bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Color Changes of Different Resin Cements in Feldspathic Ceramic Crowns After Accelerated Aging: An In Vitro Research
Authors: Eskitaşçıoğlu Murat , Akdeniz Mehmet Şerif , Değirmenci Beyza Ünalan
Published: October 2021

Aims:

To evaluate the color changes that occur after accelerated aging in feldspathic ceramic crowns cemented with three different dual-cured resin cements.

Materials and Methods:

For each of the A2-colored RelyX U200, G-CEM LinkForce, and Panavia V5 cement groups, 45 dies from A2-colored zirconia blocks and 45 crowns from CEREC blocks were prepared. Color measurements after 24 h of cementation (T1) and after cycles of aging of 1750 (T2), 3500 (T3), and 7000 (T4) in the thermal cycle device were made using SpectroShade Micro device. The coordinates of the color were used L*, a*, and b* as base and the color change was calculated with ∆ E00 in determining the color. One-way analysis of variance test was used to compare the times in terms of ∆ L*, ∆ a*, and ∆ b* values.

Results:

It was found that ∆ L* value decreased significantly in period of the T2, T3, and T4 times compared to T1 in all groups ( P < .05), whereas the change between period of T2, T3, and T4 times was not significant ( P > .05). The ∆ a* value increased significantly in the period of T3 and T4 times compared to T1 in the only G-CEM LinkForce group, whereas the ∆ b* value increased significantly in the period of T4 time compared to T1 in the only Panavia V5 group. The changes in ∆ E00 values, which were observed in all period of times, were found to be between 0.43 and 1.04, 0.43 and 1.43, and 0.40 and 0.97 in RelyX U200, G-CEM LinkForce, and Panavia V5 groups, respectively.

Conclusion:

After accelerated aging, it was found that the color of all cements became darker and the G-CEM LinkForce group turned red and the Panavia V5 group turned yellow. However, it was found that the color changes that occurred were within clinically acceptable visible levels.
Comparison of Gene Expression of Inflammation- and Fibrosis-Related Factors Between the Anterior and Posterior Capsule in Patients With Rotator Cuff Tear and Shoulder Stiffness
Authors: Kim Yang-Soo , Lee Yun-Gyoung , Park Hyung-Seok , Cho Ryu-Kyoung , Lee Hyo-Jin
Published: October 2021

Background:

Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness, yet there are no basic studies that can explain the extent of the release.

Purpose:

This study aimed to compare the genetic expression of inflammation- and fibrosis-related factors between the anterior and posterior capsules in patients with shoulder stiffness and rotator cuff tear.

Study Design:

Descriptive laboratory study.

Methods:

Enrolled in this study were 35 patients who underwent arthroscopic capsular release for shoulder stiffness along with the rotator cuff repair. Anterior and posterior glenohumeral joint capsular tissues were obtained during the capsular release. For the control tissue, anterior capsule was obtained from 40 patients without stiffness who underwent arthroscopic rotator cuff repair. The gene expression of collagen types I and III, fibronectin, extracellular matrix, basic fibroblast growth factor, transforming growth factor–β, connective tissue growth factor, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, intercellular adhesion molecule 1, interleukin 1, and tumor necrotizing factor–α were analyzed using real-time reverse transcription polymerase chain reaction. Differences in gene expression between the anterior capsule, the posterior capsule, and the control tissue were compared with the Kruskal-Wallis test.

Results:

The expression levels of collagen types I and III were significantly higher in the anterior capsule with stiffness com (pared with both the posterior capsule with stiffness ( P = .010 for both) and the control ( P = .038 and .010, respectively). The levels of fibronectin, MMP-2, and MMP-9 in the anterior capsule were significantly higher than in both the posterior capsule ( P = .013, .003, and .006, respectively) and the control ( P = .014, .003, and .005, respectively).

Conclusion:

Genetic analysis of the shoulder capsule revealed that more fibrogenic processes occur in the anterior capsule compared with the posterior capsule in patients with shoulder stiffness.

Clinical Relevance:

Capsular release for shoulder stiffness should be more focused on the anterior capsule than on the posterior capsule.
Influence of Continuous Elbow Valgus Stress on the Medial Elbow Joint Space
Authors: Ikuta Tomoya , Yoshioka Kanta , Matsuzawa Kanta , Maruyama Sae , Edama Mutsuaki
Published: October 2021

Background:

To investigate the effect of ulnar collateral ligament stretching due to the "creep phenomenon," the effect of accumulating elbow valgus stress on ligaments must be clarified.

Purpose:

To evaluate the effect of continuous elbow valgus stress on the medial elbow joint space (JS).

Study Design:

Controlled laboratory study.

Methods:

The authors measured the JS of the nondominant elbow joints of 20 healthy male university students (age, 21.4 ± 0.5 years; height, 171.4 ± 6.5 cm; weight, 65.7 ± 9.1 kg). The participants were seated with their shoulder at 90° of abduction and external rotation and their elbow at 30° of flexion, and elbow valgus stress was maintained at loads of 30 and 60 N using a Telos stress device. The JS was measured on ultrasound images of the medial elbow joint with the elbow in the start limb position (0 N) and then immediately (0 seconds) and at 60, 120, 180, 240, and 300 seconds after loading. In addition, muscle activity of the pronator teres muscle during JS measurement was monitored to examine the presence or absence of defensive contraction due to pain. Analysis of variance and the Bonferroni method for post hoc testing were used for statistical analysis.

Results:

No participants showed defensive contractions of the pronator teres. At 30 N, JS was significantly larger 60 seconds after loading compared with immediately after loading ( P = .007). At 60 N, JS was significantly larger after 120 seconds, as the loading time of valgus stress increased, compared with immediately after loading ( P = .002).

Conclusion:

JS was significantly larger immediately after loading of valgus stress, with an increase in continuous elbow valgus stress after 60 seconds at 30 N and after 120 seconds at 60 N. These results suggest that a creep phenomenon may develop around the soft tissue of the elbow when loaded by a continuous valgus stress.

Clinical Relevance:

JS is significantly increased by continuous elbow valgus stress.
Patient-reported Outcome Measures – A Call for More Narrative Evidence
Authors: Meadows Keith
Published: October 2021

This article puts forward the need to reconsider the current underlying quantitative approach underpinning the application of patient reported outcomes, to a mixed methods approach through the tandem use of patients’ narrative that enables informants in addition to their scores to express the reality of the ways in which their lives are physically and mentally impacted by their health status.
Post‐operative Complication Rate Comparison Between Airway Surgery and Upper Airway Stimulation Using NSQIP and ADHERE
Authors: Van Daele Douglas J. , Cromwell John W. , Hsia Jennifer K. , Nord Ryan S.
Published: October 2021

Objective

Postoperative complication rates were compared between obstructive sleep apnea surgery (OSAS) and hypoglossal nerve upper airway stimulation (UAS).

Study Design

Cohort.

Setting

Multi‐institutional international databases.

Methods

OSAS data were collected from the NSQIP database (2014; American College of Surgeons National Surgery Quality Improvement Program). UAS data were obtained from the ADHERE registry (Adherence and Outcome of Upper Airway Stimulation for OSA International Registry; 2016–December 2019). ADHERE comorbidities and complications were categorized to match NSQIP definitions. A chi‐square test was used for proportion P values.

Results

There were 1623 UAS procedures in ADHERE and 310 in NSQIP. The UAS group was older than the OSAS group (mean ± SD, 60 ± 11 vs 42 ± 13 years) but similarly male (75% vs 77%) and overweight (body mass index, 29 ± 4 vs 29 ± 3 kg/m2). There was a higher proportion of hypertension, diabetes, and heart disease in the UAS cohort. Palatopharyngoplasty was the most common surgical procedure (71%), followed by tonsillectomy (25%). UAS operative time was longer (132 ± 47 vs 54 ± 33 minutes). Postoperative length of stay was not normally distributed, as 71% of UAS stays were <1 day as opposed to 40% of OSA stays (P <. 0001). Thirty‐day return to the operating room related to the procedure was 0.1% for UAS and 4.8% for OSAS (P <. 0001). Surgical site infections were 0.13% for UAS and 0.9% for OSAS (P =. 046).

Conclusion

The UAS cohort was older and more likely to have comorbid hypertension, diabetes, and heart disease. Despite baseline differences, the postoperative complication rate was lower with UAS than with OSAS.
Sustainable Employment and Livelihoods for All
Authors: Pawar Manohar
Published: October 2021

The coronavirus pandemic has not only caused unemployment and livelihood issues, among others, but also has exposed the (pre-pandemic) need for greater employment opportunities and working conditions, and social protection measures. This special issue on ‘Sustainable Employment and Livelihoods for All’ discusses how in/formal workers’ lives are impacted and calls for immediate policy reforms and innovative programs to salvage and prevent millions of people from further plunging into poverty.
Variation in Deformation Behaviors Along the Transverse Direction During the Warm Rolling of a 1480-mm-Wide AZ31B Plate
Authors: Zhi Chenchen , Ma Lifeng , Jia Weitao , Liu Pengtao , Le Qichi , Huang Zhiquan , Han Tingzhuang
Published: October 2021

A decrease in the weight of aerospace vehicles, large ships, weapons, and high-speed trains will increase the demand for wide-width magnesium alloy plates and their composite parts to replace steel and plastic. An investigation was conducted to study the variation in deformation behaviors along the transverse direction during the warm rolling of a 1480-mm-wide AZ31B plate. A uniaxial thermal compression test with a 59 % reduction was performed at different positions on a 13.7-mm-thick rolled plate along the width direction at a temperature of 220 °C and 270 °C and strain rate of 15 s−1. At the same time, the 13.7-mm-thick plate was rolled in a single pass to 5.6 mm on a mill with a 1725-mm-wide roll to confirm the thermal deformation behavior and the dynamic recrystallization (DRX). The results show that the main texture type does not change and the grain size does not have a clear deflection when the magnesium alloy plate reaches a certain value under rolling accumulative reduction. The grain size of a 13.7-mm-thick plate increases with a decrease in the distance to the center layer in the thickness direction. In the width direction, the edge (R6) first decreases and then increases toward the symmetric plane (R1). The critical stress required for dynamic recrystallization in the transition zone R3 of the rolled plate width is minimum, and the average grain size is minimum owing to the relatively complete recrystallization.
Subway Embedded Track Geometric Irregularity Safety Limits
Authors: Zhang Yuxiang , Han Jian , Song Huilai , Liu Yu
Published: October 2021

A coupling dynamic model of a subway train and an embedded track is established to study the safety limits of track irregularities. The simulated vehicle system was a 74-degrees of freedom multi-rigid body model, and the rail was a Timoshenko beam. The slab was a three-dimensional solid finite element model. The sensitive wavelength irregularity was first studied, and then the safety limit of the sensitive wavelength was analyzed. The wheel-rail lateral force exhibited a substantial effect on the track alignment and gauge irregularity safety limit. The wheel-rail vertical force and the rate of wheel load reduction significantly affected the height and cross-level irregularity safety limit. The results demonstrate that the safety limits of the alignment, gauge, height, and cross-level embedded track geometric irregularity are 5.3 mm, [− 10.5, 8] mm, 5.6 mm, and 6 mm, respectively.
Unveiling the Atomic and Electronic Structure of Stacked-Cup Carbon Nanofibers
Authors: Boukhvalov D. W. , Zhidkov I. S. , Kiryakov A. , Menéndez J. L. , Fernández-García L. , Kukharenko A. I. , Cholakh S. O. , Zatsepin A. F. , Kurmaev E. Z.
Published: October 2021

We report results of comprehensive experimental exploration (X-ray photoemission, Raman and optical spectroscopy) of carbon nanofibers (CNFs) in combination with first-principles modeling. Core-level spectra demonstrate prevalence of sp2 hybridization of carbon atoms in CNF with a trace amount of carbon–oxygen bonds. The density functional theory (DFT)-based calculations demonstrated no visible difference between mono- and bilayers because σ-orbitals are related to in-plane covalent bonds. The influence of the distortions on π-peak is found to be significant only for bilayers as a result of π–π interlayer bonds formation. These results are supported by both experimental Raman and XPS valence band spectra. The combination of optical measurements with a theoretical modeling indicates the formation of optically active graphene quantum dots (GQDs) in the CNF matrix, with a radiative relaxation of the excited π* state. The calculated electronic structure of these GQDs is in quantitative agreement with the measured optical transitions and provides an explanation of the absence of visible contribution from these GQDs to the measured valence bands spectra.
Integrated analysis of mRNA-seq and miRNA-seq reveals the advantage of polyploid Solidago canadensis in sexual reproduction
Authors: Wu Miao , Liu Huiyuan , Li Bingbing , Zhu Tao
Published: October 2021

Background

The invasion of Solidago canadensis probably related to polyploidy, which may promotes its potential of sexual reproductive. S. canadensis as an invasive species which rapidly widespread through yield huge numbers of seed, but the mechanism remains unknown. To better understand the advantages of sexual reproduction in hexaploid S. canadensis, transcriptome and small RNA sequencing of diploid and hexaploid cytotypes in flower bud and fruit development stages were performed in this study.

Results

The transcriptome analysis showed that in the flower bud stage, 29 DEGs were MADS-box related genes with 14 up-regulated and 15 down-regulated in hexaploid S. canadensis; 12 SPL genes were detected differentially expressed with 5 up-regulated and 7 down-regulated. In the fruit development stage, 26 MADS-box related genes with 20 up-regulated and 6 down-regulated in hexaploid S. canadensis; 5 SPL genes were all up-regulated; 28 seed storage protein related genes with 18 were up-regulated and 10 down-regulated. The weighted gene co-expression network analysis (WGCNA) identified 19 modules which consisted of co-expressed DEGs with functions such as sexual reproduction, secondary metabolism and transcription factors. Furthermore, we discovered 326 miRNAs with 67 known miRNAs and 259 novel miRNAs. Some of miRNAs, such as miR156, miR156a and miR156f, which target the sexual reproduction related genes.

Conclusion

Our study provides a global view of the advantages of sexual reproduction in hexaploid S. canadensis based on the molecular mechanisms, which may promote hexaploid S. canadensis owing higher yield and fruit quality in the process of sexual reproduction and higher germination rate of seeds, and finally conductive to diffusion, faster propagation process and enhanced invasiveness.
Intriguing findings of liver fibrosis following COVID-19
Authors: Kolesova Oksana , Vanaga Ieva , Laivacuma Sniedze , Derovs Aleksejs , Kolesovs Aleksandrs , Radzina Maija , Platkajis Ardis , Eglite Jelena , Hagina Elvira , Arutjunana Seda , Putrins Davis Simanis , Storozenko Jelena , Rozentale Baiba , Viksna Ludmila
Published: October 2021

Background

Studies on a new coronavirus disease (COVID-19) show the elevation of liver enzymes and liver fibrosis index (FIB-4) independently on pre-existing liver diseases. It points to increased liver fibrogenesis during acute COVID-19 with possible long-term consequences. This study aimed to assess liver fibrosis in COVID-19 patients by serum hyaluronic acid (HA) and FIB-4.

Methods

The study included the acute COVID-19 group (66 patients, 50% females, mean age 58.3 ± 14.6), the post-COVID group (58 patients in 3–6 months after the recovery, 47% females, mean age 41.2 ± 13.4), and a control group (17 people, 47% females, mean age 42.8 ± 11.0). Ultrasound elastography was performed in the post-COVID and control groups.

Results

Sixty-five percent of the acute COVID-19 group had increased FIB-4 (> 1.45), and 38% of patients had FIB-4 ≥ 3.25. After matching by demographics, 52% of acute COVID-19 and 5% of the post-COVID group had FIB-4 > 1.45, and 29% and 2% of patients had FIB-4 ≥ 3.25, respectively. Increased serum HA (≥ 75 ng/ml) was observed in 54% of the acute COVID-19 and 15% of the post-COVID group. In the acute COVID-19 group, HA positively correlated with FIB-4, AST, ALT, LDH, IL-6, and ferritin and negatively with blood oxygen saturation. In the post-COVID group, HA did not correlate with FIB-4, but it was positively associated with higher liver stiffness and ALT.

Conclusion

More than half of acute COVID-19 patients had increased serum HA and FIB-4 related to liver function tests, inflammatory markers, and blood oxygen saturation. It provides evidence for the induction of liver fibrosis by multiple factors during acute COVID-19. Findings also indicate possible liver fibrosis in about 5% of the post-COVID group.
Estimating trunk fat in children according to sex using basic somatic readings: an opportunity for improving evaluation among girls
Authors: Moya Manuel , Pérez-Fernandez Virginia
Published: October 2021

Background

The fat mass estimators waist-to-height ratio (WHtR) and relative fat mass—pediatric (RFMp) complement the widely accepted body mass index (BMI) in obesity evaluation. Aims of the Study: Conduct an easy appraisal of trunk fat and the cardiometabolic risk associated with pediatric obesity.

Methods

A total of 472 children (39% boys in the total sample) were classified as underweight, normal weight, overweight or obese (nutritional groups, NGs) according to BMI Z-score after initial anthropometric data were obtained and ad hoc exclusion criteria were applied. WHtR and RFMp (% of total fat) were calculated for each group, associations were assessed through multiple linear regression (MLR), and differences between sexes were evaluated (medians, IQR).

Results

The mean age (mean (95% CI)) was 10.8 y (10.1–11.1). The values in the total sample were as follows: WHtR, 0.5 (0.49–0.51) and RFMp%, 32.3 (31.7–33.0). In the overweight group, the values were as follows: WHtR, 0.51 (0.50–0.52) and RFMp(%), 34.2 (33.3–35.1). In the obese group, the values were as follows: WHtR, 0.56 (0.55–0.57) and RFMp(%), 37.8 (36.9–38.6). The associations were as follows (NG; independent variables): In the NG, adjusted R2 values were between 0.74 and 0.78. In the total sample, the beta coefficient was 3.36 (P < 0.001) for RFMp for girls; for waist circumference (WC), the beta coefficient was 2.97 (P < 0.001), and for WHtR the beta coefficients were − 0.01 (p < 0.001) and 0.03 (p < 0.001),for girls and for WC respectively.

The sex differences were as follows: BMI exhibited no differences in the NG (Mann-Whitney U). WHtR (median (IQR)) differed (M vs. F) in the total sample (0.49 (0.45–0.54) vs. 0.52 (0.45–0.56), p < 0.004); in the overweight group (0.51 (0.48–0.53) vs. 0.54 (0.51–0.55), p < 0.001); and in the obese group (0.55 (0.52–0.57) vs. 0.57 (0.54–0.60), p < 0.004). RFMp (%) differed in the total group (29.21 (24.27–32.92) vs. 36.63 (30.2–39.51), p < 0.001); in the overweight group (31.24 (28.35–32.35) vs. 37.95 (35.75–38.82), p < 0.001) and in the obese group (35.89 (32.05–36.15) vs. 40.63 (38.27–42.42), p < 0.001).

Conclusions

WHtR and RFMp are simple and reliable indices that do not require centile charts. Their values, including waist circumference, can be used to estimate the different trunk fat components in boys and girls better than BMI, especially if individuals are overweight or obese. RFMp proved to be more reliable as it considers sex. Both should be included in routine anthropometric readings.
Legal status as a life course determinant of health: parent status, adjudication stages, and HIV knowledge among highlanders in Thailand
Authors: Koning Stephanie M. , Flaim Amanda , Baldiga Leo , Feingold David A.
Published: October 2021

Background

Rising nativism and political volatility worldwide threaten to undermine hard-won achievements in human rights and public health. Risks are particularly acute for hundreds of millions of migrants, minorities, and Indigenous peoples, who face disproportionately high health burdens, including HIV/AIDS, and precarious legal status (LS). While LS is receiving increasing attention as a social determinant of health and HIV, understandings are still limited to select immigrant communities. Its effects on health among stateless communities, particularly in the Global South, remain largely unknown. Moreover, widespread limitations in census measures of LS reduce its complexity to a simplistic citizen/non-citizen binary or insufficient proxies. Thailand’s ethnolinguistically diverse highlander population experiences disproportionately high HIV prevalence and comprises one of the world’s largest and most protracted cases of statelessness, an acute condition of precarious LS. As such, analysis of LS and health outcomes among highlanders is both critically warranted, and useful as a case study outside of the migration paradigm.

Methods

Drawing on the UNESCO Highland Peoples Survey II (2010), an unprecedented and unique cross-sectional census of highlanders in Thailand, we mobilize complex measures of LS in adjusted ordinal logistic regression models to assess how parent citizenship and LS adjudication over the early life course condition adult HIV knowledge—a key protective factor against transmission (n = 8079).

Results

Adjusted ordinal logistic regression on knowledge scores reveal that parent citizenship predicts odds of greater knowledge by 1.4- to 2.2-fold, depending on ethnic group. This is partially explained by divergent stages of LS adjudication between birth and adulthood, including successful birth registration and adult citizenship acquisition, along with secondary school completion. Preciselyhowthese factors contribute to HIV knowledge varies by ethnic group.

Conclusions

This study advances knowledge of LS outside of the migration paradigm, reveals heretofore unexamined connections between LS and access to public health information, and elucidates how instabilities in LS adjudication stages underlie health inequalities over the life course. Findings indicate that securing success in public health and human rights agendas requires attention to how states adjudicate and deploy LS in multiple stages across the life course to structure access and exclusion among migrant and non-migrant communities alike.
Depression in public officials during the COVID-19 pandemic in Paraguay: a web-based study
Authors: Kim Ji Eon , Lee Ji Ho , Kang Yanghee , Lee Sun Ha , Shin Hyein , Rönnebeck Nadia , Rönnebeck Renato , Nam Eun Woo
Published: October 2021

Background

According to the World Health Organization, the coronavirus disease 2019 (COVID-19) pandemic has created situations that have a negative effect on people and threaten their mental health. Paraguay announced the Estado de Emergencia Sanitaria (Presidential Decree No. 3456) on March 16, 2020, which was followed by the imposition of a 24-h restriction on movement order on March 21. Self-quarantine at home may have been the most effective method of preventing the spread of infectious diseases; however, with the global pandemic becoming more prolonged and the consequent lengthening of the 24-h self-quarantine period, it is highly probable that both physical and psychological problems will arise.

Methods

In this study, a web-based cross-sectional method was used to analyze the factors influencing COVID-19-induced depressive feelings in Paraguayan public officials.

Results

Public officials reported a high level of depressive symptoms with a high level of apprehension in early stage of COVID-19. In addition, this study identified that when the self-quarantine period increased, levels of depressive feelings also increased. Since self-quarantine is characterized by the requirement that individuals endure an undetermined period within a confined area, it may have caused stress and anxiety, as well as the consequent experience of depressive feelings.

Conclusions

Paraguayan government should develop a program for the delivery of mental health care and services to public officials in COVID-19 Pandemic period. Moreover, a program is required for people facing deteriorating mental health due to social isolation and loneliness caused by social distancing during the prolonged period of self-quarantine. Finally, mental health care programs should be organized in a community-focused way by utilizing online systems to enhance the effectiveness of mental health recovery.
miR-30a-5p inhibits osteogenesis and promotes periodontitis by targeting Runx2
Authors: Liu Xiangdong , Yang Bo , Zhang Yan , Guo Xiaorui , Yang Qianjuan , Liu Xiaojing , Bai Qingxia , Lu Qun
Published: October 2021

Background

Periodontitis is the most extensive chronic inflammatory bone resorption disease. MiRNAs offer a potential way for potential therapy. Indeed, miR-30a-5p had an increasing expression in periodontitis gingivae, but whether it promotes osteogenesis and inhibits inflammation remains unknown.

Methods

Periodontitis model was exhibited by wire ligation and verified by micro-CT and HE staining; qPCR was used to detect the expression of miR-30a-5p; miR-30a-5p inhibitors and mimics were transfected into MC3T3-E1 cell line by lipofectamine 3000; The dual luciferase reporter gene experiment and RIP experiment were used to detect the relationship between miR-30a-5p and Runx2; Rescue experiment was used to verify the relationship between miR-30a-5p and Runx2.

Results

Periodontitis model was exhibited successfully and miR-30a-5p was overexpressed at the bone and gingival tissues of this model. miR-30a-5p inhibitors not only promoted the osteogenesis but also relieved inflammation. Runx2 is a target of miR-30a-5p by dual luciferase reporter gene experiment and RIP experiment. Rescue experiments revealed that miR-30a-5p inhibitors would promote osteogenesis and relieve inflammation by targeting Runx2 in inflammation of MC3T3-E1 cell line.

Conclusions

That all suggested that miR-30a-5p-mediated-Runx2 provided a novel understanding of mechanism of periodontitis.
Response to: viva la VOSCE?
Authors: Motie Lucinda Zahrah , Kaini Shahil
Published: October 2021

Boyle et al. discuss the development and implementation of a Virtual Objective Structured Clinical Examination due to the COVID-19 pandemic lockdown precluding face-to-face Objective Structured Clinical Examinations, something we too as clinical medical students studying at University College London have experienced. We commend Boyle et al. for promptly creating and delivering this assessment. However, we believe this style of assessment has the potential to exacerbate the ethnic and social inequalities that currently exist within medical education. Going forward, it is imperative that the home environment is considered in an attempt to level the playing field.
COVID-19 pandemic and waiting times in outpatient specialist care in Germany: an empirical analysis
Authors: Muschol Jennifer , Gissel Christian
Published: October 2021

Background

International healthcare systems face the challenge that waiting times may create barriers to accessing medical care, and that those barriers are unequally distributed between different patient groups. The disruption of healthcare systems caused by the COVID-19 pandemic could exacerbate this already strained demand situation. Using the German healthcare system as an example, this study aims to analyze potential effects of the COVID-19 pandemic on waiting times for outpatient specialist care and to evaluate differences between individual patient groups based on their respective insurance status and the level of supply.

Methods

We conducted an experiment in which we requested appointments by telephone for different insurance statuses in regions with varying levels of supply from 908 outpatient specialist practices in Germany before and during the COVID-19 pandemic. Data from 589 collected appointments were analyzed using a linear mixed effect model.

Results

The data analysis revealed two main counteracting effects. First, the average waiting time has decreased for both patients with statutory (mandatory public health insurance) and private health insurance. Inequalities in access to healthcare, however, remained and were based on patients’ insurance status and the regional level of supply. Second, the probability of not receiving an appointment at all significantly increased during the pandemic.

Conclusions

Patient uncertainty due to the fear of a potential COVID-19 infection may have freed up capacities in physicians’ practices, resulting in a reduction of waiting times. At the same time, the exceptional situation caused by the pandemic may have led to uncertainty among physicians, who might thus have allocated appointments less frequently. To avoid worse health outcomes in the long term due to a lack of physician visits, policymakers and healthcare providers should focus more on regular care in the current COVID-19 pandemic.
The evolution of pelvic canal shape and rotational birth in humans
Authors: Stansfield Ekaterina , Fischer Barbara , Grunstra Nicole D. S. , Pouca Maria Villa , Mitteroecker Philipp
Published: October 2021

Background

The human foetus typically needs to rotate when passing through the tight birth canal because of the complex shape of the pelvis. In most women, the upper part, or inlet, of the birth canal has a round or mediolaterally oval shape, which is considered ideal for parturition, but it is unknown why the lower part of the birth canal has a pronounced anteroposteriorly oval shape.

Results

Here, we show that the shape of the lower birth canal affects the ability of the pelvic floor to resist the pressure exerted by the abdominal organs and the foetus. Based on a series of finite element analyses, we found that the highest deformation, stress, and strain occur in pelvic floors with a circular or mediolaterally oval shape, whereas an anteroposterior elongation increases pelvic floor stability.

Conclusions

This suggests that the anteroposterior oval outlet shape is an evolutionary adaptation for pelvic floor support. For the pelvic inlet, by contrast, it has long been assumed that the mediolateral dimension is constrained by the efficiency of upright locomotion. But we argue that the mediolateral elongation has evolved because of the limits on the anteroposterior diameter imposed by upright posture. We show that an anteroposteriorly deeper inlet would require greater pelvic tilt and lumbar lordosis, which compromises spine health and the stability of upright posture. These different requirements of the pelvic inlet and outlet likely have led to the complex shape of the pelvic canal and to the evolution of rotational birth characteristic of humans.
Emerging roles of dysregulated adenosine homeostasis in brain disorders with a specific focus on neurodegenerative diseases
Authors: Chang Ching-Pang , Wu Kuo-Chen , Lin Chien-Yu , Chern Yijuang
Published: October 2021

In modern societies, with an increase in the older population, age-related neurodegenerative diseases have progressively become greater socioeconomic burdens. To date, despite the tremendous effort devoted to understanding neurodegenerative diseases in recent decades, treatment to delay disease progression is largely ineffective and is in urgent demand. The development of new strategies targeting these pathological features is a timely topic. It is important to note that most degenerative diseases are associated with the accumulation of specific misfolded proteins, which is facilitated by several common features of neurodegenerative diseases (including poor energy homeostasis and mitochondrial dysfunction). Adenosine is a purine nucleoside and neuromodulator in the brain. It is also an essential component of energy production pathways, cellular metabolism, and gene regulation in brain cells. The levels of intracellular and extracellular adenosine are thus tightly controlled by a handful of proteins (including adenosine metabolic enzymes and transporters) to maintain proper adenosine homeostasis. Notably, disruption of adenosine homeostasis in the brain under various pathophysiological conditions has been documented. In the past two decades, adenosine receptors (particularly A1and A2Aadenosine receptors) have been actively investigated as important drug targets in major degenerative diseases. Unfortunately, except for an A2Aantagonist (istradefylline) administered as an adjuvant treatment with levodopa for Parkinson’s disease, no effective drug based on adenosine receptors has been developed for neurodegenerative diseases. In this review, we summarize the emerging findings on proteins involved in the control of adenosine homeostasis in the brain and discuss the challenges and future prospects for the development of new therapeutic treatments for neurodegenerative diseases and their associated disorders based on the understanding of adenosine homeostasis.
Improving access to primary health care: a cross-case comparison based on an a priori program theory
Authors: Spooner Catherine , Lewis Virginia , Scott Cathie , Dahrouge Simone , Haggerty Jeannie , Russell Grant , Levesque Jean-Frederic , Dionne Emilie , Stocks Nigel , Harris Mark F. ,   IMPACT team
Published: October 2021

Background

Inequitable access to primary health care (PHC) remains a problem for most western countries. Failure to scale up effective interventions has been due, in part, to a failure to share the logic and essential elements of successful programs. The aim of this paper is to describe what we learned about improving access to PHC for vulnerable groups across multiple sites through use of a common theory-based program logic model and a common evaluation approach. This was the IMPACT initiative.

Methods

IMPACT’s evaluation used a mixed methods design with longitudinal (pre and post) analysis of six interventions. The analysis for this paper included four of the six sites that met study criteria. These sites were located in Canada (Alberta, Quebec and Ontario) and Australia (New South Wales). Using the overarching logic model, unexpected findings were reviewed, and alternative explanations were considered to understand how the mechanisms of each intervention may have contributed to results.

Results

Each site addressed their local access problem with different strategies and from different starting points. All sites observed changes in patient abilities to access PHC and provider access capabilities. The combination of intended and observed consequences for consumers and providers was different at each site, but all sites achieved change in both consumer ability and provider capability, even in interventions where there was no activity targeting provider behaviors.

Discussion

The model helped to identify, explore and synthesize intended and unintended consequences of four interventions that appeared to have more differences than similarities. Similar outcomes for different interventions and multiple impacts of each intervention on abilities were observed, implying complex causal pathways.

Conclusions

All the interventions were a low-cost incremental attempt to address unmet health care needs of vulnerable populations. Change is possible; sustaining change may be more challenging. Access to PHC requires attention to both patient abilities and provider characteristics. The logic model proved to be a valuable heuristic tool for defining the objectives of the interventions, evaluating their impacts, and learning from the comparison of ‘cases’.
Crosstalk between cancer-associated fibroblasts and immune cells in the tumor microenvironment: new findings and future perspectives
Authors: Mao Xiaoqi , Xu Jin , Wang Wei , Liang Chen , Hua Jie , Liu Jiang , Zhang Bo , Meng Qingcai , Yu Xianjun , Shi Si
Published: October 2021

Cancer-associated fibroblasts (CAFs), a stromal cell population with cell-of-origin, phenotypic and functional heterogeneity, are the most essential components of the tumor microenvironment (TME). Through multiple pathways, activated CAFs can promote tumor growth, angiogenesis, invasion and metastasis, along with extracellular matrix (ECM) remodeling and even chemoresistance. Numerous previous studies have confirmed the critical role of the interaction between CAFs and tumor cells in tumorigenesis and development. However, recently, the mutual effects of CAFs and the tumor immune microenvironment (TIME) have been identified as another key factor in promoting tumor progression. The TIME mainly consists of distinct immune cell populations in tumor islets and is highly associated with the antitumor immunological state in the TME. CAFs interact with tumor-infiltrating immune cells as well as other immune components within the TIME via the secretion of various cytokines, growth factors, chemokines, exosomes and other effector molecules, consequently shaping an immunosuppressive TME that enables cancer cells to evade surveillance of the immune system. In-depth studies of CAFs and immune microenvironment interactions, particularly the complicated mechanisms connecting CAFs with immune cells, might provide novel strategies for subsequent targeted immunotherapies. Herein, we shed light on recent advances regarding the direct and indirect crosstalk between CAFs and infiltrating immune cells and further summarize the possible immunoinhibitory mechanisms induced by CAFs in the TME. In addition, we present current related CAF-targeting immunotherapies and briefly describe some future perspectives on CAF research in the end.
Prescription rate and treatment patterns for allergic rhinitis from 2010 to 2018 in South Korea: a retrospective study
Authors: Son Jaemin , Kim Eun-San , Choi Hee-seung , Ha In-Hyuk , Lee Donghyo , Lee Yoon Jae
Published: October 2021

Background

There has been little investigation on how guidelines for allergic rhinitis (AR) treatment are applied in current clinical practice. We aimed to analyze prescription trends and patterns for AR treatment according to patient characteristics over a 9-year period in Korea.

Methods

We used cross-sectional data from the Korean Health Insurance Review & Assessment Service National Patient Sample from 2010 to 2018. We analyzed 1,719,194 patients with AR as the principal diagnosis. Prescription rates of antihistamines, steroids, and other drugs; combination prescriptions; and first-choice prescriptions were analyzed.

Results

The prescription rate of first-generation antihistamines decreased over the years (2010: 29.13; 2018: 23.41). By contrast, the prescription rate of systemic steroids (2010: 23.60; 2018: 28.70), nasal steroids (2010: 9.70; 2018: 14.67), and leukotriene receptor antagonists (LTRAs) (2010: 11.13; 2018: 26.56) increased. The prescription rate of steroids was lower in patients aged 0–5 years and ≥ 65 years than in other age groups and that of LTRAs was the highest in patients aged 0–5 years. The rate of combination prescribing antihistamines and nasal steroids increased (2010: 7.99; 2018: 12.09). The rate of first-choice prescriptions with antihistamines and nasal steroids also increased (2010: 4.72; 2018: 7.24).

Conclusions

The results confirmed a decrease in antihistamine prescriptions, especially with first-generation, and an increase in steroid and LTRA prescriptions in patients with AR in Korea. Regarding prescription patterns, steroids were increasingly prescribed in combination with antihistamines. However, the trend was opposite in the 0–5 years and ≥ 65 years groups.
Quantitative proteomics by iTRAQ-PRM based reveals the new characterization for gout
Authors: Chen Guangqi , Cheng Jiafen , Yu Hanjie , Huang Xiao , Bao Hui , Qin Ling , Wang Ling , Song Yaxiang , Liu Xinying , Peng Ai
Published: October 2021

Background

Gout is a common and complex form of immunoreactive arthritis based on hyperuricemia, while the symptoms would turn to remission or even got worse. So, it is hard to early identify whether an asymptomatic hyperuricemia (AHU) patient will be susceptible to get acute gout attack and it is also hard to predict the process of gout remission to flare. Here, we report that the plasma proteins profile can distinguish among acute gout (AG), remission of gout (RG), AHU patients, and healthy controls.

Methods

We established an isobaric tags for relative and absolute quantification (iTRAQ) and parallel reaction monitoring (PRM) based method to measure the plasma proteins for AG group (n = 8), RG group (n = 7), AHU group (n = 7) and healthy controls (n = 8).

Results

Eleven differentially expressed proteins such as Histone H2A, Histone H2B, Thrombospondin-1 (THBS1), Myeloperoxidase (MPO), Complement C2, Complement component C8 beta chain (C8B), Alpha-1-acid glycoprotein 1 (ORM1), Inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4), Carbonic anhydrase 1 (CA1), Serum albumin (ALB) and Multimerin-1 (MMRN1) were identified. Histone H2A, Histone H2B and THBS1 might be the strongest influential regulator to maintain the balance and stability of the gout process. The complement and coagulation cascades is one of the main functional pathways in the mechanism of gout process.

Conclusions

Histone H2A, Histone H2B and THBS1 are potential candidate genes for novel biomarkers in discriminating gout attack from AHU or RG, providing new theoretical insights for the prognosis, treatment, and management of gout process.

Trial registration

This study is not a clinical trial.
Diabetes free life expectancy and years of life lost associated with type 2 diabetes: projected trends in Germany between 2015 and 2040
Authors: Tönnies Thaddäus , Baumert Jens , Heidemann Christin , von der Lippe Elena , Brinks Ralph , Hoyer Annika
Published: October 2021

Background

Type 2 diabetes (T2D) causes substantial disease burden and is projected to affect an increasing number of people in coming decades. This study provides projected estimates of life years free of type 2 diabetes (T2D) and years of life lost ($${\mathrm{YLL}}$$
YLL
) associated with T2D for Germany in the years 2015 and 2040.

Methods

Based on an illness-death model and the associated mathematical relation between prevalence, incidence and mortality, we projected the prevalence of diagnosed T2D using currently available data on the incidence rate of diagnosed T2D and mortality rates of people with and without diagnosed T2D. Projection of prevalence was achieved by integration of a partial differential equation, which governs the illness-death model. These projected parameters were used as input values to calculate life years free of T2D and $${\mathrm{YLL}}$$
YLL
associated with T2D for the German population aged 40 to 100 years in the years 2015 and 2040, while accounting for different assumptions on future trends in T2D incidence and mortality.

Results

Assuming a constant incidence rate, women and men at age 40 years in 2015 will live approximately 38 years and 33 years free of T2D, respectively. Up to the year 2040, these numbers are projected to increase by 1.0 years and 1.3 years. Assuming a decrease in T2D-associated excess mortality of 2% per year, women and men aged 40 years with T2D in 2015 will be expected to lose 1.6 and 2.7 years of life, respectively, compared to a same aged person without T2D. In 2040, these numbers would reduce by approximately 0.9 years and 1.6 years. This translates to 10.8 million and 6.4 million $${\mathrm{YLL}}$$
YLL
in the German population aged 40–100 years with prevalent T2D in 2015 and 2040, respectively.

Conclusions

Given expected trends in mortality and no increase in T2D incidence, the burden due to premature mortality associated with T2D will decrease on the individual as well as on the population level. In addition, the expected lifetime without T2D is likely to increase. However, these trends strongly depend on future improvements of excess mortality associated with T2D and future incidence of T2D, which should motivate increased efforts of primary and tertiary prevention.
Zinc-mediated activation of CREB pathway in proliferation of pulmonary artery smooth muscle cells in pulmonary hypertension
Authors: Xiao Genfa , Lian Guili , Wang Tingjun , Chen Weixiao , Zhuang Wei , Luo Li , Wang Huajun , Xie Liangdi
Published: October 2021

Background

Transcription factor CREB is involved in the development of pulmonary hypertension (PH). However, little is known about the role and regulatory signaling of CREB in PH.

Methods

A series of techniques, including bioinformatics methods, western blot, cell proliferation and luciferase reporter assay were used to perform a comprehensive analysis of the role and regulation of CREB in proliferation of pulmonary artery smooth muscle cells (PASMCs) in PH.

Results

Using bioinformatic analysis of the differentially expressed genes (DEGs) identified in the development of monocrotaline (MCT)- and hypoxia-induced PH, we found the overrepresentation of CRE-containing DEGs. Western blot analysis revealed a sustained increase in total- and phosphorylated-CREB in PASMCs isolated from rats treated with MCT. Similarly, an enhanced and prolonged serum-induced CREB phosphorylation was observed in hypoxia-pretreated PASMCs. The sustained CREB phosphorylation in PASMCs may be associated with multiple protein kinases phosphorylated CREB. Additionally, hierarchical clustering analysis showed reduced expression of the majority of CREB phosphatases in PH, including regulatory subunits of PP2A, Ppp2r2c and Ppp2r3a. Cell proliferation analysis showed increased PASMCs proliferation in MCT-induced PH, an effect relied on CREB-mediated transcriptional activity. Further analysis revealed the raised intracellular labile zinc possibly from ZIP12 was associated with reduced phosphatases, increased CREB-mediated transcriptional activity and PASMCs proliferation.

Conclusions

CREB pathway was overactivated in the development of PH and contributed to PASMCs proliferation, which was associated with multiple protein kinases and/or reduced CREB phosphatases and raised intracellular zinc. Thus, this study may provide a novel insight into the CREB pathway in the pathogenesis of PH.