of five wards following the change in rostering practice. Average sick leave across the five wards increased from 173.7 days per month before the change to 213.4 days per month after the change. Data for NHPPD showed no drastic change in manpower (e.g. resignation/training leave) during this period.

Conclusions:

There was an observed increase in absenteeism following the change in the rostering practice of nurses.
Does avatar design in educational games promote a positive emotional experience among learners?
Authors: Segaran Kogilathah , Mohamad Ali Ahmad Zamzuri , Hoe Tan Wee
Published: February 2021

Virtual learning companions, such as avatars, have shown significant potential in assisting learners—particularly in the Digital Game-Based Learning (DGBL) condition. Since there are many avatar design approaches which can be utilized in DGBL, questions arise on which type of these are most preferred by learners. Mainly, in ensuring that the design promotes positive emotional experience throughout the learning process. This research has specifically explored the realism aspect of avatar design. In particular, we have found that moderate cartoon-like character designs can be more promising in promoting positive emotional experiences among viewers, in comparison to slightly realistic and overly exaggerated avatar designs.
Diffuse large B-cell lymphoma mimicking chronic osteomyelitis of the ankle joint: A case report
Authors: Kheder Emam M , Sharahlii Hussain H , AlSubaie Saad M , Algarni Mushref A , Al Omar Hussain
Published: February 2021

Lymphoma is the seventh most common type of malignancy in both males and females. It may develop in any location where lymphomatous tissue exists. Although extranodal presentation in the lower limb and pelvis are uncommon, it could present with diverse manifestations. We report an unusual case of primary extranodal large B-cell lymphoma of the ankle joint initially presumed to be a chronic osteomyelitis. This case report discusses the impact of imaging studies on decision-making and highlights the need to consider malignancy in chronic infections.
Remote administration of the symbol digit modalities test to individuals with multiple sclerosis is reliable: A short report
Authors: Eilam-Stock Tehila , Shaw Michael T , Sherman Kathleen , Krupp Lauren B , Charvet Leigh E
Published: February 2021

Background

The Symbol Digit Modalities Test (SDMT) is the gold standard for cognitive screening in multiple sclerosis (MS).

Objective

Due to the recent COVID-19 pandemic and the increased need for virtual clinical visits, we examined the reliability of remote administration of the SDMT vs. standard in-person administration to individuals with MS.

Methods

Pearson’s correlation analysis was performed between SDMT scores on the in-person and remote administrations.

Results

For n = 132 participants, remote and in-person SDMT scores were strongly correlated (r = .80, p = .000).

Conclusion

Remote administration of the SDMT is a reliable cognitive screening approach in MS.
Low-Energy Pelvic Ring Fractures: A Care Conundrum
Authors: Abernathy Bailey R. , Schroder Lisa K. , Bohn Deborah C. , Switzer Julie A.
Published: February 2021

Introduction:

A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care.

Results:

Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population.

Conclusions:

Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.
Evaluation of Spinal Fusion in Thoracic and Thoracolumbar Spine on Standard X-Rays: A New Grading System for Spinal Interbody Fusion
Authors: Patil Nirmal D. , El Ghait Hussein Abou , Boehm Christian , Boehm Heinrich
Published: February 2021

Study Design:

Retrospective evaluation of prospectively collected data.

Objective:

Analyzing time course and stages of interbody fusion of a uniformly operated cohort, defining a grading system and establishing diagnosis-dependent periods of bone healing.

Methods:

Sequential lateral radiographs of 238 patients (313 levels) with interbody fusion operated thoracoscopically were analyzed.

Results:

Evaluation of 1696 radiographs with a mean follow-up of 65.19 months and average numbers of 5.42 (2-18) images per level was performed. Diagnoses were Pyogenic Spondylitis (74), Fracture (96), Ankylosing Spondylitis (38) and Degenerative Disease (105). No case with Grade 2 deteriorated to Grade 5. On average, Grade 4 persisted for 113 days, Grade 3 for 197 days, Grade 2 for 286 days and Grade 1 for 316 days. The first 95% of levels (“Green Zone”, ≤ Grade 2) fused at 1 year, the remaining 4% levels fused between 12 and 17 months (“Yellow Zone”) and the last 1% (“Red Zone”) fused after 510 days.

Conclusion:

Sequential lateral radiographs permit evaluation of interbody fusion. Grade 2 is the threshold point for fusion; once accomplished, failure is unlikely. If fusion (Grade 2,1 or 0) is not reached within 510 days, it should be regarded as failed. The 510-day-threshold could reduce the necessity of CT scanning for assessing fusion.
Posterior Focal Curettage and Spine Stability Reconstruction by Temporary Pedicle Screw Fixation in Children With Collapsed Vertebrae due to Eosinophilic Granuloma
Authors: Zheng Yiming , Ning Bo , Wu Chunxing , Qian Chuang , Meng Junrong , Wang Dahui
Published: February 2021

Study Design:

Retrospective case series.

Objectives:

To evaluate the efficacy of growth-preserving posterior spinal column reconstruction surgery in children with collapsed vertebral eosinophilic granuloma (EG).

Methods:

We retrospectively reviewed 15 confirmed cases of vertebral EG who met the inclusion and exclusion criteria from March 2015 to March 2018 in our hospital. The recovery of diseased vertebrae was assessed.

Results:

The cases were composed of 11 males and 4 females with a mean age of 74.3 ± 38.8 months. Nine cases presented with thoracic vertebral destruction, 6 cases with lumbar vertebral destruction. Under Garg’s classification, 10, 3 and 2 cases were classified as Grade IIA, IB and IIB lesions, respectively. All patients had mild to moderate night-aggravated back pain and recovered at 1-week after surgery. Three patients had Frankel D neurologic symptoms and recovered at 1-week, 1-week and 4-weeks after surgery, respectively. Follow-up time after surgery ranged from 1.9 years to 4.5 years, with a mean of 2.9 years. The median vertebral height at 12 months after surgery was significantly higher than the preoperative height. Furthermore, the vertebral heights of all diseased vertebrae displayed significant recovery trends at 3, 6 and 12 months after surgical treatment. The percentages of vertebral height recovery to references at 12 months after surgery ranged from 34.7% to 92.5%, with an average of 71.2%.

Conclusions:

In children with collapsed vertebral EGs, active surgical treatment is necessary to retain the ability to restore height and to reconstruct the spine stability.
Prevalence of dysmenorrhea, its association with overall academic engagement, and management among nursing undergraduates at Peradeniya University, Sri Lanka: A cross-sectional study
Authors: Alahakoon A. M. Shashi Shardha , Wickramarathne D. B. Mahinda
Published: February 2021

Background:

Dysmenorrhea or painful menstrual periods is one of the common health issues the female university students experience which intervenes with academic activities and quality of life.

Objectives:

We aimed to find the prevalence, intensity, extent of impairment in academic engagement, and efficacy of the management of dysmenorrhea among nursing students at Peradeniya University, Sri Lanka.

Methodology:

This cross sectional study comprised 86 female nursing students who represented all four academic years. A self-administered questionnaire was used. The intensity and level of dysmenorrhea were assessed. Association of the extent of working impairment with the level of pain determined by Pearson correlation. Duration of dysmenorrhea persisted before and after management was compared using paired sample t-test. The effectiveness of management was analyzed using Wilcoxon signed-rank test.

Results:

The prevalence of dysmenorrhea was 97.7%. The majority (54.7%) suffered moderate pain. Mean age of the participants was 24.02 (±1.503). During the period of dysmenorrhea, 32.6%, 33.7%, and 17.4% students experienced slight, moderate, and heavy impairment of overall academic engagement. A positive correlation was observed between level of pain and extent of academic impairment ( p < 0.05). The majority practiced pharmacological and non-pharmacological pain relieving methods together. Wilcoxon signed-rank test value revealed more negative ranks and statistically significant reduction in intensity in post-management period ( z = −7.793, p = 0). Post-management dysmenorrhea duration was significantly reduced than pre-management ( t76 = 8.984, p = 0).

Conclusion:

A substantial percent of undergraduates suffer from dysmenorrhea. It is associated impairment of overall academic engagement. The nursing students were able to manage dysmenorrhea successfully.
Long-term treatment of endometriosis with dienogest: Real-world results from the VIPOS study
Authors: Moehner Sabine , Becker Kerstin , Lange Jens A , von Stockum Sophia , Serrani Marco , Heinemann Klaas
Published: February 2021

Introduction:

The Visanne Post-approval Observational Study (VIPOS) was designed to assess the safety of dienogest 2 mg (DNG, Visanne) compared to other hormonal endometriosis treatments.

Methods:

Large, prospective, non-interventional, active surveillance study in six European countries (Germany, Poland, Russia, Hungary, Switzerland, and Ukraine). Women with a new hormonal therapy for endometriosis were enrolled by gynecologists and specialized centers between 2010 and 2016 and observed for up to 7 years. Self-administered questionnaires during study entry and follow-up collected information on baseline characteristics, health status and endometriosis treatment. Self-reported clinical outcomes of interest were validated by health care professionals.

Results:

Among the >27,000 enrolled participants, 3262 women started DNG use either at study entry or during follow-up. A total of 798 study participants used DNG during follow-up continuously for 15 months or longer (DNG long-term users). When comparing the occurrence of serious adverse events (SAE) in users treated with DNG, no safety signal emerged for long-term users; the SAE incidence rate per 10,000 women-years was 367.7 (95% CI: 274.1–481.9) in DNG long-term users and 416.4 (349.1–492.5) in short-term users (treated with DNG for less than 15 months).

Conclusions:

Previous data on DNG long-term safety were derived from studies with relatively low numbers of patients and limited follow-up time. VIPOS provided valuable real-world data on the long-term use of DNG 2 mg in around 800 women treated in Europe and observed no safety signal regarding serious adverse events.
Cervical sagittal alignment in patients with dropped head syndrome
Authors: Qian Weiqing , Endo Kenji , Aihara Takato , Sawaji Yasunobu , Suzuki Hidekazu , Matsuoka Yuji , Takamatsu Taichiro , Murata Kazuma , Yamamoto Kengo
Published: February 2021

Background:

Dropped head syndrome (DHS) can be divided into two types, the positive sagittal vertical axis (SVA) type and the negative SVA type. However, the cervical sagittal alignment of DHS including global sagittal spinal alignment and the typical cervical alignment of the types of DHS is still unclear. The purpose of this study was to clarify the character of cervical sagittal alignment of DHS and analyze the relationship between cervical sagittal alignment and global sagittal spinal alignment.

Methods:

The subjects were 35 DHS patients (10 men, 25 women, mean 71.1 years old). They were divided into two groups: negative DHS (N-DHS group, SVA < 0 mm) and positive DHS group (P-DHS group, SVA ≥ 0 mm). As control, 28 age-matched cervical spondylosis patients (CS, 21 men, 7 women, mean 67.4 years old) were analyzed. The following parameters were measured on lateral global-spine standing radiographs: cervical SVA (C2-C7SVA), O-C2A (O-C2 angle), C2 slope (C2S), C2-7A (C2-7 angle), T1 slope (T1S) and C7SVA.

Results:

The results of measurements of each of the averaged sagittal alignment parameters were (CS, P-DHS, N-DHS): C2-7SVA(26.2 mm, 47.3 mm, 44.5 mm), O-C2 angle (35.0°, 37.1°, 39.3°), C2S (16.5°, 31.4°, 33.8°), C2-7A (9.3°, 9.9°, −16.6°), T1S (22.9°, 39.7°, 25.7°), C7SVA (35.3 mm, 51.0 mm, −43.1 mm). C2-C7SVA and C2S were significantly larger in both types of DHS compared to CS. Comparing P-DHS with N-DHS, C2-C7A and T1S were significantly smaller in N-DHS.

Conclusions:

O-C2A did not differ significantly among CS, P-DHS and N-DHS. In DHS patients, C2-7SVA and C2S were significantly larger than those of CS regardless of the type of DHS. The typical cervical sagittal alignment of DHS was different between P-DHS and N-DHS. In P-DHS, C2-7A and T1S were larger than those in N-DHS and the imbalance of thoraco-lumbar alignment should be noted.
A Case Report of Coccidioidomycosis in the Renal Parenchyma of Unusual Severity
Authors: Coleman Jeffrey A. , Civelli Valerie F. , Sharma Rupam , Heidari Arash , Johnson Royce H.
Published: February 2021

Coccidioidomycosis (CM) is an endemic fungal infection that is found in the Southwestern United States and adjacent areas of Mexico as well as Central and South America. In the United States, 150 000 to 300 000 infections occur annually. The majority are asymptomatic. Of the symptomatic cases, the majority are primary pneumonic disease that varies from mild to very severe. A minority of persons develop disseminated disease (extrapulmonary disease). These typically manifest as meningitis, osteomyelitis, synovitis, and integumentary. CM has been described in virtually every part of the body, including the genitourinary system. Disseminated CM to the genitourinary tract is well known to occur but is rarely documented. It is believed this is the first case to report disseminated CM to the renal parenchyma. Diagnosis and treatment are described in a 56-year-old Hispanic male.
CK-MB Elevation in Mild Hypothermia: What We Did and We Should Have Done
Authors: Sawalha Khalid , Vedala Krishna , Liu Eddie
Published: February 2021

An 88-year-old male patient with a past medical history of hypertension and gastroesophageal disease presented with nausea, vomiting, and hypothermia. He was admitted for further testing, which revealed elevated creatine kinase and its MB isoenzyme (CK-MB) and troponin with no significant electrocardiogram changes. He denied cardiac symptoms or any previous cardiac history. The patient was treated with fluids and antibiotics in which improvement in his symptoms was noted. In this article, we share this rare case of hypothermia associated with elevation of CK-MB.
Social Studies Textbook Effects: Evidence From Texas
Authors: Savage Corey , Hübner Nicolas , Biewen Martin , Nagengast Benjamin , Polikoff Morgan S.
Published: February 2021

Well-informed decisions on curricular materials can be an efficient way to boost student achievement. Prior studies have employed experimental and quasi-experimental designs to investigate the effects of textbooks on mathematics achievement. This is the first study to consider textbook effects in social studies education. Within the context of a textbook adoption cycle in Texas, we use a difference-in-differences approach with district-level administrative data and estimate the effects of adopting a state-approved textbook on social studies achievement. We find no evidence of a practically meaningful adoption effect. We conclude by highlighting the need for further high-quality research in this often-overlooked school subject area.
Comparative Analysis of Structural Transformation Process of Selected Asian Developing Economies
Authors: Aggarwal Roopali
Published: February 2021

This article tries to analyse country-level variations in the selected Asian developing economies in terms of their growth path and their position in the process of structural transformation in the recent decades, by estimating the turning point (TP) for each country. It also examines the magnitude of the contribution of intersectoral shifts and within-sector productivity gains in the economy-wide labour productivity growth by conducting the shift-share analysis. The results of turning point (TP) estimation show that all these countries had achieved their turning points except the Philippines between 1980 and 2018. However, the productivity increase in agriculture is not evident as their GAP in the year when TP would have been achieved is not even near to zero. Further, the shift-share analysis highlights the contribution of within-sector productivity growth is relatively more than that of intersectoral shifts of labour. Thus, the main concern is to make sure that there is a steady intersectoral movement of labour from low productive to high productive sectors, which can be done primarily through expanding the productive sectors (industry and services) to generate employment opportunities. Also, equally important is increasing the productivity of the agricultural sector so that the process of structural transformation could happen smoothly. For this, the public and private investments in R&D of both agriculture and non-agriculture sectors are highly crucial.
The Utility of Musculoskeletal Ultrasonography in Diagnosing Pyomyositis: A Comparison With Surgically and Conservatively Treated Cases
Authors: Bionat Edgar David , Ongchuan Mae Angeleine
Published: February 2021

Objective:

The study aimed to determine the accuracy of sonography in diagnosing pyomyositis.

Methods:

A retrospective review of pyomyositis cases in a government hospital between January 1, 2016 and June 30, 2019 was done. All cases underwent a sonogram for the indication of pyomyositis. Positive purulence for surgical cases and improved laboratory parameters for conservative cases were confirmatory for pyomyositis. Comparison with sonographic results using a 2 × 2 contingency table was done to determine sensitivity and specificity.

Results:

A total of 122 cases were included. The sonographic results corresponded with 95% of surgical cases and 89% of conservative cases. A lack of false and true negatives for surgical cases resulted in a sensitivity of 100% (95% confidence interval [CI] = 93%–100%) and a specificity of 0% (95% CI = 0%–71%). In conservative cases, sonography had a sensitivity of 92% (95% CI = 82%–97%) and a specificity of 0% (95% CI = 0%–84%) due to a lack of true negatives.

Conclusion:

Sonography is not limited to primarily as a screening tool but a capable diagnostic imaging choice for pyomyositis, particularly in low-resource settings. The results show the strength of sonography, particularly in the suppurative stage of pyomyositis. [Box: see text]
Correction to: Impact of primary headache disorder on quality of life among school students in Kuwait
Authors: Al-Hashel Jasem Y. , Alroughani R. , Shuaibi S. , AlAshqar A. , AlHamdan F. , AlThufairi H. , Owayed S. , Ahmed Samar F.
Published: February 2021

An amendment to this paper has been published and can be accessed via the original article.
Relative versus absolute RNA quantification: a comparative analysis based on the example of endothelial expression of vasoactive receptors
Authors: Kuhlmann Kevin , Cieselski Melanie , Schumann Julia
Published: February 2021

Background

In the present study, two distinct PCR methods were used for the quantification of genetic material and their results were compared: real-time-PCR (qPCR; relative quantification) and droplet digital PCR (ddPCR; absolute quantification). The comparison of the qPCR and the ddPCR was based on a stimulation approach of microvascular endothelial cells in which the effect of a pro-inflammatory milieu on the expression of vasoactive receptors was investigated.

Results

There was consistency in directions of effects for the majority of genes tested. With regard to the indicated dimension of the effects, the overall picture was more differentiated. It was striking that deviations were more pronounced if the measured values were on the extreme edges of the dynamic range of the test procedures.

Conclusions

To obtain valid and reliable results, dilution series are recommended, which should be carried out initially. In case of ddPCR the number of copies per µl should be adjusted to the low three-digit range. With regard to qPCR it is essential that the stability and reliability of the reference genes used is guaranteed. Here, ddPCR offers the advantage that housekeeping genes are not required. Furthermore, an absolute quantification of the sample can be easily performed by means of ddPCR. Before using ddPCR, however, care should be taken to optimize the experimental conditions. Strict indications for this methodology should also be made with regard to economic and timing factors.
Fine-scale habitat heterogeneity favours the coexistence of supergene-controlled social forms in Formica selysi
Authors: Zahnd Sacha , Fontcuberta Amaranta , Koken Mesut , Cardinaux Aline , Chapuisat Michel
Published: February 2021

Background

Social insects vary widely in social organization, yet the genetical and ecological factors influencing this variation remain poorly known. In particular, whether spatially varying selection influences the maintenance of social polymorphisms in ants has been rarely investigated. To fill this gap, we examined whether fine-scale habitat heterogeneity contributes to the co-existence of alternative forms of social organization within populations. Single-queen colonies (monogyne social form) are generally associated with better colonization abilities, whereas multiple-queen colonies (polygyne social form) are predicted to be better competitors and monopolize saturated habitats. We hypothesize that each social form colonizes and thrives in distinct local habitats, as a result of their alternative dispersal and colony founding strategies. Here, we test this hypothesis in the Alpine silver ant, in which a supergene controls polymorphic social organization.

Results

Monogyne and polygyne colonies predominate in distinct habitats of the same population. The analysis of 59 sampling plots distributed across six habitats revealed that single-queen colonies mostly occupy unconnected habitats that were most likely reached by flight. This includes young habitats isolated by water and old habitats isolated by vegetation. In contrast, multiple-queen colonies were abundant in young, continuous and saturated habitats. Hence, alternative social forms colonize and monopolize distinct niches at a very local scale.

Conclusions

Alternative social forms colonized and monopolized different local habitats, in accordance with differences in colonization and competition abilities. The monogyne social form displays a colonizer phenotype, by efficiently occupying empty habitats, while the polygyne social form exhibits a competitor phenotype, thriving in saturated habitats. The combination of the two phenotypes, coupled with fine-scale habitat heterogeneity, may allow the coexistence of alternative social forms within populations. Overall, these results suggest that spatially varying selection may be one of the mechanisms contributing to the maintenance of genetic polymorphisms in social organization.
Family medicine practitioners’ stress during the COVID-19 pandemic: a cross-sectional survey
Authors: Dutour Marion , Kirchhoff Anna , Janssen Cécile , Meleze Sabine , Chevalier Hélène , Levy-Amon Sandrine , Detrez Marc-Antoine , Piet Emilie , Delory Tristan
Published: February 2021

Background

The COVID-19 pandemic has shaken the world in early 2020. In France, General Practitioners (GPs) were not involved in the care organization’s decision-making process before and during the first wave of the COVID-19 pandemic. This omission could have generated stress for GPs. We aimed first to estimate the self-perception of stress as defined by the 10-item Perceived Stress Score (PSS-10), at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes, a french administrative area severely impacted by COVID-19. Second, we aimed to identify factors associated with a self-perceived stress (PSS-10 ≥ 27) among socio-demographic characteristics of GPs, their access to reliable information and to personal protective equipment during the pandemic, and their exposure to well established psychosocial risk at work.

Methods

We conducted an online cross-sectional survey between 8th April and 10th May 2020. The self-perception of stress was evaluated using the PSS-10, so to see the proportion of “not stressed” (≤20), “borderline” (21 ≤ PSS-10 ≤ 26), and “stressed” (≥27) GPs. The agreement to 31 positive assertions related to possible sources of stress identified by the scientific study committee was measured using a 10-point numeric scale. In complete cases, factors associated with stress (PSS-10 ≥ 27) were investigated using logistic regression, adjusted on gender, age and practice location. A supplementary analysis of the verbatims was made.

Results

Overall, 898 individual answers were collected, of which 879 were complete. A total of 437 GPs (49%) were stressed (PSS-10 ≥ 27), and 283 GPs (32%) had a very high level of stress (PSS-10 ≥ 30). Self-perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements. However, in this context of health crisis, the primary source of stress was the diversity and quantity of information from diverse sources (614 GPs (69%, OR = 2.21, 95%CI [1.40–3.50], p < 0.001). Analysis of verbatims revealed that GPs felt isolated in a hospital-based model.

Conclusion

The first wave of the pandemic was a source of stress for GPs. The diversity and quantity of information received from the health authorities were among the main sources of stress.
Burden and consequence of birth defects in Nepal-evidence from prospective cohort study
Authors: Paudel Prajwal , Sunny Avinash K. , Gurung Rejina , Gurung Abhishek , Malla Honey , Rana Netra B. , KC Nawaraj , Chaudhary Ram Narayan , KC Ashish
Published: February 2021

Background

Every year an estimated 7.9 million babies are born with birth defect. Of these babies, more than 3 million die and 3.2 million have disability. Improving nationwide information on prevalence of birth defect, risk factor and consequence is required for better resource allocation for prevention, management and rehabilitation. In this study, we assess the prevalence of birth defect, associated risk factors and consequences in Nepal.

Method

This is a prospective cohort study conducted in 12 hospitals of Nepal for 18 months. All the women who delivered in the hospitals during the study period was enrolled. Independent researchers collected data on the social and demographic information using semi-structured questionnaire at the time of discharge and clinical events and birth outcome information from the clinical case note. Data were analyzed on the prevalence and type of birth defect. Logistic regression was done to assess the risk factor and consequences for birth defect.

Results

Among the total 87,242 livebirths, the prevalence of birth defects was found to be 5.8 per 1000 live births. The commonly occurring birth defects were anencephaly (3.95%), cleft lip (2.77%), cleft lip and palate (6.13%), clubfeet (3.95%), eye abnormalities (3.95%) and meningomyelocele (3.36%). The odds of birth defect was higher among mothers with age < 20 years (adjusted Odds ratio (aOR) 1.64; 95% CI, 1.18–2.28) and disadvantaged ethnicity (aOR 1.78; 95% CI, 1.46–2.18). The odds of birth asphyxia was twice fold higher among babies with birth defect (aOR 1.88; 95% CI, 1.41–2.51) in reference with babies without birth defect. The odds of neonatal infection was twice fold higher among babies with birth defect (aOR 1.82; 95% CI, 1.12–2.96) in reference with babies without birth defect. Babies with birth defect had three-fold risk of pre-discharge mortality (aOR 3.00; 95% CI, 1.93–4.69).

Conclusion

Maternal age younger than 20 years and advantaged ethnicity were risk factors of birth defects. Babies with birth defect have high risk for birth asphyxia, neonatal infection and pre-discharge mortality at birth. Further evaluation on the care provided to babies who have birth defect is warranted.

Funding

Swedish Research Council (VR).
Patterns of pain location in music students: a cluster analysis
Authors: Cruder Cinzia , Barbero Marco , Soldini Emiliano , Gleeson Nigel
Published: February 2021

Background

According to existing literature, musicians experience high rates of musculoskeletal (MSK) disorders involving different anatomical areas. The aim of the study was to identify patterns of pain location in a sample of music students enrolled in different pan-European music institutions. A further goal was to explore the association between the identified pain patterns and students’ characteristics.

Methods

A total of 340 music students (mean age 23.3 years, 66.2% female) with current MSK pain completed a web-based questionnaire including both background information (i.e. lifestyle and physical activity, practice habits) and clinical features (i.e. pain characteristics, disability, pain self-efficacy, psychological distress, perfectionism and fatigue).

Results

Five patterns of pain location were identified by hierarchical cluster analysis: wrist pain (WP) representing 22.6% of the total sample, widespread pain (WSP) (16.9%), right shoulder pain (RSP) (18.5%), both shoulders pain – left concentrated (LSP) (23.2%), neck and back pain (NBP) (18.8%). Amongst the identified patterns of pain location, bivariate analysis identified the WSP cluster as containing the largest number of associated variables. Participants in this cluster reported a higher percentage of women (p < .05), a higher perceived exertion (p < .01) and psychological distress (p < .001), as well as a lower level of self-efficacy (p < .01). Similarly, a higher percentage of participants included in the WSP cluster perceived their musical activity as the main cause of their MSK pain (p < .01). Additionally, a higher level of disability in relation to playing-related activity was reported by participants included in the WP and WSP clusters (p < .001). The RSP cluster was characterised by a higher percentage of participants playing an instrument in a neutral position (p < .001) and lower levels of socially prescribed perfectionism (p < .01). A higher percentage of participants playing an instrument with both arms elevated in the left quadrant position were included in the LSP cluster and a higher percentage of singers were included in the NBP cluster (p < .001).

Conclusions

Five distinct patterns of pain location were identified and their associations with the students’ characteristics were explored. These findings may be helpful in the exploration of different aetiologies of MSK pain among musicians and in the development of targeted preventive strategies and treatments.
Correction to: Near-infrared auto-fluorescence spectroscopy combining with Fisher’s linear discriminant analysis improves intraoperative real-time identification of normal parathyroid in thyroidectomy
Authors: Liu Junsong , Wang Xiaoxia , Wang Rui , Xu Chongwen , Zhao Ruimin , Li Honghui , Zhang Shaoqiang , Yao Xiaobao
Published: February 2021

An amendment to this paper has been published and can be accessed via the original article.
Serum neurofilament light and tau as prognostic markers for all-cause mortality in the elderly general population—an analysis from the MEMO study
Authors: Rübsamen Nicole , Maceski Aleksandra , Leppert David , Benkert Pascal , Kuhle Jens , Wiendl Heinz , Peters Annette , Karch André , Berger Klaus
Published: February 2021

Background

Neurofilament light chain (NfL) is a cytoskeletal protein component whose release into blood is indicative of neuronal damage. Tau is a microtubule-associated protein in neurons and strongly associated with overall brain degeneration. NfL and tau levels are associated with mortality in different neurological diseases, but studies in the general population are missing. We investigated whether NfL and tau serum levels could serve as prognostic markers for overall mortality in elderly individuals without pre-defined neurological conditions. Further, we investigated the cross-sectional associations between NfL, tau, neuropsychological functioning, and brain structures.

Methods

In 1997, 385 inhabitants of Augsburg who were aged 65 years and older were included in the Memory and Morbidity in Augsburg Elderly (MEMO) study. They participated in a face-to-face medical interview including neuropsychological tests and magnetic resonance imaging (MRI) of the brain. NfL and tau were measured from non-fasting blood samples using highly sensitive single molecule array assays. To assess the prognostic accuracy of the biomarkers, concordance statistics based on the predicted 5-year survival probabilities were calculated for different Cox regression models. Associations between the biomarkers and the neuropsychological test scores or brain structures were investigated using linear or logistic regression.

Results

NfL (HR 1.27, 95% CI [1.14–1.42]) and tau (1.20 [1.07–1.35]) serum levels were independently associated with all-cause mortality. NfL, but not tau, increased the prognostic accuracy when added to a model containing sociodemographic characteristics (concordance statistic 0.684 [0.612–0.755] vs. 0.663 [0.593–0.733]), but not when added to a model containing sociodemographic characteristics and brain atrophy or neuropsychological test scores. NfL serum levels were cross-sectionally associated with neuropsychological test scores and brain structures.

Conclusions

The association between NfL serum levels and brain atrophy and neuropsychological performance in individuals without overt neurological disease is similar to that seen in patients with neurodegenerative diseases. These findings support the concept of a continuum of physiological aging and incipient, subclinical pathology, and manifest disease.

NfL, but not tau, serum levels might serve as a prognostic marker for all-cause mortality if no other clinical information is available.
The impact of energy retrofits on pediatric asthma exacerbation in a Boston multi-family housing complex: a systems science approach
Authors: Tieskens Koen F. , Milando Chad W. , Underhill Lindsay J. , Vermeer Kimberly , Levy Jonathan I. , Fabian M. Patricia
Published: February 2021

Background

Pediatric asthma is currently the most prevalent chronic disease in the United States, with children in lower income families disproportionately affected. This increased health burden is partly due to lower-quality and insufficient maintenance of affordable housing. A movement towards ‘green’ retrofits that improve energy efficiency and increase ventilation in existing affordable housing offers an opportunity to provide cost-effective interventions that can address these health disparities.

Methods

We combine indoor air quality modeling with a previously developed discrete event model for pediatric asthma exacerbation to simulate the effects of different types of energy retrofits implemented at an affordable housing site in Boston, MA.

Results

Simulation results show that retrofits lead to overall better health outcomes and healthcare cost savings if reduced air exchange due to energy-saving air tightening is compensated by mechanical ventilation. Especially when exposed to indoor tobacco smoke and intensive gas-stove cooking such retrofit would lead to an average annual cost saving of over USD 200, while without mechanical ventilation the same children would have experienced an increase of almost USD 200/year in health care utilization cost.

Conclusion

The combination of indoor air quality modeling and discrete event modeling applied in this paper can allow for the inclusion of health impacts in cost-benefit analyses of proposed affordable housing energy retrofits.
Triglycerides to high-density lipoprotein cholesterol ratio is superior to triglycerides and other lipid ratios as an indicator of increased urinary albumin-to-creatinine ratio in the general population of China: a cross-sectional study
Authors: Xue Jing , Wang Yuxia , Li Bing , Yu Songyan , Wang Anping , Wang Weiqing , Gao Zhengnan , Tang Xulei , Yan Li , Wan Qin , Qin Guijun , Chen Lulu , Ning Guang , Mu Yiming
Published: February 2021

Background

Dyslipidemia contributes to the pathogenesis of renal dysfunction. Previous research demonstrated that triglycerides (TG), instead of other individual lipid indexes, has a significant link with elevated urinary albumin-to-creatinine ratio (UACR). However, it is unclear whether lipid ratios are superior indicators of increased UACR compared with TG. This research is to determine whether there are close relationships of lipid ratios with UACR in a general population.

Methods

35,751 participants from seven centers across China were enrolled. UACR equal or higher than 30 mg/g was recognized as increased albuminuria. The associations of TG, low-density lipoprotein cholesterol (LDL-C)/ high-density lipoprotein cholesterol (HDL-C), TG/HDL-C and non-high-density lipoprotein cholesterol (non-HDL-C)/HDL-C with increased UACR were evaluated by linear and logistic regression analyses in females and males separately.

Results

There were 3692 (14.8%) female subjects, and 1307 (12.0%) male subjects characterized as having increased UACR. There were significantly differences in TG/HDL-C and non-HDL-C/HDL-C between the normal UACR group and the increased UACR group, while LDL-C/HDL-C was not. Furthermore, linear regression analysis was implemented and showed that TG and TG/HDL-C were both positively related to UACR even after a variety of potential confounders were adjusted regardless of sexes, while the correlation between non-HDL-C/HDL-C and elevated UACR were only significant in females. Further analyses utilizing logistic regression demonstrated that compared with non-HDL-C/HDL-C and TG, TG/HDL-C showed the strongest association with increased UACR (quartile 1 of TG/HDL-C as a reference; OR [95% CI] of quartile 4: 1.28 [1.13–1.44] in women, 1.24 [1.02–1.50] in men) after fully adjusting for potential confounding factors. Stratified analyses revealed that in males who were overweight and in females who were overweight or over 55 years or had prediabetes or prehypertension, TG/HDL-C had significant associations with abnormal UACR.

Conclusions

Compared with TG and other routine lipid ratios, TG/HDL-C is a superior indicator for increased UACR.
Silencing of Vangl2 attenuates the inflammation promoted by Wnt5a via MAPK and NF-κB pathway in chondrocytes
Authors: Zhang Ke , Li Zhuoying , Lu Yunyang , Xiang Linyi , Sun Jiadong , Zhang Hong
Published: February 2021

Background

The Wnt planar cell polarity (PCP) pathway is implicated in osteoarthritis (OA) both in animals and in humans. Van Gogh-like 2 (Vangl2) is a key PCP protein that is required for the orientation and alignment of chondrocytes in the growth plate. However, its functional roles in OA still remain undefined. Here, we explored the effects of Vangl2 on OA chondrocyte in vitro and further elucidated the molecular mechanism of silencing Vangl2 in Wnt5a-overexpressing OA chondrocytes.

Methods

Chondrocytes were treated with IL-1β (10 ng/mL) to simulate the inflammatory microenvironment of OA. The expression levels of Vangl2, Wnt5a, MMPs, and related proinflammatory cytokines were measured by RT-qPCR. Small interfering RNA (siRNA) of Vangl2 and the plasmid targeting Wnt5a were constructed and transfected into ATDC5 cells. Then, the functional roles of silencing Vangl2 in the OA chondrocytes were investigated by Western blotting, RT-qPCR, and immunocytochemistry (ICC). Transfected OA chondrocytes were subjected to Western blotting to analyze the relationship between Vangl2 and related signaling pathways.

Results

IL-1β induced the production of Vangl2, Wnt5a, and MMPs in a time-dependent manner and the significantly increased expression of Vangl2. Vangl2 silencing effectively suppressed the expression of MMP3, MMP9, MMP13, and IL-6 at both gene and protein levels and upregulated the expression of type II collagen and aggrecan. Moreover, knockdown of Vangl2 inhibited the phosphorylation of MAPK signaling molecules (P38, ERK, and JNK) and P65 in Wnt5a-overexpressing OA chondrocytes.

Conclusions

For the first time, we demonstrate that Vangl2 is involved in the OA process. Vangl2 silencing can notably alleviate OA progression in vitro by inhibiting the expression of MMPs and increasing the formation of the cartilage matrix and can inhibit the proinflammatory effects of Wnt5a via MAPK and NF-κB pathway. This study provides new insight into the mechanism of cartilage inflammation.
CellWalker integrates single-cell and bulk data to resolve regulatory elements across cell types in complex tissues
Authors: Przytycki Pawel F. , Pollard Katherine S.
Published: February 2021

Single-cell and bulk genomics assays have complementary strengths and weaknesses, and alone neither strategy can fully capture regulatory elements across the diversity of cells in complex tissues. We present CellWalker, a method that integrates single-cell open chromatin (scATAC-seq) data with gene expression (RNA-seq) and other data types using a network model that simultaneously improves cell labeling in noisy scATAC-seq and annotates cell type-specific regulatory elements in bulk data. We demonstrate CellWalker’s robustness to sparse annotations and noise using simulations and combined RNA-seq and ATAC-seq in individual cells. We then apply CellWalker to the developing brain. We identify cells transitioning between transcriptional states, resolve regulatory elements to cell types, and observe that autism and other neurological traits can be mapped to specific cell types through their regulatory elements.
Acquired hemophilia A that required surgical hemostasis of hematomas occupying oral cavity: a case report
Authors: Maeda Keigo , Yamamoto Shinsuke , Taniike Naoki , Takenobu Toshihiko
Published: February 2021

Background

Acquired hemophilia A is a rare coagulopathy caused by inhibitors of blood coagulation factor VIII. Patients with acquired hemophilia A have a higher mortality risk (5–10%) than those with congenital hemophilia. Moreover, there is no established evidence of management recommended for patients with acquired hemophilia A. Previous studies have reported the presence of hematomas in the oral cavities of patients with acquired hemophilia A, which were treated conservatively. Here, we describe the case of a patient with acquired hemophilia A, where emergency surgical hemostasis was required for large intraoral hematomas.

Case presentation

A 65-year-old Japanese man was referred to our hospital with a chief complaint of bleeding from large intraoral hematomas. On examination, he could not close his mouth because of the hematomas, which were bleeding spontaneously. Computed tomography angiography revealed no evidence of arteriovenous malformation, and blood test results showed that the activated partial thromboplastin time was elevated beyond the normal limit. To avoid a life-threatening hemorrhage from hematomas, emergency surgical hemostasis was performed with nasotracheal intubation using fiberoptic bronchoscopy. Hemostasis was successfully performed, as the hematomas were carefully removed. Moreover, the clinical course was successfully completed using intravenously administered activated prothrombin complex concentrate for hemostasis after operation.

Conclusions

Acquired hemophilia A can cause a life-threatening hemorrhage without predictive factors. Intraoral hematoma may cause airway obstruction. There is no consensus regarding the management of hemorrhage in patients with acquired hemophilia A. As shown here, exophytic hematomas in the oral cavity can be safely removed and nasotracheal intubation with fiberoptic bronchoscopy may be useful in patients with coagulopathy disease.