bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation progress following reverse total shoulder replacement and internal fixation for geriatric three and four-part proximal humerus fractures – a propensity score matched comparison
Authors: Tong Chi Him , Fang Christian Xinshuo
Published: July 2023

Background

Proximal humerus fracture is one of the most common fractures in the elderly population. However, in patients with complex fracture patterns, there is still no general consensus in the best treatment method. This study aims to evaluate the outcomes between those treated with reverse total shoulder arthroplasty (rTSA) and open reduction internal fixation (ORIF).

Methods

All geriatric patients (> 60 years of age) with proximal humerus fractures undergoing surgical treatment were analysed. There were 25 patients treated with rTSA and 75 with ORIF. Propensity score matching was used to select 25 matching patients from the ORIF group according to age and gender. All patients underwent surgical intervention within 7 days (mean 3.8 days). All patients followed a protocol-driven rehabilitation programme with outcome assessment at 3, 6, 12 and 24 months. Constant score, qDASH, range of motion, rate of complications and revision surgery were recorded and compared.

Results

Twenty-five rTSA were age and gender matched with 25 ORIF patients. The average age of patients in rTSA and ORIF groups were 77.0 years and 75.2 years respectively. At 3 months, mean Constant score was 37.7 (rTSA) vs 45.5 (ORIF) (p = 0.099). Mean qDASH score was 50.6 (rTSA) vs 29.4 (ORIF) (p = 0.003). Mean forward flexion range was 72.9° (rTSA) vs 94.4° (ORIF) (p = 0.007). Mean abduction range was 64.0° (rTSA) vs 88.6° (ORIF) (p = 0.001). At 2 years, mean Constant score was 72.8 (rTSA) vs 70.8 (ORIF) (p = 0.472). Mean qDASH score was 4.50 (rTSA) vs 11.0 (ORIF) (p = 0.025). Mean forward flexion range was 143° (rTSA) vs 109° (ORIF) (p < 0.001). Mean abduction range was 135° (rTSA) vs 110° (ORIF) (p = 0.025). There was a higher number of complications observed for ORIF (3) than rTSA (1) (p = 0.297) and a higher number of re-operations for ORIF (3) than rTSA (1) (p = 0.297), which was not statistically significant.

Conclusion

rTSA appears to yield a slower recovery at 3 months but a better outcome at 2 years. It is a promising treatment for geriatrics with three- and four-part proximal humerus fractures aiming for a better long-term functional outcome.
The associations of depression, anxiety, and insomnia at baseline with disability at a five-year follow-up point among outpatients with chronic low back pain: a prospective cohort study
Authors: Wang Le-Yung , Fu Tsai-Sheng , Tsia Mei-Chu , Hung Ching-I
Published: July 2023

Background

No previous study has investigated the associations of depression, anxiety, and insomnia at baseline with disability at a five-year follow-up point among outpatients with chronic low back pain (CLBP). The study aimed to simultaneously compare the associations of depression, anxiety, and sleep quality at baseline with disability at a 5-year follow-up point among patients with CLBP.

Methods

Two-hundred and twenty-five subjects with CLBP were enrolled at baseline, and 111 subjects participated at the five-year follow-up point. At follow-up, the Oswestry Disability Index (ODI) and total months of disability (TMOD) over the past five years were used as the indices of disability. The depression (HADS-D) and anxiety (HADS-A) subscales of the Hospital Anxiety and Depression Scale and the Insomnia Severity Index (ISI) were used to assess depression, anxiety, and insomnia at baseline and follow-up. Multiple linear regression was employed to test the associations.

Results

The scores of the HADS-D, HADS-A, and ISI were correlated with the ODI at the same time points (both at baseline and follow-up). A greater severity on the HADS-D, an older age, and associated leg symptoms at baseline were independently associated with a greater ODI at follow-up. A greater severity on the HADS-A and fewer educational years at baseline were independently associated with a longer TMOD. The associations of the HADS-D and HADS-A at baseline with disability at follow-up were greater than that of the ISI at baseline, based on the regression models.

Conclusion

Greater severities of depression and anxiety at baseline were significantly associated with greater disability at the five-year follow-up point. The associations of depression and anxiety at baseline with disability at the long-term follow-up point might be greater than that of insomnia at baseline.
High expression of IL4I1 is correlated with poor prognosis and immune infiltration in thyroid cancer
Authors: Zhu Liying , Wang Jun , Hu Jia’an
Published: July 2023

Background

Thyroid cancer-related deaths mostly result from metastasis. It was reported that the immunometabolism associated enzyme interleukin-4-induced-1 (IL4I1) was related to tumor metastasis. The present study was intended to investigate the effects of IL4I1 on thyroid cancer metastasis and its relationship with the prognosis.

Methods

Data from Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) were analyzed to find out the different mRNA expressions of IL4I1 between thyroid cancer and normal tissues. And Human Protein Atlas (HPA) was used to assess IL4I1 protein expression. To further differentiate thyroid cancer from normal tissues and estimate the impact of IL4I1 on the prognosis, the receiver operating characteristic curve (ROC) and Kaplan–Meier (KM) method was performed. The protein–protein interaction (PPI) network was established using STRING, and functional enrichment analyses were conducted by “clusterProfiler” package. Then, we assayed the correlation between IL4I1 and some related molecules. The relationship between IL4I1 and immune infiltration was performed using “Gene Set Variation Analysis (GSVA)” package in TCGA and tumor-immune system interaction database (TISIDB). Finally, we did in vitro experiments in order to further prove the bioeffects of IL4I1 on metastasis.

Results

The expression of IL4I1 mRNA and IL4I1 protein was significantly upregulated in thyroid cancer tissues. The increment of IL4I1 mRNA expression was related to high-grade malignancy, lymph node metastases and extrathyroidal extension. The ROC curve displayed the cutoff value of 0.782, with the sensitivity of 77.5% and the specificity of 77.8%. KM survival analysis showed that there was a worse PFS in patients with high IL4I1 expression than those with low IL4I1 expression (p = 0.013). Further study indicated that IL4I1 was associated with lactate, body fluid secretion, positive regulation of T cell differentiation, and cellular response to nutrients in Gene Ontology (GO) analysis. Moreover, IL4I1 was found correlated with immune infiltration. Finally, the in vitro experiments revealed the promotion of IL4I1 on cancer cell proliferation, migration and invasion.

Conclusions

The increased IL4I1 expression is markedly correlated with the immune imbalance in the tumor microenvironment (TME) and predicts poor survival in thyroid cancer. This study reveals the potential clinical biomarker of poor prognosis and the target of immune therapy in thyroid cancer.
How can social robot use cases in healthcare be pushed - with an interoperable programming interface
Authors: Glauser Robin , Holm Jürgen , Bender Matthias , Bürkle Thomas
Published: July 2023

Introduction

Research into current robot middleware has revealed that most of them are either too complicated or outdated. These facts have motivated the development of a new middleware to meet the requirements of usability by non-experts. The proposed middleware is based on Android and is intended to be placed over existing robot SDKs and middleware. It runs on the android tablet of the Cruzr robot. Various toolings have been developed, such as a web component to control the robot via a webinterface, which facilitates its use.

Methods

The middleware was developed using Android Java and runs on the Cruzr tablet as an app. It features a WebSocket server that interfaces with the robot and allows control via Python or other WebSocket-compatible languages. The speech interface utilizes Google Cloud Voice text-to-speech and speech-to-text services. The interface was implemented in Python, allowing for easy integration with existing robotics development workflows, and a web interface was developed for direct control of the robot via the web.

Results

The new robot middleware was created and deployed on a Cruzr robot, relying on the WebSocket API and featuring a Python implementation. It supports various robot functions, such as text-to-speech, speech-to-text, navigation, displaying content and scanning bar codes. The system’s architecture allows for porting the interface to other robots and platforms, showcasing its adaptability. It has been demonstrated that the middleware can be run on a Pepper robot, although not all functions have been implemented yet. The middleware was utilized to implement healthcare use cases and received good feedback.

Conclusion

Cloud and local speech services were discussed in regard to the middleware’s needs, to run without having to change any code on other robots. An outlook on how the programming interface can further be simplified by using natural text to code generators has been/is given. For other researchers using the aforementioned platforms (Cruzr, Pepper), the new middleware can be utilized for testing human-robot interaction. It can be used in a teaching setting, as well as be adapted to other robots using the same interface and philosophy regarding simple methods.
Systems resilience in the implementation of a large-scale suicide prevention intervention: a qualitative study using a multilevel theoretical approach
Authors: Ellis Louise A , Zurynski Yvonne , Long Janet C , Clay-Williams Robyn , Ree Eline , Sarkies Mitchell , Churruca Kate , Shand Fiona , Pomare Chiara , Saba Maree , Haraldseid-Driftland Cecilie , Braithwaite Jeffrey
Published: July 2023

Background

Resilience, the capacity to adapt and respond to challenges and disturbances, is now considered fundamental to understanding how healthcare systems maintain required levels of performance across varying conditions. Limited research has examined healthcare resilience in the context of implementing healthcare improvement programs across multiple system levels, particularly within community-based mental health settings or systems. In this study, we explored resilient characteristics across varying system levels (individual, team, management) during the implementation of a large-scale community-based suicide prevention intervention.

Methods

Semi-structured interviews (n=53) were conducted with coordinating teams from the four intervention regions and the central implementation management team. Data were audio-recorded, transcribed, and imported into NVivo for analysis. A thematic analysis of eight transcripts involving thirteen key personnel was conducted using a deductive approach to identify characteristics of resilience across multiple system levels and an inductive approach to uncover both impediments to, and strategies that supported, resilient performance during the implementation of the suicide prevention intervention.

Results

Numerous impediments to resilient performance were identified (e.g., complexity of the intervention, and incompatible goals and priorities between system levels). Consistent with the adopted theoretical framework, indicators of resilient performance relating to anticipation, sensemaking, adaptation and tradeoffs were identified at multiple system levels. At each of the system levels, distinctive strategies were identified that promoted resilience. At the individual and team levels, several key strategies were used by the project coordinators to promote resilience, such as building relationships and networks and carefully prioritising available resources. At the management level, strategies included teambuilding, collaborative learning, building relationships with external stakeholders, monitoring progress and providing feedback. The results also suggested that resilience at one level can shape resilience at other levels in complex ways; most notably we identified that there can be a downside to resilience, with negative consequences including stress and burnout, among individuals enacting resilience.

Conclusions

The importance of considering resilience from a multilevel systems perspective, as well as implications for theory and future research, are discussed.
A new compact adenine base editor generated through deletion of HNH and REC2 domain of SpCas9
Authors: Qian Yuqiang , Wang Di , Niu Wenchao , Zhao Ding , Li Jinze , Liu Zhiquan , Gao Xun , Han Yang , Lai Liangxue , Li Zhanjun
Published: July 2023

Background

Adenine base editors (ABEs) are promising therapeutic gene editing tools that can efficiently convert targeted A•T to G•C base pairs in the genome. However, the large size of commonly used ABEs based on SpCas9 hinders its delivery in vivo using certain vectors such as adeno-associated virus (AAV) during preclinical applications. Despite a number of approaches having previously been attempted to overcome that challenge, including split Cas9-derived and numerous domain-deleted versions of editors, whether base editor (BE) and prime editor (PE) systems can also allow deletion of those domains remains to be proven. In this study, we present a new small ABE (sABE) with significantly reduced size.

Results

We discovered that ABE8e can tolerate large single deletions in the REC2 (Δ174-296) and HNH (Δ786-855) domains of SpCas9, and these deletions can be stacked together to create a new sABE. The sABE showed higher precision than the original ABE8e, with proximally shifted protospacer adjacent motif (PAM) editing windows (A3- A15), and comparable editing efficiencies to 8e-SaCas9-KKH. The sABE system efficiently generated A-G mutations at disease-relevant loci (T1214C in GAA and A494G in MFN2) in HEK293T cells and several canonical Pcsk9 splice sites in N2a cells. Moreover, the sABE enabled in vivo delivery in a single adeno-associated virus (AAV) vector with slight efficiency. Furthermore, we also successfully edited the genome of mouse embryos by microinjecting mRNA and sgRNA of sABE system into zygotes.

Conclusions

We have developed a substantially smaller sABE system that expands the targeting scope and offers higher precision of genome editing. Our findings suggest that the sABE system holds great therapeutic potential in preclinical applications.
Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review
Authors: Khan Zahra , Vowles Zoe , Fernandez Turienzo Cristina , Barry Zenab , Brigante Lia , Downe Soo , Easter Abigail , Harding Seeromanie , McFadden Alison , Montgomery Elsa , Page Lesley , Rayment-Jones Hannah , Renfrew Mary , Silverio Sergio A. , Spiby Helen , Villarroel-Williams Nazmy , Sandall Jane
Published: July 2023

Background

Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this population, in high-income countries (HIC). The review aimed to identify and evaluate the current evidence related to targeted health and social care service interventions in HICs which can improve health inequalities experienced by childbearing women and infants at disproportionate risk of poor outcomes and experiences.

Methods

Twelve databases searched for studies across all HICs, from any methodological design. The search concluded on 8/11/22. The inclusion criteria included interventions that targeted disadvantaged populations which provided a component of clinical care that differed from standard maternity care.

Results

Forty six index studies were included. Countries included Australia, Canada, Chile, Hong Kong, UK and USA. A narrative synthesis was undertaken, and results showed three intervention types: midwifery models of care, interdisciplinary care, and community-centred services. These intervention types have been delivered singularly but also in combination of each other demonstrating overlapping features. Overall, results show interventions had positive associations with primary (maternal, perinatal, and infant mortality) and secondary outcomes (experiences and satisfaction, antenatal care coverage, access to care, quality of care, mode of delivery, analgesia use in labour, preterm birth, low birth weight, breastfeeding, family planning, immunisations) however significance and impact vary. Midwifery models of care took an interpersonal and holistic approach as they focused on continuity of carer, home visiting, culturally and linguistically appropriate care and accessibility. Interdisciplinary care took a structural approach, to coordinate care for women requiring multi-agency health and social services. Community-centred services took a place-based approach with interventions that suited the need of its community and their norms.

Conclusion

Targeted interventions exist in HICs, but these vary according to the context and infrastructure of standard maternity care. Multi-interventional approaches could enhance a targeted approach for at risk populations, in particular combining midwifery models of care with community-centred approaches, to enhance accessibility, earlier engagement, and increased attendance.

Trial registration

PROSPERO Registration number: CRD42020218357.
Making ‘being less sedentary feel normal’ –investigating ways to reduce adolescent sedentary behaviour at school: a qualitative study
Authors: Parrish Anne-Maree , Okely Anthony D. , Salmon Jo , Trost Stewart , Hammersley Megan , Murdoch Anisse
Published: July 2023

Background

Adolescents spend over 50% of a 24-hour period and 63% of the school day sedentary. Few comprehensive qualitative studies have explored teachers’ and students’ perceptions of potential strategies to reduce sedentary behaviour (SB) in the secondary school setting. This project aimed to elicit students’ and teachers’ perspectives of feasible and acceptable ways to encourage adolescents to “sit less and stand or move more” during the school day.

Methods

Students, teachers, and executives from four schools in the Illawarra and surrounding areas (New South Wales) Australia, were invited to participate. Focus group implementation used a participatory research design (‘problem and solution tree’). Participants were interviewed in three groups, younger adolescents, older adolescents and teachers/executives. Firstly the ‘problem’ (high rates of SB) was explained, participants were then asked to identify contributing school related factors, and to suggest feasible ideas to reduce SB during the school day.

Results

Fifty-five students (24 from Years 7/8 aged 12–14 years and 31 from Years 9/10 aged 14–16 years), and 31 teachers consented to participate. Thematic analysis elicited five main ‘problems’: lesson structure, non-conducive classroom environment/structure, non-conducive break-time environment, curricular pressures and school-related factors increasing sedentary behaviour outside of school. Suggested ‘solutions’ included: changes to classroom layout/furniture, pedagogical changes, hands-on learning, outdoor lessons, more comfortable uniforms, more breaks during class time, compulsory physical activity, and outdoor equipment.

Conclusions

The proposed solutions to reduce adolescent SB during the school day have potential to be feasibly implemented in the school setting, even with limited funding.
Real-time predictors of food parenting practices and child eating behaviors in racially/ethnically diverse families
Authors: Berge Jerica M. , Fertig Angela R. , Trofholz Amanda , de Brito Junia N.
Published: July 2023

Background

Prior research has shown associations between controlling food parenting practices (e.g., pressure-to-eat, restriction) and factors that increase risk for cardiovascular disease in children (e.g., low diet quality, obesity). This study aimed to examine associations between real-time parental stress and depressed mood, food parenting practices, and child eating behaviors in a longitudinal cohort study.

Methods

Children ages 5–9 years and their families (n = 631) from six racial/ethnic groups (African American, Hispanic, Hmong, Native American, Somali/Ethiopian, White) were recruited for this study through primary care clinics in a large metromolitan area in the US (Minneapolis/St. Paul, MN) in 2016–2019. Ecological momentary assessment was carried out over seven days with parents at two time points, 18 months apart. Adjusted associations between morning stress and depressed mood of parents on food parenting practices and child eating behaviors at the evening meal were examined. Interactions tested whether food security, race/ethnicity and child sex moderated associations.

Results

High levels of parental stress and depressed mood experienced earlier in the day were associated with controlling food parenting practices and child food fussiness at dinner the same night. Results were dependent on food security status, race/ethnicity, and child sex.

Conclusions

Health care professionals may want to consider, or continue, screening parents for stress, depression, and food insecurity during well-child visits and discuss the influence these factors may have on food parenting practices and child eating behaviors. Future research should use real-time interventions such as ecological momentary intervention to reduce parental stress and depressed mood to promote healthy food parenting practices and child eating behaviors.
Blood RNA-Seq profiling reveals a set of circular RNAs differentially expressed in frail individuals
Authors: Iparraguirre Leire , Alberro Ainhoa , Iñiguez Saioa GS , Muñoz-Culla Maider , Vergara Itziar , Matheu Ander , Otaegui David
Published: July 2023

Background

Frailty is an intermediate and reversible geriatric syndrome that often precedes dependence. Therefore, its identification is essential to prevent dependence. Several molecules have been proposed as biomarkers of frailty, but none of them have reached clinical practice. Recently, circular RNAs have emerged as new non-coding RNAs. Their regulatory role together with their high stability in biofluids makes them good candidates as biomarkers for various processes, but, to date, no study has characterized the expression of circRNA in frailty.

Results

We studied RNA from leukocytes of 35 frails and 35 robust individuals. After RNA-Sequencing, circRNA detection was performed by CIRI2 and Circexplorer2 and differential expression analysis by DESeq2. Validation was performed by Quantitative-PCR. Linear Discriminant Analysis was performed to determine the best circRNA combination to discriminate frail from robust. In addition, CircRNA candidates were studied in 13 additional elder donors before and after a 3-month physical intervention. We found 89 differentially expressed circRNAs (p-value<0.05, FC>|1.5|) with frailty. Upregulation of hsa_circ_0007817, hsa_circ_0101802 and hsa_circ_0060527 in frail individuals was validated. The combination of hsa_circ_0079284, hsa_circ_0007817 and hsa_circ_0075737 levels showed a great biomarker value with a 95.9% probability of correctly classifying frail and robust individuals. Moreover, hsa_circ_0079284 levels decreased after physical intervention in concordance with an improvement in frailty scores.

Conclusions

This work describes for the first time a different expression pattern of circular RNA (circRNAs) between frail and robust individuals. Moreover, the level of some circRNAs is modulated after a physical intervention. These results suggest that they could be used as minimally invasive biomarkers of frailty.
Human papillomavirus spectrum of HPV-infected women in Nigeria: an analysis by next-generation sequencing and type-specific PCR
Authors: Dom-Chima Ngozi , Ajang Yakubu Abubakar , Dom-Chima Chinyere Ifeoma , Biswas-Fiss Esther , Aminu Maryam , Biswas Subhasis B.
Published: July 2023

Background

Human papillomavirus (HPV) infection and cervical cancer are leading health problems and causes of death in many parts of the world. There are ~ 200 HPV types that can infect humans. This study aims to understand the spectrum of HPV infections in Nigerian women with normal or abnormal cytology.

Methods

We screened cervical samples from 90 women with possible HPV infections collected in two regional hospitals in Nigeria. The first screening was done using next-generation DNA sequencing (NGS), identifying multiple HPV types in many samples. Thereafter, type-specific PCR analysis was used to verify the NGS-identified HPV types in each sample.

Results

NGS analysis of the 90 samples from the Nigerian cohort identified 44 HPV types. The type-specific PCR confirmed 25 HPV types out of the 44 HPV types detected by NGS, and ~ 10 of these types were the most prevalent. The top five prevalent types found in the Nigerian cohort were HPV71 (17%), HPV82 (15%), HPV16 (16%), HPV6 (10%), and HPV20 (7%). Among the PCR-confirmed HPV types, we found 40.98% high-risk HPV types, 27.22% low-risk HPV types, and 31.15% undetermined HPV types. Among these 25 HPV types in Nigeria, only six were included in the current nine-valent HPV vaccine. We also observed strikingly high multiple HPV infections in most patients, with as many as nine HPV types in a few single samples.

Conclusions

Our NGS-PCR approach of HPV typing in the Nigerian cohort samples unveiled all possible HPV types currently circulating in Nigerian people. We confirmed 25 HPV types using NGS and PCR, with many samples infected with multiple HPV types. However, only six of these types are part of the nine-valent HPV vaccines indicating the need to develop region-specific selective vaccines.
Vaccinia virus induces endoplasmic reticulum stress and activates unfolded protein responses through the ATF6α transcription factor
Authors: Leão Thiago Lima , Lourenço Karine Lima , de Oliveira Queiroz Cid , Serufo Ângela Vieira , da Silva Aristóbolo Mendes , Barbosa-Stancioli Edel F. , da Fonseca Flávio Guimarães
Published: July 2023

Background

Cell responses to different stress inducers are efficient mechanisms that prevent and fight the accumulation of harmful macromolecules in the cells and also reinforce the defenses of the host against pathogens.Vaccinia virus(VACV) is an enveloped, DNA virus, belonging to the Poxviridae family. Members of this family have evolved numerous strategies to manipulate host responses to stress controlling cell survival and enhancing their replicative success. In this study, we investigated the activation of the response signaling to malformed proteins (UPR) by the VACV virulent strain—Western Reserve (WR)—or the non-virulent strain—Modified Vaccinia Ankara (MVA).

Methods

Through RT-PCR RFLP and qPCR assays, we detected negative regulation of XBP1 mRNA processing in VACV-infected cells. On the other hand, through assays of reporter genes for the ATF6 component, we observed its translocation to the nucleus of infected cells and a robust increase in its transcriptional activity, which seems to be important for virus replication. WR strain single-cycle viral multiplication curves in ATF6α-knockout MEFs showed reduced viral yield.

Results

We observed that VACV WR and MVA strains modulate the UPR pathway, triggering the expression of endoplasmic reticulum chaperones through ATF6α signaling while preventing IRE1α-XBP1 activation.

Conclusions

The ATF6α sensor is robustly activated during infection while the IRE1α-XBP1 branch is down-regulated.
Potential effect modifiers for treatment with chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7–14 years: development of and results from a secondary analysis of a randomised clinical trial
Authors: Lynge Susanne , Vach Werner , Dissing Kristina Boe , Hestbaek Lise
Published: July 2023

Background

A recent randomized controlled trial (RCT) investigating the effect of chiropractic manipulation in 199 children aged 7–14 years with recurrent headaches demonstrated a significant reduction of number of days with headache and a better global perceived effect (GPE) in the chiropractic manipulation group compared to a sham manipulation group. However, potential modifiers for the effectiveness of chiropractic manipulation of children with recurrent headaches have never been identified. The present study is a secondary analysis of data from that RCT and will investigate potential effect modifiers for the benefit of chiropractic manipulation for children with headache.

Methods

Sixteen potential effect modifiers were identified from the literature and a summary index was prespecified based on clinical experience. Relevant variables were extracted from baseline questionnaires, and outcomes were obtained by means of short text messages. The modifying effect of the candidate variables was assessed by fitting interaction models to the data of the RCT. In addition, an attempt to define a new summary index was made.

Results

The prespecified index showed no modifying effect. Four single variables demonstrated a treatment effect difference of more than 1 day with headache per week between the lower and the upper end of the spectrum: intensity of headache (p = 0.122), Frequency of headache (p = 0.031), sleep duration (p = 0.243), and Socioeconomic status (p = 0.082). Five variables had a treatment effect difference of more than 0.7 points on the GPE scale between the lower and the upper end of the spectrum: Frequency of headache (p = 0.056), Sport activity (p = 0.110), Sleep duration (p = 0.080), History of neck pain (p = 0.011), and Headache in the family (0.050). A new summary index could be constructed giving highest weight to History of neck pain and Headache in the family and Frequency of headache. The index suggests a difference of about 1 point in GPE between low and high values of the index.

Conclusion

Chiropractic manipulation offers a moderate benefit for a broad spectrum of children. However, it cannot be excluded that specific headache characteristics, family factors, or a history of neck pain may modify the effect. This question must be addressed in future studies.

Trial registration: ClinicalTrials.gov (Albers et al in Curr Pain Headache Rep 19:3–4, 2015), identifier NCT02684916, registered 02/18/2016—retrospectively registered.
Changes in patient admission patterns at orthopedics and traumatology outpatient clinics before and after the earthquakes on 6 February 2023 in Turkey
Authors: Asfuroğlu Zeynel Mert , Gümüşoğlu Ender
Published: July 2023

Background

The increase in orthopedic injuries after earthquakes imposes a significant burden on the health system. However, the impact of earthquakes on outpatient admissions remains unclear. This study compared patient admissions to the orthopedics and traumatology outpatient clinics before and after earthquakes.

Methods

The study was conducted at a tertiary university hospital near the earthquake zone. In total, 8549 outpatient admissions were retrospectively analyzed. The study population was divided into pre-earthquake (pre-EQ) and post-earthquake (post-EQ) groups. Factors such as gender, age, city of origin, and diagnosis were compared between the groups. In addition, unnecessary outpatient utilization (UOU) was defined and analyzed.

Results

The pre-EQ and post-EQ groups included 4318 and 4231 patients, respectively. The two groups had no significant differences in age and sex distribution. However, the proportion of non-local patients increased after the earthquake (9.6% vs. 24.4%, p < 0.001). UOU was the most common reason for admission in both groups. The distribution of diagnoses differed significantly between the pre-EQ and post-EQ groups, with an increase in the number of trauma-related diagnoses (15.2% vs. 27.3%, p < 0.001) and a decrease in UOU (42.2% vs. 31.1%, p < 0.001) after the earthquake.

Conclusions

Patient admission patterns at orthopedics and traumatology outpatient clinics changed significantly after the earthquake. The number of non-local patients and trauma-related diagnoses increased, whereas the number of unnecessary outpatients decreased.

Level of evidence Observational study.
Pathophysiology and probable etiology of cerebral small vessel disease in vascular dementia and Alzheimer’s disease
Authors: Inoue Yasuteru , Shue Francis , Bu Guojun , Kanekiyo Takahisa
Published: July 2023

Vascular cognitive impairment and dementia (VCID) is commonly caused by vascular injuries in cerebral large and small vessels and is a key driver of age-related cognitive decline. Severe VCID includes post-stroke dementia, subcortical ischemic vascular dementia, multi-infarct dementia, and mixed dementia. While VCID is acknowledged as the second most common form of dementia after Alzheimer’s disease (AD) accounting for 20% of dementia cases, VCID and AD frequently coexist. In VCID, cerebral small vessel disease (cSVD) often affects arterioles, capillaries, and venules, where arteriolosclerosis and cerebral amyloid angiopathy (CAA) are major pathologies. White matter hyperintensities, recent small subcortical infarcts, lacunes of presumed vascular origin, enlarged perivascular space, microbleeds, and brain atrophy are neuroimaging hallmarks of cSVD. The current primary approach to cSVD treatment is to control vascular risk factors such as hypertension, dyslipidemia, diabetes, and smoking. However, causal therapeutic strategies have not been established partly due to the heterogeneous pathogenesis of cSVD. In this review, we summarize the pathophysiology of cSVD and discuss the probable etiological pathways by focusing on hypoperfusion/hypoxia, blood–brain barriers (BBB) dysregulation, brain fluid drainage disturbances, and vascular inflammation to define potential diagnostic and therapeutic targets for cSVD.
A self-guided Internet-based intervention for individuals with chronic pain and depressive symptoms: study protocol of a randomized controlled trial
Authors: Borsutzky Swantje , Moritz Steffen , Hottenrott Birgit , Gehlenborg Josefine
Published: July 2023

Background

Despite the existence of evidence-based therapy options for the treatment of chronic pain and comorbid depressive symptoms (e.g., CBT), many individuals remain untreated. Treatment gaps result from a lack of specialists, patient fear of stigmatization, or patient immobility. Internet-based self-help interventions could serve as an anonymous and flexible alternative treatment option. In a pilot study, chronic pain patients with comorbid depressive symptoms who used a generic Internet-based depression program showed a significant reduction in depressive symptoms (but not pain symptoms) compared to a waitlist control group. Based on these findings, we developed the low-threshold, anonymous, and cost-free Internet-based self-help intervention Lenio that is tailored to the specific needs of chronic pain patients with comorbid depressive symptoms. Lenio is accompanied by the smartphone application (app) COGITO designed to increase therapeutic success. With Lenio and COGITO addressing both chronic pain and depressive symptoms, the trial aims to increase treatment effects of online interventions for chronic pain patients by reducing both depressive symptoms and pain.

Methods

The effectiveness of the Internet-based self-help intervention and accompanying smartphone app will be evaluated in a randomized controlled trial (RCT). A total of 300 participants will be randomized into an intervention group (Lenio/COGITO), an active control group (depression-focused smartphone app), or a waitlist control group. Assessments will be done at baseline, after an 8-week intervention period (post), and after 16 weeks (follow-up). The primary outcome is the post-assessment reduction in “pain impairment” (mean value of impairment in daily life, free time, and work) as assessed by the DSF (German pain questionnaire).

Secondary outcomes will include the reduction in depressive symptoms as well as in the severity of pain.

Discussion

Lenio is one of the first Internet-based interventions to reduce chronic pain and depression that will be empirically evaluated. Internet-based interventions could offer a promising alternative to conventional face-to-face psychotherapy in the treatment of chronic pain patients. The primary objective of the current study is to add essential insight into the feasibility, effectiveness, and acceptance of Internet-based interventions for people with chronic pain and depressive symptoms.

Trial registration

DRKS-ID DRKS00026722, Registered on October 6th, 2021.
Minimax optimal control problems for an extensible beam equation with uncertain initial velocity
Authors: Hwang Jin-soo
Published: July 2023

This paper is devoted to the problem of minimax optimal control problems of an extensible beam equation with distributed controls and initial velocity disturbances (or noises). The existence of optimal solutions for distributed control with fixed disturbance, namely the $(P_{v})$
(

P
v

)
problem, and the existence of minimax optimal solutions to $(P)$
(
P
)
problem without restricting the initial disturbance are proved. We derive the necessary optimality conditions for optimal solutions of the $(P_{v})$
(

P
v

)
and $(P)$
(
P
)
problems in the form of Pontryagin’s maximum principle.
The association between deficiencies in paternal and maternal reflective functioning and anorexia nervosa symptomatology
Authors: Goshen Dor , Stein Daniel , Kurman Jenny , Farbstein Dan , Enoch-Levy Adi , Aival-Naveh Erez , Gur Eitan , Yoeli Neta , Bretler Tali , Koren Danny , Rothschild-Yakar Lily
Published: July 2023

Background

A large theoretical body of knowledge exists emphasizing the importance of parental mentalizing in the context of anorexia-nervosa (AN). However, the empirical support to these assumptions is still scarce. The aim of the present study was to examine whether parents of patients with AN are characterized by a lower mentalizing ability, and whether it is associated with impaired mentalizing, AN symptomatology and eating disorder (ED) related psychological traits in the daughters.

Methods

Thirty-two family triads (fathers, mothers, and daughters) of female adolescent and young adult inpatients with AN were compared with thirty-three non-clinical family triads (N = 195). The mentalizing ability of all the participants was assessed using semi-structured interviews and coded using the Reflective Functioning Scale (RFS). Self-report questionnaires were administered to the daughters to evaluate ED symptomatology and ED related psychological traits (e.g., low self-esteem, interpersonal insecurity, emotional dysregulation).

Results

Decreased reflective functioning (RF) levels were found among mothers and fathers of patients with AN compared to their control peers. Examining the entire sample, clinical and non-clinical groups together, showed that both paternal and maternal RF were associated with the daughters' RF and each were found to have a significant and distinct contribution to the daughters' RF. Significant associations were found between lower levels of maternal and paternal RF and increased ED symptoms and ED related psychological traits. The use of a mediation model suggested a serial relationship in which low maternal and paternal RF contributes to the daughters' low RF, which in turn is associated with higher levels of psychological maladjustment, and ultimately contributes to the increased severity of ED symptoms.

Conclusions

The present results provide strong empirical support for theoretical models that suggest that deficits in parental mentalizing may represent important correlates of the presence and severity of ED symptoms in AN. Furthermore, the results highlight the relevance of fathers' mentalizing ability in the context of AN. Finally, clinical and research implications are discussed.
Robust monitoring machine: a machine learning solution for out-of-sample R$$^2$$-hacking in return predictability monitoring
Authors: Yae James , Luo Yang
Published: July 2023

The out-of-sample $$R^2$$

R
2

is designed to measure forecasting performance without look-ahead bias. However, researchers can hack this performance metric even without multiple tests by constructing a prediction model using the intuition derived from empirical properties that appear only in the test sample. Using ensemble machine learning techniques, we create a virtual environment that prevents researchers from peeking into the intuition in advance when performing out-of-sample prediction simulations. We apply this approach to robust monitoring, exploiting a dynamic shrinkage effect by switching between a proposed forecast and a benchmark. Considering stock return forecasting as an example, we show that the resulting robust monitoring forecast improves the average performance of the proposed forecast by 15% (in terms of mean-squared-error) and reduces the variance of its relative performance by 46% while avoiding the out-of-sample $$R^2$$

R
2

-hacking problem. Our approach, as a final touch, can further enhance the performance and stability of forecasts from any models and methods.
A monthly leading indicator of Swiss GDP growth based on Okun’s law
Authors: Kugler Peter , Sheldon George
Published: July 2023

We propose a unique method of nowcasting and forecasting GDP growth based on a forward-looking measure of unemployment (FLUR) and Okun’s law that offers a number of advantages over current leading indicators of the Swiss business cycle. The following investigation, covering the period from 1991/1 to 2021/4, demonstrates that our approach outperforms an AR(1) model of GDP growth equally well as the popular Business Cycle Index of the Swiss National Bank and the KOF Barometer with respect to year-to-year growth, but less so in regard to quarter-to-quarter changes. Our findings suggest that our approach offers a reliable and useful indicator to policymakers seeking easily compiled information on the current and future course of the Swiss economy at monthly time intervals.
Advanced gynecologic malignancy identified after acute stroke case report
Authors: Jnani Jack
Published: July 2023

Background

Endometrial carcinosarcomas are rare and carry a very poor prognosis. They usually present with extensive lymphatic spread. An acute presentation of a stroke may reveal the underlying diagnosis.

Case presentation

A woman in her 50s with no reported medical history presented to the emergency department as a code stroke. She was found during the evening by her sister leaving the bathroom disheveled. At that time, she was found to be mute, not following commands, with left gaze deviation and right hemiparesis. Computed tomography (CT) imaging showed an acute infarct in the left middle cerebral artery M2 branch or frontoparietal territory consistent with acute stroke. Upon further review, the sister states that she has had significant vaginal bleeding and never had menopause. On admission, she had significant anemia. CT of the abdomen and pelvis showed a large right adnexal mass, endometrial thickening, diffuse lymphadenopathy, omental nodularity, and a pulmonary nodule concerning for gynecologic malignancy with metastasis. Surgical pathology showed high grade endometrial carcinosarcoma. She was outside of the tPA window, and neurology determined her not to be a candidate for thrombectomy. She was managed medically with antiplatelet agents, high dose atorvastatin, and blood transfusions.

Conclusions

Endometrial carcinosarcoma can present with severe anemia and irregular menstrual bleeding. In patients without routine gynecologic care, endometrial carcinosarcoma can go unnoticed and only be identified after workup for another condition such as acute stroke. Endometrial biopsy for diagnosis may be challenging in a patient with severe anemia. Alternatively, transvaginal ultrasonography with Doppler study and magnetic resonance imaging may be used to support the diagnosis. Furthermore, endometrial carcinosarcoma can complicate ischemic stroke management as it can present with bleeding and make it difficult to use anticoagulating agents.
Crystal structure of rice APIP6 reveals a new dimerization mode of RING-type E3 ligases that facilities the construction of its working model
Authors: Zheng Yangyang , Zhang Xin , Liu Yang , Zhu Tongtong , Wu Xuefeng , Ning Yuese , Liu Junfeng , Wang Dongli
Published: July 2023

Ubiquitination is an important modification process in eukaryotic organisms, and ubiquitin ligase (E3) is the most diversified component of this system. APIP6 (AvrPiz-t interacting protein 6) is one of the E3s of rice, and is involved in the recognition of AvrPiz-t, one effector from the pathogen Magnaporthe oryzae, for the initiation of host defense against M. oryzae. However, the structural detail of how APIP6 performs its function remains elusive. Here, we present crystal structure of the RING domain (i.e., the E2-interaction domain) of APIP6 (APIP6-RING). APIP6-RING exists as a homodimer in crystal packing, in solution and in vivo. APIP6-RING consists of one β hairpin and one α helix, and β hairpins of two APIP6-RING molecules interact with each other in a novel ‘shoulder-to-shoulder’ mode to form a β sheet, and also rendering APIP6-RING to form a homodimer. Hydrogen bonds play a major role in the dimer formation of APIP6-RING, while hydrophobic-intermolecular interactions are inconspicuous. Due to the interaction mode between RING-type E3 and E2 is generally conserved, we constructed and verified a model of APIP6-RING/E2 complex, and proposed a working model of APIP6 with E2, ubiquitin, and the substrate AvrPiz-t. Taken together, our research presents the first structure of plant simple RING-type E3 ligase that exists in an unreported dimerization manner, as well as a working model of APIP6.
Evaluation of the changes in incidence and patient age of knee arthroscopy along with changes in time between knee arthroscopy and arthroplasty between 1998 and 2018: a nationwide register study
Authors: Ponkilainen Ville T. , Uimonen Mikko , Sihvonen Raine , Partio Nikke , Paloneva Juha , Mattila Ville M.
Published: July 2023

Background

Recent evidence has led to guidelines to refrain from recommending knee arthroscopy for patients with an osteoarthritis diagnosis. The aim of this study was to evaluate the latest changes in the incidence of arthroscopic surgery for degenerative knee disease, changes in the ages of those patients and the delay between knee arthroscopy and arthroplasty, in Finland between 1998 and 2018.

Method

The data for were collected from the Finnish National Hospital Discharge Register (NHDR). All knee arthroplasties and arthroscopies performed due to osteoarthritis, degenerative meniscal tears, and traumatic meniscal tears were included. Incidence rates (per 100,000 person-years) as well as the median age of patients were calculated.

Results

The incidence of arthroscopy decreased 74% (413 to 106 per 100,000 person-years) and knee arthroplasty increased 179% (94 to 262 per 100,000 person-years) between 1998 and 2018. The incidence of all arthroscopies increased until 2006. Subsequently, the incidence of arthroscopy due to OA decreased by 91% and arthroscopic partial meniscectomy (APM) for degenerative meniscal tears decreased by 77% until 2018. The decrease of traumatic meniscal tears begun later, leading to decrease of 57% between 2011 and 2018. Conversely, the incidence of patients undergoing APM of traumatic meniscal tear increased 375%. The median age of patients who underwent knee arthroscopy decreased from 51 to 46 and from 71 to 69 in knee arthroplasty patients.

Conclusions

Increasing evidence that recommends refraining from knee arthroscopy in OA and degenerative meniscal tears has led to a dramatic decrease in the incidence of arthroscopies. Simultaneously, the median age of the patients who undergo these operations has continued to decrease.