bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players
Authors: DeFroda Steven F. , Patel Devan D. , Milner John , Yang Daniel S. , Owens Brett D.
Published: February 2021

Background:

Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR).

Purpose/Hypothesis:

To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2.

Study Design:

Case series; Level of evidence, 4.

Methods:

An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints.

Results:

A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season ( P = .0056). Performance in the second postoperative season was not significantly different versus preinjury.

Conclusion:

NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.
Noniatrogenic Medial Patellar Dislocations: Case Series and International Patellofemoral Study Group Experience
Authors: Loeb Alexander E. , Farr Jack , Parikh Shital N. , Cosgarea Andrew J.
Published: February 2021

Background:

Most patellar dislocations occur in a lateral direction because of a summed lateral force vector and predisposing anatomic risk factors. Medial patellar instability is rare and is a well-recognized iatrogenic complication of an overly aggressive lateral retinacular release. Noniatrogenic medial patellar dislocations are rare. The management of these injuries is not well described.

Purpose:

To describe the experience of the International Patellofemoral Study Group with patients with noniatrogenic medial patellar dislocation.

Study Design:

Case series; Level of evidence, 4.

Methods:

Members of the International Patellofemoral Study Group (N = 64) were surveyed between October 2018 and April 2019. This group was chosen because of its wide referral base and interest in patellar instability. Specialists who had encountered a patient with medial patellar instability were sent a questionnaire inquiring about details of the case, including patient demographics, medical history, level of athletic competition, injury characteristics, and treatment. Cases were confirmed by physical examination records and, in some cases, with findings on advanced radiographic imaging.

Results:

The survey response rate was 73% (47/64). Three of the 47 specialists (6.4%) reported they had seen a case of noniatrogenic medial patellar dislocation, for a total of 6 cases. Four cases were described as recurrent medial dislocations in the setting of hypermobile Ehlers-Danlos syndrome; 2 were treated nonoperatively, 1 underwent lateral patellofemoral ligament reconstruction, and 1 underwent derotational osteotomies. Two medial-sided patellar dislocations in collegiate athletes were sports-related injuries that required surgical debridement but no ligamentous reconstruction. None of the patients had persistent or recurrent instability at the time of their most recent follow-up.

Conclusion:

Noniatrogenic medial patellar dislocations are extremely rare. This case review suggests that the treatment of first-time medial patellar instability in patients without known risk factors should follow the same principles as the treatment of lateral instability with no known risk factors, which is nonoperative management. For patients with documented risk factors and recurrence, surgery to address the risk factors may be appropriate.
Ankle Ligament Reconstruction - Return to Sport after Injury (ALR-RSI): a valid scale to quantify psychological readiness to return to sports after ankle ligament reconstruction
Authors: Sigonney Francois , Lopes Ronny , Bouché Pierre Alban , Stein Alexandra , Hardy Alexandre
Published: February 2021

Objectives:

Chronic instability is the main complication of ankle sprains and requires surgical intervention if non-surgical treatment fails. The aim of this study was to validate a tool to quantify psychological readiness to return to sports after ankle ligament reconstruction.

Methods:

The form was designed like the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, and the term "anterior cruciate" was replaced by "ankle". The Ankle Ligament Reconstruction - Return to Sport after Injury Scale (ALR-RSI) was completed by patients who had undergone ankle ligament reconstruction and who practiced a sport. The scale was then validated according to the COSMIN international methodology. The AOFAS and Karlsson scores were used as reference questionnaires.

Results:

57 patients (59 ankles) were included, 27 of whom were women. The ALR-RSI scale was highly correlated with the Karlsson score (r=0.79 [0.66-0.87]) and the AOFAS score (r=0.8 [0.66-0.87]). A highly significant difference was noted on the ALR-RSI scale between the subgroup of 50 patients who returned to sports and the 7 who did not: 68.8 (56.5-86.5) versus 45.0 (31.3-55.8), respectively, p = 0.02. The internal consistency of the scale was high (α = 0.96). Reproducibility of the test-retest was excellent (ρ = 0.92, 95% CI [0.86-0.96]).

Conclusion:

The ALR-RSI is a valid, reproducible scale with which to identify patients who are ready to resume the same sport after ankle ligament reconstruction. This scale can help to identify athletes who will have difficulty returning to sports.
Hospitalization in High Fracture Risk Older Adults with Osteoporosis Using the Safe Functional Motion Test: A Longitudinal Analysis
Authors: Van Dussen Daniel J. , Recknor Chris P. , Recknor Julie C.
Published: February 2021

The Safe Functional Motion Test (SFM-5) is a five item performance based clinical assessment tool quantifying habitual daily movement that may increase the risk of osteoporosis and fractures. Fractures are a major cause of hospitalization and contributor to increased health care utilization costs. A sample of 1,700 adults, aged 40 and older, from an osteoporosis specialty clinic were evaluated to determine if the initial SFM-5 score had predictive utility for determining inpatient hospitalization at 12, 24, and 36 months post fracture. When adjusted for sex, age, and prior hospitalization, logistic regression analyses indicated that the SFM-5 score significantly predicted inpatient hospitalization within 12 months, 24 months, and 36 months. For every 10 point decrease in the SFM-5 score, the 1 year risk of hospitalization increased by 24%. The SFM-5 is a tool to use when assessing habitual functional movements and hospitalization risk among high-fracture risk adults.
The Health & Economic Disparities of Congenital Musculoskeletal Disease Worldwide: An Analysis of 25 Years (1992-2017)
Authors: Mody Kush S. , Henstenburg Jeffrey , Herman Martin J.
Published: February 2021

Background: Large disparities exist in congenital musculoskeletal disease burden worldwide. The purpose of this study is to examine and quantify the health and economic disparities of congenital musculoskeletal disease by country income level from 1992 to 2017. Methods: The Global Burden of Disease database was queried for information on disease burden attributed to “congenital musculoskeletal and limb anomalies” from 1992 to 2017. Gross national income per capita was extracted from the World Bank website. Nonparametric Kruskal–Wallis tests were used to compare morbidity and mortality across years and income levels. The number of avertable DALYs was converted to an economic disparity using the human-capital and value of a statistical life approach. Results: From 1992 to 2017, a significant decrease in deaths/100 000 was observed only in upper-middle and high income countries. Northern Africa, the Middle East, and Eastern Europe were disproportionately affected. If the burden of disease in low- and middle- income countries (LMICs) was equivalent to that in high income countries (HICs), 10% of all DALYs and 70% of all deaths attributable to congenital musculoskeletal disease in LMICs could be averted. This equates to an economic disparity of about $2 billion to $3 billion (in 2020 $USD). Conclusion: Considerable inequity exists in the burden of congenital musculoskeletal disease worldwide and there has been no change over the last 25 years in total disease burden and geographical distribution. By reducing the disease burden in LMICs to rates found in HICs, a large proportion of the health and economic consequences could be averted.
Does Coaching Hospitalists in a Community Hospital Improve the Measured Experience of Care?
Authors: Pratt David , Wu Aaron , Huppertz John W
Published: February 2021

Hospitals initiate physician communication training programs expecting to improve patient experience measures. However, most efforts have relied on methods with limited attention to bedside physician–patient interactions. We conducted an intensive in-person hospitalist coaching program to improve patient experience in a community hospital. Full-time hospitalists were coached twice monthly by physician-coaches using a structured process featuring direct observation of care and immediate recommendations. Coach-observed care measures improved marginally. Difference-in-differences analysis of 1137 Hospital Consumer Assessment of Healthcare Providers and Systems surveys revealed no significant improvements by trained hospitalists in preintervention versus intervention comparisons, calling into question the strategy of using coaching programs to improve hospitals’ doctor communication measures.
Acute Pulmonary Embolism in the COVID-19 Era: The Experience of a Ghanaian Patient
Authors: Asamoah Kofi Tekyi
Published: February 2021

The coronavirus pandemic has resulted in profound changes in healthcare delivery, some based on official reforms and others driven by healthcare professionals’ fear of exposure to coronavirus disease (COVID-19). Many patients require screening tests of one form or the other before being attended to in hospitals. The protean clinical manifestations of this highly transmissible infection require that a high index of suspicion be maintained. Pulmonary embolism is a potentially fatal emergency whose presentation is mimicked by COVID-19. Delays in ruling out COVID-19 may result in undue delays in initiating treatment for pulmonary embolism, potentially resulting in significant morbidity and mortality. This article presents a patient whose treatment for acute pulmonary embolism was forestalled by delays in getting the polymerase chain reaction test for COVID-19 done. It reiterates the need for physicians to test promptly in order to allow early focus on differential diagnoses which were routinely being investigated promptly prior to the COVID-19 pandemic.
Dynamic Characteristics of Rotor System with a Slant Crack Based on Fractional Damping
Authors: Li Zhinong , Li Yunlong , Wang Dong , Peng Zhike , Wang Haifeng
Published: February 2021

The traditional modeling method of rotor system with a slant crack considers only integer-order calculus. However, the model of rotor system based on integer-order calculus can merely describe local characteristics, not historical dependent process. The occur of fractional order calculus just makes up for the deficiency in integer-order calculus. Therefore, a new dynamic model with a slant crack based on fractional damping is proposed. Here, the stiffness of rotor system with a slant crack is solved by zero stress intensity factor method. The proposed model is simulated by Runge-Kutta method and continued fraction Euler method. The influence of the fractional order, rotating speed, and crack depth on the dynamic characteristics of rotor system is discussed. The simulation results show that the amplitude of torsional excitation frequency increases significantly with the increase of the fractional order. With the increase of the rotating speed, the amplitude of first harmonic component becomes gradually larger, the amplitude of the second harmonic becomes smaller, while the amplitude of the other frequency components is almost invariant. The shaft orbit changes gradually from an internal 8-type shape to an ellipse-type shape without overlapping. With the increase of the slant crack depth, the amplitude of the transverse response frequency in the rotor system with a slant crack increases, and the amplitude in the second harmonic component also increases significantly. In addition, the torsional excitation frequency and other coupling frequency components also occur. The proposed model is further verified by the experiment. The valuable conclusion can provide an important guideline for the fault diagnosis of rotor system with a slant crack.
Actuation Spaces Synthesis of Lower-Mobility Parallel Mechanisms Based on Screw Theory
Authors: Li Shihua , Shan Yanxia , Yu Jingjun , Ke Yaxiong
Published: February 2021

The lower-mobility parallel mechanism has been widely used in the engineering field due to its numerous excellent characteristics. However, little work has been devoted to the actuator selection and placement that best satisfy the system’s functional requirements during concept design. In this study, a unified approach for synthesizing the actuation spaces of both rigid and flexure parallel mechanisms has been presented, and all possible combinations of inputs could be obtained, laying a theoretical foundation for the subsequent optimization of inputs. According to the linear independence of actuation space and constraint space of the lower-mobility parallel mechanism, a general expression of actuation spaces in the format of screw systems is deduced, a unified synthesis process for the lower-mobility parallel mechanism is derived, and the efficiency of the method is validated with two selective examples based on screw theory. This study presents a theoretical framework for the input selection problems of parallel mechanisms, aiming to help designers select and place actuators in a correct and even optimal way after the configuration design.
Comparative efficacy, safety and durability of dolutegravir relative to common core agents in treatment-naïve patients infected with HIV-1: an update on a systematic review and network meta-analysis
Authors: Nickel Katharina , Halfpenny Nicholas J. A. , Snedecor Sonya J. , Punekar Yogesh Suresh
Published: February 2021

Background

The objective of this study was to assess the durability of response of dolutegravir (DTG) as an antiretroviral core agent by comparing its efficacy and safety with other recommended or commonly used core agents up to 96-weeks (W96).

Methods

A previously published systematic review was updated to identify phase 3/4 randomised controlled trials (RCTs) of core agents in treatment-naïve HIV-1 patients. Efficacy [virologic suppression (VS), CD4+ cell change from baseline] and safety [adverse events [AEs], discontinuations, drug-related AEs [DRAEs]] were analysed at W96 using Bayesian network meta-analysis (NMA) adjusting for nucleoside/nucleotide reverse transcriptase inhibitors' (NRTIs') backbone. Subgroups of patients with VL > 100,000 copies/mL or CD4+ ≤ 200 cells/μL at baseline were analysed separately.

Results

The NMA included 20 studies reporting data at W96. A higher proportion of patients receiving DTG achieved VS compared to those on protease inhibitors [PI:Range:8.7%(CrI:3.1,16.0)-19.9%(10.8,30.5)], efavirenz [EFV:6.9%(1.3,10.8)] and cobicistat-boosted elvitegravir [EVG/c:8.2%(0.2,17.4)], and similar but numerically higher compared to rilpivirine [RPV:5.0%(− 2.8,12.5)], raltegravir [RAL:2.9%(− 1.6,7.7)] and bictegravir [BIC:2.7%(− 2.7,10.6)]. The probability that more patients on DTG would achieve VS at W96 compared to any other core agent was greater than 80%. A higher proportion of patients on DTG achieved VS compared to PI/rs [Range:33.1%(13.6,50.4)-45.3%(24.1,61.6)] and RAL [16.7%(3.3,31.2)] in patients with VL > 100,000 copies/mL at baseline, and similar VS was achieved in patients with CD4+ ≤ 200 cells/μL at baseline. DTG also achieved greater increase in CD4+ cells from baseline compared to EFV [32.6(10.7,54.7)], ritonavir-boosted darunavir [DRV/r:25.7(3.6,48.1)] and BIC [24.7(1.5,47.7)]. Patients receiving DTG had lower odds of discontinuing therapy by W96 compared to PI/rs, EFV, RAL and EVG/c. Patients on DTG had lower odds of experiencing an adverse event (AE) compared to patients on EFV [odds ratio:0.6(0.3,0.9)], ATV/r [0.4(0.3,0.6)] and LPV/r [0.3(0.2,0.5)]. For patients on DTG, the odds of experiencing a drug-related AE were lower than the odds for patients on EFV [0.3(0.2,0.4)], comparable to patients on RAL [1.1(0.8,1.4)] and higher than those on BIC [1.5(1.1,2.0)].

Conclusion

Un-boosted integrase inhibitors had better efficacy and similar safety compared to PI/rs at W96 in treatment-naïve patients with HIV-1, with DTG being among the most efficacious core agent, particularly in patients with baseline VL > 100,000 copies/mL or ≤ 200 CD4+ cells/μL, who can be difficult to treat.
Accelerometer-measured physical activity and its impact on sleep quality in patients suffering from restless legs syndrome
Authors: Reimers A. K. , Heidenreich V. , Bittermann H-J , Knapp G. , Reimers C. D.
Published: February 2021

Background

The primary symptoms of restless legs syndrome (RLS) are sleep onset insomnia and difficulty to maintain sleep. Previous studies have shown that regular physical activity can reduce the risk of developing RLS. However, the relationship between physical activity and sleep quality parameters in individuals suffering from RLS has not yet been investigated by applying accelerometry. Thus, the present study investigates the impact of physical activity (measuring both intensity levels and duration of physical activity) during the day (7–12 h, 12–18 h, 18–23 h) on sleep quality in patients suffering from idiopathic RLS by applying a real-time approach.

Methods

In a sample of 47 participants suffering from idiopathic RLS, physical activity and sleep quality were measured over one week using accelerometers. For data analysis, physical activity levels and step counts during three periods of the day (morning, afternoon, evening) were correlated with sleep quality parameters of the subsequent night.

Results

This observational study revealed that in most instances physical activity was not correlated with sleep parameters (two exceptions exist: steps taken in the morning were negatively correlated with periodic leg movements during sleep, and physical activity in the evening was negatively correlated with total sleep time). The physical activity levels of the participants in this study, however, were unexpectedly high compared to population-level data and variance in physical activity was low. The average activity was 13,817 (SD = 4086) steps and 347 (SD = 117) minutes of moderate physical activity per day in females, and 10,636 (SD = 3748) steps and 269 (SD = 69) minutes of moderate physical activity in males, respectively. Participants did not engage in any vigorous physical activity.

Conclusions

Further interventional studies are needed to investigate the daily effects of different intensities of physical activity on RLS symptoms.
Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial
Authors: Karsberg Sidsel Helena , Pedersen Mads Uffe , Hesse Morten , Thylstrup Birgitte , Pedersen Michael Mulbjerg
Published: February 2021

Background

Alcohol and other drug use disorders contribute substantially to the global burden of illness. The majority of people with substance use disorders do not receive any treatment for their problems, and developing treatments that are attractive and effective to patients should be a priority. However, whether treatment is best delivered in a group format or an individual format has only been studied to a very limited degree. The COMDAT (Combined Drug and Alcohol Treatment) trial evaluates the feasibility, acceptability, and cost effectiveness of MOVE group (MOVE-G) treatment versus MOVE individual (MOVE-I) treatment in four community-based outpatient treatment centres in Denmark.

Methods

A two-arm non-inferiority trial comparing MOVE-I (Pedersen et al., Drug Alcohol Depend 218:108363, 2020) with MOVE-G a combined group treatment for both alcohol use disorder and drug use disorder. The primary objective is to examine whether MOVE-G is non-inferior to MOVE-I in relation to abstinence from drug and/or alcohol, number of sessions received, and completion of treatment as planned. All participants will receive treatment based on cognitive behavioral therapy and motivational interviewing, vouchers for attendance and text reminders, as well as medication as needed (MOVE). Participants (n = 300) will be recruited over a one-year period at four public treatment centers in four Danish municipalities. A short screening will determine eligibility and randomization status. Hereafter, participants will be randomized to the two treatment arms. A thorough baseline assessment will be conducted approximately 1 week after randomization. Follow-up assessments will be conducted at 9 months post-randomization. In addition, patients’ use of drugs and alcohol, and patients’ wellbeing will be measured in all sessions. The main outcome measures are drug and alcohol intake at 9 months follow-up, number of sessions attended, and dropout from treatment.

Discussion

The present study will examine the potential and efficacy of combined groups (patients with alcohol and drug disorders in the same group) versus individually based treatment both based on the treatment method MOVE (Pedersen et al., Drug Alcohol Depend 218:108363, 2020).

Trial registration

ISRCTN88025085, registration date 30/06/2020.
Cryoneurolysis for the management of chronic pain in patients with knee osteoarthritis; a double-blinded randomized controlled sham trial
Authors: Nygaard Niels-Peter Brøchner , Koch-Jensen Carsten , Vægter Henrik Bjarke , Wedderkopp Niels , Blichfeldt-Eckhardt Morten , Gram Bibi
Published: February 2021

Objective

Pain is the principal symptom in knee osteoarthritis (OA). Current non-operative treatment options have only moderate effects and often patients experience persistent pain or side-effects. Novel advances in the field of cryoneurolysis applies low temperatures to disrupt nerve signaling at the painful area, providing pain relief. The primary aim of this randomized controlled trial (RCT) is to investigate if cryoneurolysis is superior to sham at decreasing pain intensity 2 weeks after the intervention in patients with knee OA. Secondary aims are to explore effects on pain, quality of life and functional performance over 24 months.

Methods

This two-arm, parallel-group RCT, approved by the Regional Ethics Committee, will randomly allocate patients (n = 94) to a cryoneurolysis intervention group + standardized education and exercise (CRYO) or a sham group + standardized education and exercise (SHAM) (1:1 ratio). Both groups will be assessed at baseline, 2 weeks post intervention, post education and exercise and at 6, 12 and 24 months after cryoneurolysis. The primary outcome is the NRS knee pain intensity score assessed 2 weeks post the intervention. Secondary outcome measures include functional performance (chair-stand test, 40 m walk, stair test and maximum voluntary contraction of the knee), patient reported outcomes (quality of life (EQ5D), Knee and osteoarthritis outcome scores (KOOS), among others), use of analgesics, and adverse events over 24 months.

Impact statement

Cryoneurolysis could potentially provide an effective, safe and non-pharmacological therapeutic option to treat pain in OA patients. The potential benefits include increased functional capacity and quality of life as a result of significant pain relief and improved benefits of physical exercise.

Trial registration

Clinicaltrials.gov,NCT03774121, registered 3 March 2018,http://www.clinicaltrials.gov
Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis
Authors: Tang Chris Yuk Kwan , Kamath Vijay H. D. , Cheung Prudence Wing Hang , Cheung Jason Pui Yin
Published: February 2021

Background

Adolescent idiopathic scoliosis (AIS) is a common spinal deformity. Posterior spinal fusion remains an important surgical treatment for AIS. This study aims to determine the predictive factors for intraoperative blood loss in AIS surgery.

Methods

Patients who had undergone posterior spinal fusion for adolescent idiopathic scoliosis in a single university hospital were reviewed over a 7-year period. Predictive factors for intra-operative blood loss were studied by multivariate analysis to derive a regression model. Receiver operating characteristic analysis was performed to determine the cut-off values of factors contributing to significant intraoperative blood loss (≥500 ml).

Results

Two hundred and twelve patients were included. Intraoperative blood loss was found to be correlated with gender (rs = 0.30 (0.17–0.43)), preoperative hemoglobin level (rs = 0.20 (0.04–0.31)), preoperative Cobb angle (rs = 0.20 (0.02–0.29)), number of fused levels (rs = 0.46 (0.34–0.58)), operation duration (rs = 0.65 (0.54–0.75)), number of anchors (rs = 0.47 (0.35–0.59)), and p-value ranged from < 0.001 to < 0.05. Significant intraoperative blood loss was influenced by the male gender, operation duration greater than 257.5 min and more than 10 anchors used.

Conclusions

Male gender, increased operation duration and higher number of anchors predicted higher intra-operative blood loss.
Patients and family caregivers report high treatment expectations during palliative chemotherapy: a longitudinal prospective study
Authors: Ikander Tine , Jeppesen Stefan Starup , Hansen Olfred , Raunkiær Mette , Dieperink Karin Brochstedt
Published: February 2021

Background

When discussing treatment options and future care, it is important to understand the expectations of patients and family caregivers related to palliative chemotherapy and to identify patterns in patients’ quality of life. The study aims were to evaluate differences in treatment expectations and quality of life between patients with thoracic cancer (non-small-cell lung cancer, small-cell lung cancer and mesothelioma) who were < 70 and ≥ 70 years of age and receiving palliative chemotherapy and to assess family caregivers’ treatment expectations.

Methods

A prospective longitudinal study included patients with thoracic cancer receiving outpatient palliative chemotherapy at a university hospital in Denmark and their family caregivers. Patients’ treatment expectations and quality of life were assessed three times during treatment with a survey of treatment expectations and the Functional Assessment of Cancer Therapy – General questionnaire. Family caregivers’ treatment expectations were assessed once.

Results

A total of 48 patients and 36 family caregivers participated between 2018 and 2019. No statistically significant age-related differences in treatment expectations and quality of life were identified. 28% of patients aged < 70 years and 7% of those aged ≥70 years expected a cure. Among family caregivers, 36% expected a cure. Across both age groups, mean total quality of life scores significantly decreased from 73.2 at first palliative chemotherapy cycle to 70.5 at third cycle (p = 0.02). No meaningful changes were found in quality of life within either age group. A subgroup analysis found no significant between-group differences in quality of life. Mean physical well-being score for all patients decreased from 20.3 at first cycle to 18.4 at third cycle (p = 0.03) and mean emotional well-being score decreased from 15.4 at first cycle to 14.6 at third cycle (p = 0.04).

Conclusion

This study emphasizes the importance of initiating conversations about treatment expectations and paying attention to expectations that may differ by the age of the patient and between patients and family caregivers. Addressing treatment expectations among patients and family caregivers and monitoring quality of life among patients is important in clinical practice.
mTOR-dependent dysregulation of autophagy contributes to the retinal ganglion cell loss in streptozotocin-induced diabetic retinopathy
Authors: Madrakhimov Sanjar Batirovich , Yang Jin Young , Kim Jin Ha , Han Jung Woo , Park Tae Kwann
Published: February 2021

Background

Neurodegeneration, an early event in the pathogenesis of diabetic retinopathy (DR), precedes clinically detectable microvascular damage. Autophagy dysregulation is considered a potential cause of neuronal cell loss, however underlying mechanisms remain unclear. The mechanistic target of rapamycin (mTOR) integrates diverse environmental signals to coordinate biological processes, including autophagy. Here, we investigated the role of mTOR signaling in neuronal cell death in DR.

Methods

Diabetes was induced by a single intraperitoneal injection of streptozotocin and tissue samples were harvested at 1, 2, 3, 4, and 6 months of diabetes. Early-stage of DR was investigated in 1-month-diabetic mice treated with phlorizin (two daily subcutaneous injections at a dose of 200 mg/kg of body weight during the last 7 full days of the experiment and the morning of the 8th day, 3 h before sacrifice) or rapamycin (daily intraperitoneal injections, at a dose of 3 mg/kg for the same period as for phlorizin treatment). The effect of autophagy modulation on retinal ganglion cells was investigated in 3-months-diabetic mice treated with phlorizin (two daily subcutaneous injections during the last 10 full days of the experiment and the morning of the 11th day, 3 h before sacrifice) or MHY1485 (daily i.p. injections, at a dose of 10 mg/kg for the same period as for phlorizin treatment). Tissue samples obtained from treated/untreated diabetic mice and age-matched controls were used for Western blot and histologic analysis.

Results

mTOR-related proteins and glucose transporter 1 (GLUT1) was upregulated at 1 month and downregulated in the following period up to 6 months. Diabetes-induced neurodegeneration was characterized by an increase of apoptotic marker—cleaved caspase 3, a decrease of the total number of cells, and NeuN immunoreactivity in the ganglion cell layer, as well as an increase of autophagic protein. Insulin-independent glycemic control restored the mTOR pathway activity and GLUT1 expression, along with a decrease of autophagic and apoptotic proteins in 3-months-diabetic mice neuroretina. However, blockade of autophagy using MHY1485 resulted in a more protective effect on ganglion cells compared with phlorizin treatment.

Conclusion

Collectively, our study describes the mechanisms of neurodegeneration through the hyperglycemia/ mTOR/ autophagy/ apoptosis pathway.
Neuroendocrine patterns underlying seasonal song and year-round territoriality in male black redstarts
Authors: Villavicencio Camila P. , Windley Harriet , D’Amelio Pietro B. , Gahr Manfred , Goymann Wolfgang , Quispe René
Published: February 2021

Background

The connection between testosterone and territoriality in free-living songbirds has been well studied in a reproductive context, but less so outside the breeding season. To assess the effects of seasonal androgenic action on territorial behavior, we analyzed vocal and non-vocal territorial behavior in response to simulated territorial intrusions (STIs) during three life-cycle stages in free-living male black redstarts: breeding, molt and nonbreeding. Concurrently, we measured changes in circulating testosterone levels, as well as the mRNA expression of androgen and estrogen receptors and aromatase in the preoptic, hypothalamic and song control brain areas that are associated with social and vocal behaviors.

Results

Territorial behavior and estrogen receptor expression in hypothalamic areas did not differ between stages. But plasma testosterone was higher during breeding than during the other stages, similar to androgen receptor and aromatase expression in the preoptic area. The expression of androgen receptors in the song control nucleus HVC was lower during molt when birds do not sing or sing rarely, but similar between the breeding and the nonbreeding stage. Nevertheless, some song spectral features and the song repertoire differed between breeding and nonbreeding. Territorial behavior and song rate correlated with the expression of steroid receptors in hypothalamic areas, and in the song control nucleus lMAN.

Conclusions

Our results demonstrate seasonal modulation of song, circulating testosterone levels, and brain sensitivity to androgens, but a year-round persistency of territorial behavior and estrogen receptor expression in all life-cycle stages. This suggests that seasonal variations in circulating testosterone concentrations and brain sensitivity to androgens is widely uncoupled from territorial behavior and song activity but might still affect song pattern. Our study contributes to the understanding of the complex comparative neuroendocrinology of song birds in the wild.
The Kickstart Walk Assist System for improving balance and walking function in stroke survivors: a feasibility study
Authors: Yao Jiajia , Sado Takashi , Wang Wenli , Gao Jiawen , Zhao Yichao , Qi Qi , Mukherjee Mukul
Published: February 2021

Background

Compared with traditional physical therapy for stroke patients, lower extremity exoskeletons can provide patients with greater endurance and more repeatable and controllable training, which can reduce the therapeutic burden of the therapist. However, most exoskeletons are expensive, heavy or require active power to be operated. Therefore, a lighter, easy to wear, easy to operate, low-cost technology for stroke rehabilitation would be a welcome opportunity for stroke survivors, caregivers and clinicians. One such device is the Kickstart Walk Assist system and the purpose of this study was to determine feasibility of using this unpowered exoskeleton device in a sample of stroke survivors.

Methods

Thirty stroke survivors were enrolled in the study and experienced walking with the Kickstart exoskeleton device that provided spring-loaded assistance during gait. After 5 days of wearing the exoskeleton, participants were evaluated in the two states of wearing and not wearing the exoskeleton. Outcome measures included: (a) spatio-temporal gait measures, (b) balance measures and (c) exoskeleton-use feedback questionnaire.

Results

In comparison to not wearing the device, when participants wore the Kickstart walking system, weight bearing asymmetry was reduced. The time spent on the 10-m walk test was also reduced, but there was no difference in the timed-up-and-go test (TUGT). Gait analysis data showed reduction in step time and double support time. Stroke survivors were positive about the Kickstart walking system’s ability to improve their balance, speed and gait. In addition, their confidence level and willingness to use the device was also positive.

Conclusions

These findings show the feasibility of using the Kickstart walking system for improving walking performance in stroke survivors. Our future goal is to perform a longer duration study with more comprehensive pre- and post-testing in a larger sample of stroke survivors.

Trial registration Chinese Clinical Trial Registry, ChiCTR2000032665. Registered 5 May 2020—Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=53288
Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review
Authors: Neibling Bridee A. , Jackson Sarah M. , Hayward Kathryn S. , Barker Ruth N.
Published: February 2021

Background

Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke.

Methods

A systematic mixed studies review with sequential exploratory synthesis was undertaken. Studies investigating adult stroke survivors with upper limb disability undertaking technology-facilitated home-based upper limb practice administered ≥ 3 times/week over a period of ≥ 4 weeks were included. Qualitative outcomes were stroke survivors’ and family members’ perceptions of their experience utilising technology to facilitate home-based upper limb practice. Quantitative outcomes were adherence and dropouts, as surrogate measures of perseverance. The Mixed Methods Appraisal Tool was used to assess quality of included studies.

Results

Forty-two studies were included. Six studies were qualitative and of high quality; 28 studies were quantitative and eight were mixed methods studies, all moderate to low quality. A conceptual framework of perseverance with three stages was formed: (1) getting in the game; (2) sticking with it, and; (3) continuing or moving on. Conditions perceived to influence perseverance, and factors mediating these conditions were identified at each stage. Adherence with prescribed dose ranged from 13 to 140%. Participants were found to be less likely to adhere when prescribed sessions were more frequent (6–7 days/week) or of longer duration (≥ 12 weeks).

Conclusion

From the mixed methods findings, we propose a framework for perseverance with technology-facilitated home-based upper limb practice. The framework offers opportunities for clinicians and researchers to design strategies targeting factors that influence perseverance with practice, in both the clinical prescription of practice and technology design. To confirm the clinical utility of this framework, further research is required to explore perseverance and the factors influencing perseverance.

Registration: PROSPERO CRD42017072799—https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72799
CpG islands in MyD88 and ASC/PYCARD/TMS1 promoter regions are differentially methylated in head and neck squamous cell carcinoma and primary lung squamous cell carcinoma
Authors: Šutić Maja , Baranašić Jurica , Bilić Lana Kovač , Bilić Mario , Jakovčević Antonija , Brčić Luka , Seiwerth Sven , Jakopović Marko , Samaržija Miroslav , Zechner Ulrich , Knežević Jelena
Published: February 2021

Background

Patients with head and neck squamous cell carcinoma (HNSCC) can develop lung squamous cell carcinoma (LuSCC), which could be the second primary tumor or HNSCC metastasis. Morphologically it is difficult to distinguish metastatic HNSCC from a second primary tumor which presents a significant diagnostic challenge. Differentiation of those two malignancies is important because the recommended treatments for metastatic HNSCC and primary LuSCC differ significantly. We investigated if the quantification of the promotor methylation status in HNSCC and LuSCC differs.

Methods

Primary HNSCC (N = 36) and LuSCC (N = 17) were included in this study. Methylation status in the ASC/TMS1/PYCARD (apoptosis-associated speck-like protein containing a caspase recruitment domain; 8 CpG sites) and MyD88 (Myeloid differentiation primary response protein 88; 10 CpG sites) promoters was analyzed. Bisulfite converted DNA, isolated from tumor tissue was quantified using pyrosequencing. Results of pyrosequencing analysis were expressed as a percentage for each tested CpG site. Receiver-operating characteristic (ROC) curve analysis was used for the evaluation of the diagnostic properties of selected biomarkers.

Results

CpG sites located in the promoters of ASC/TMS1/PYCARD_CpG8 (− 65 upstream) and MyD88_CpG4 (− 278 upstream) are significantly hypermethylated in the HNSCC when compared with LuSCC (p ≤ 0.0001). By performing ROC curve analysis we showed that corresponding areas under the curve (AUC) were 85–95%, indicating that selected CpG sites are useful for a distinction between primary LuSCC and primary HNSCC.

Conclusions

Results of the present study indicate that there is a significant difference in the methylation status of tested genes between primary HNSCC and LuSCC. However, to prove this approach as a useful tool for distinguishing second primary LuSCC from HNSCC metastasis, it would be necessary to include a larger number of samples, and most importantly, metastatic samples.
Identification of E2F transcription factor 7 as a novel potential biomarker for oral squamous cell carcinoma
Authors: Zhou Ping , Xiao Lei , Xu Xiaonan
Published: February 2021

Background

As a tumor-accelerating transcriptional factor, E2F transcription factor 7 (E2F7) was up-regulated in many forms of cancers. Nevertheless, little has been reported about the impacts of E2F7 on oral squamous cell carcinoma (OSCC). Here, we aimed to probe whether E2F7 had influences on OSCC and its potential mechanism.

Methods

The expression of E2F7 in OSCC tissues was analyzed using the data acquired from TCGA and ONCOMINE databases. E2F7 prognostic value in OSCC patients was analyzed utilizing TCGA database. The expression of E2F7 in OSCC cell lines was detected by qRT-PCR. Gain-and loss-function of E2F7 assays in TCA-83 and CAL27 cells were performed respectively to inquire the function of E2F7. Western blotting was applied to test the alternations of EMT-related markers.

Results

In OSCC tissues, E2F7 was highly expressed. Besides, high expression of E2F7 predicted worse prognosis in OSCC patients. Moreover, E2F7 was over-expressed in TCA-83, HSC-4 and CAL27 (all OSCC cell lines) cells relative to that in HNOK (a normal cell line) cells. Gain-and loss-function assays displayed that deficiency of E2F7 suppresses CAL27 cell growth, migration, invasion and E2F7 high-expression resulted in inverse outcomes in TCA-83 cells. Finally, we found that silencing of E2F7 facilitated E-cadherin protein expression level and reduced N-cadherin, Vimentin and Snail protein levels in CAL27 cells, whilst E2F7 high-expression exhibited the opposite effects in TCA-83 cells.

Conclusions

These outcomes indicated that E2F7 performs a carcinogenic role in OSCC, which provides a theoretical basis for the therapeutic strategies of OSCC.
Narrative Exposure Therapy versus treatment as usual in a sample of trauma survivors who live under ongoing threat of violence in Rio de Janeiro, Brazil: study protocol for a randomised controlled trial
Authors: Serpeloni Fernanda , Narrog Jeanine Arabella , Gonçalves de Assis Simone , Quintes Avanci Joviana , Carleial Samuel , Koebach Anke
Published: February 2021

Background

One in three individuals who live in Rio de Janeiro experience a traumatic event within a period of 12 months. In thefavelasparticularly, trauma exposure is ongoing. Psychological sequalae include posttraumatic stress disorder (PTSD), depression and other mental disorders. Trauma-focused therapy approaches have emerged as the treatment of choice when the dangerous events are over, but symptoms have remained for an extended time period. Ideally, the victim is in a safe context during treatment. However, frequently, survivors cannot escape from situations characterised by ongoing threat and traumatic stress. The aim of this study is to research the effectiveness of Narrative Exposure Therapy in a sample of PTSD patients living under these conditions.

Methods

Individuals fulfilling the criteria for PTSD and who live in conditions of ongoing community violence (i.e. in thefavelas) in Rio de Janeiro will be randomly assigned to one of two treatments: Narrative Exposure Therapy (NET) or treatment as usual (TAU). Clinical endpoints will be primarily PTSD and secondarily symptoms of shutdown dissociation, depression, substance involvement  and functionality.

Discussion

Effective treatment for PTSD patients who live in unsafe conditions could substantially reduce suffering of individuals and their families in Brazil. Based on this result, the extent to which such interventions may be useful as a first step in tackling the consequences of violence on a global scale will be discussed.

Trial registration

Deutsches Register Klinischer Studien (German Clinical Trials Register)DRKS00017843. Registered on September 24, 2019
An inertially constructed forward–backward splitting algorithm in Hilbert spaces
Authors: Arfat Yasir , Kumam Poom , Khan Muhammad Aqeel Ahmad , Ngiamsunthorn Parinya Sa , Kaewkhao Attapol
Published: February 2021

In this paper, we develop an iterative algorithm whose architecture comprises a modified version of the forward–backward splitting algorithm and the hybrid shrinking projection algorithm. We provide theoretical results concerning weak and strong convergence of the proposed algorithm towards a common solution of the fixed point problem associated to a finite family of demicontractive operators, the split equilibrium problem and the monotone inclusion problem in Hilbert spaces. Moreover, we compute a numerical experiment to show the efficiency of the proposed algorithm. As a consequence, our results improve various existing results in the current literature.