Associations of Duration of Preadoption Out-of-home Care, Genetic Risk for Schizophrenia Spectrum Disorders and Adoptive Family Functioning with Later Psychiatric Disorders of Adoptees

The objective was to examine the impacts of duration of preadoption out-of-home care and adoptive family functioning on later psychiatric morbidity of adoptees with high (HR) and low (LR) genetic risk for schizophrenia spectrum disorders. The study uses nationwide data from the Finnish Adoptive Family Study of Schizophrenia. The study population in this substudy consisted of 43 h adoptees and 128 LR adoptees. Of these adoptees, 90 had spent 0-6 months and 81 over 6 months in preadoption out-of-home care. The family functioning of adoptive families was assessed based on Global Family Ratings and psychiatric disorders on DSM-III-R criteria. The results showed that among the adoptees with over 6 months in preadoption out-of-home care, the likelihood for psychiatric disorders was significantly increased in HR adoptees compared to LR adoptees. In adoptees with 6 months or less in preadoption out-of-home care, an increased likelihood for psychiatric disorders was found among those living in adoptive families with dysfunctional processes. These findings indicate that especially for HR children, a well-functioning early caregiving environment is crucial in terms of subsequent mental wellbeing. The results emphasize that when adoption is necessary, early placement and well-functioning adoptive family environment are beneficial to children.

The traits of Autism Spectrum Disorder and bullying victimization in an epidemiological population

Autistic children (Autism Spectrum Disorder, ASD) show an increased risk of bullying victimization and often face challenges in communication and peer relationships. However, it is unclear to what extent the amount and quality of ASD traits are associated with bullying victimization. This study examined the association of bullying victimization and ASD traits in an epidemiological population of 8-year-old children (n = 4408) using parent and teacher completed Autism Spectrum Screening Questionnaires (ASSQs), both separately and combined. The ASSQ items relating to loneliness and social isolation, lack of co-operating skills, clumsiness and lack of common sense were associated with victimization in the study population. The higher the ASSQ scores, the more the children were victimized: the ASSQ scores increased in parallel with victimization from 0 (0% victimized) to 45 (64% victimized). The victimization rate was 46% in ASD sample, 2% in the total population sample and 2% in the non-ASD population sample. The results enable more targeted means for recognizing potential victimization.

Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a 5-10-year follow-up of the randomized controlled multicenter study

PURPOSE

In this long-term follow-up of a prospective, randomized, and multicenter study, we compare the results of a group receiving laparoscopic incisional ventral hernia repair using intraperitoneal onlay mesh (LG) to a group receiving a hybrid hernia repair where open closure of fascial defect was added to intraperitoneal mesh placement (HG).

METHODS

Originally, 193 patients with 2-7 cm incisional hernias were randomly assigned to either the LG or HG during the 30-month recruitment period in 2012 to 2015. Long-term follow-up was conducted 5-10 years after surgery to evaluate hernia recurrence rate and quality of life (QoL).

RESULTS

In all, 65 patients in the LG and 60 in the HG completed the long-term follow-up with a median follow-up period of 87 months. Recurrent hernia was detected in 11 of 65 patients (16.9%) in the LG and 10 of 60 patients (16.7%) in the HG (p  >  0.9). Kaplan-Meier analysis demonstrated a recurrence rate approaching 20% in both groups, with similar curves. Three patients in the LG (4.6% and five patients in the HG (8.1%) had undergone re-operation due to recurrence (p  = 0.48). There was no difference in patient-reported QoL measured using the SF-36 questionnaire. Mean pain scores were similar between groups, mean numeric rating scale (NRS) 0 to 10 being 1.1 in the LG and 0.7 in the HG (p  = 0.43).

CONCLUSION

Fascial closure did not reduce hernia recurrence rate in this study population, even though it has been shown to be beneficial and recommended in surgery guidelines. In the long term, recurrence rate for both groups is similar.

The Potential Role of Probiotics in the Management of Osteoarthritis Pain: Current Status and Future Prospects

PURPOSE OF REVIEW

This narrative review article comprehensively explains the pathophysiology of osteoarthritis (OA) pain perception, how the gut microbiota is correlated with it, possible molecular pathways involved in probiotics-mediated OA pain reduction, limitations in the current research approaches, and future perspectives.

RECENT FINDINGS

The initiation and progression of OA, including the development of chronic pain, is intricately associated with activation of the innate immune system and subsequent inflammatory responses. Trauma, lifestyle (e.g., obesity and metabolic disease), and chronic antibiotic treatment can disrupt commensal homeostasis of the human microbiome, thereby affecting intestinal integrity and promoting leakage of bacterial endotoxins and metabolites such as lipopolysaccharides (LPS) into circulation. Increased level of LPS is associated with knee osteophyte severity and joint pain. Both preclinical and clinical studies strongly suggest that probiotics may benefit patients with OA pain through positive gut microbiota modulation and attenuating low-grade inflammation via multiple pathways. Patent data also suggests increased interest in the development of new innovations that involve probiotic use for reducing OA and joint pain. Recent data suggest that probiotics are attracting more and more attention for OA pain management. The advancement of knowledge in this area may pave the way for developing different probiotic strains that can be used to support joint health, improve treatment outcomes in OA, and reduce the huge impact of the disease on healthcare systems worldwide.

Quantification of Upper Limb Movements in Patients with Hereditary or Idiopathic Ataxia

Assessment of ataxic movements is usually based on clinical judgment. Technical devices can be employed in the quantification of ataxic movements in addition to clinical evaluation. The effect of maximal speed in upper limb movements in ataxia patients has not been quantified. The aim was to quantify upper limb movements in patients with hereditary or idiopathic ataxia and to find features of movement that are characteristic for ataxia. We examined 19 patients with degenerative ataxia and 21 healthy controls. An ad hoc system comprising a touch screen, an accelerometer, and a gyroscope was used to measure speed, angular acceleration, consistency, and accuracy of upper limb movements. The movements were quantified during finger-to-nose test that the patients were asked to perform at their own pace and as fast as possible. Disease severity was estimated by using the Scale for the Assessment and Rating of Ataxia (SARA). The mean SARA score of the patients was 13.5. Compared to the controls the performance of the patients was slow (p < 0.001) and arrhythmic (p < 0.001), but end-point accuracy on the touch screen was intact. The SARA score correlated with the standard deviation of amplitude of angular acceleration in Z-axis (F(1,17) = 15.00, p < 0.001 with R2 = 0.47). Upper limb movements of the patients with degenerative ataxia were slower and more arrhythmic than those in the controls. The patients retained spatial end-point accuracy.

Social-Emotional and Behavioural Difficulties in Children with Neurodevelopmental Disorders: Emotion Perception in Daily Life and in a Formal Assessment Context

Children with neurodevelopmental disorders often have social-emotional and behavioural difficulties. The present study explored these difficulties in children (n = 50, aged 6-10 years) with autism spectrum disorder, attention-deficit/hyperactivity disorder and developmental language disorder. Parents, teachers and therapists evaluated children's social-emotional and behavioural difficulties through a self-devised questionnaire and the Strengths and Difficulties Questionnaire. Additionally, the children, along with their typically developing age peers (n = 106), completed six emotion discrimination tasks. Analysis revealed some impaired emotion discrimination skills that were predictive for behavioural challenges in daily life and associated with the parent-reported existence of friends. Timely intervention in these children is needed, and it should also include emotion perception training.

Social leisure time activities as a mediating link between self-reported psychological symptoms in adolescence and psychiatric morbidity by young adulthood: the Northern Finland 1986 Birth Cohort study

Research indicates that adolescent psychological symptoms are associated with subsequent mental health disorders. Studies also show the association of leisure activity with improved current and future mental health. However, research is limited on whether social leisure time activity is a mediating link in the association between psychological symptoms and later psychiatric morbidity. We examined whether adolescence-related social leisure time activity, per se, is a mediating link in the association between adolescent psychological symptoms and later psychiatric morbidity. The study population was based on the Northern Finland Birth Cohort 1986 Study (NFBC 1986; n = 6709; 3227 males). Psychological symptoms at age 15-16 years were measured with the Youth Self Report (YSR) questionnaire. Study participants' psychiatric morbidity by the age of 33 years was assessed using the diagnoses from the nationwide health care registers. Our results showed an association between psychological symptoms and leisure time activities that varied depending on the level of social activity. Leisure time activity was found to be a mediating link between psychological symptoms in adolescence and psychiatric disorders in early adulthood. Adolescence-related leisure time activities, which differed with regard to social interactions, appeared to serve as a mediating link between adolescent psychological symptoms and later onset of psychiatric disorders. Socially active leisure time during adolescence is related to better long-term mental health, while socially inactive leisure time associates with the likelihood of later psychiatric morbidity. To prevent psychiatric disorders, enhancing such leisure time activities in society is highly recommended.

The ultrasound assessment of osteoarthritis: the current status

Traditionally, osteoarthritis (OA) is diagnosed with the clinical examination supplemented by the conventional radiography (CR). In the research literature, the role of ultrasound (US) imaging in the diagnostics of OA has risen steadily during the last two decades. US imaging is cheap and globally widely available often already in primary healthcare. Here, we reviewed the most essential US literature focusing on OA diagnostics and progression prediction using the various search engines. Starting from the year 2000, our search provided 1 445 journal articles. After reviewing the abstracts, 89 articles were finally included. Most of the reviewed articles focused on the imaging of knee and hand OA, whereas only a minority dealt with the imaging of hip, ankle, midfoot, acromioclavicular, and temporomandibular joints. Overall, during the last 20 years, the use of US imaging for OA assessment has increased in the scientific literature. In knee and hand joints, US imaging has been reported to be a promising tool to evaluate OA changes. Furthermore, the reproducibility of US as well as its association to MRI findings are excellent. Importantly, US seems to even outperform CR in certain aspects, such as detection of osteophytes, joint inflammation, meniscus protrusion, and localized cartilage damage (especially at the medial femoral condyle and sulcus area). Based on the reviewed literature, US can be truly considered as a complementary tool to CR in the clinical setup for OA diagnostics. New technical developments may even enhance the diagnostic value of the US in the future.

Gestational diabetes is associated with the risk of offspring's congenital anomalies: a register-based cohort study

BACKGROUND

Gestational diabetes mellitus (GDM) is a common pregnancy-related disorder and a well-known risk factor for adverse pregnancy outcomes. There are conflicting findings on the association of GDM with the risk of congenital anomalies (CAs) in offspring. In this study, we aimed to determine study whether maternal GDM is associated with an increased risk of major CAs in offspring.

METHODS

This Finnish Gestational Diabetes (FinnGeDi) register-based study included 6,597 women with singleton pregnancies and a diagnosis of GDM and 51,981 singleton controls with no diabetes identified from the Finnish Medical Birth Register (MBR) in 2009. Data from MBR were combined in this study with the Register of Congenital Malformations, which includes the data of CAs. We used logistic regression to calculate odds ratios (OR) for CAs, together with their 95% confidence intervals (CIs), adjusting for maternal age, parity, pre-pregnancy body mass index (BMI), and maternal smoking status.

RESULTS

The risk of major CAs was higher in the GDM-exposed (n = 336, 5.09%) than in the non-exposed group (n = 2,255, 4.33%) (OR: 1.18, 95% CI: 1.05-1.33, p = 0.005). The adjusted OR (aOR) was 1.14 (95% CI: 1.00-1.30, p = 0.047). There was a higher overall prevalence of CAs, particularly chromosomal abnormalities (0.52% vs. 0.21%), in the GDM-exposed group (OR: 2.49, 95% Cl: 1.69-3.66, p < 0.001). The aOR was 1.93 (95% Cl: 1.25-2.99, p = 0.003).

CONCLUSIONS

Offspring exposed to GDM have a higher prevalence of major CAs. Of note, risk factors other than GDM, such as older maternal age and a higher pre-pregnancy BMI, diminished the between group differences in the prevalence of major CAs. Nevertheless, our findings suggest that offspring exposed to maternal GDM are more likely to be diagnosed with a chromosomal abnormality, independent of maternal age, parity, pre-pregnancy BMI, and smoking.

Psychiatric symptoms in Salla disease

Salla disease (SD) is a rare lysosomal storage disorder characterised by intellectual disability ataxia, athetosis, nystagmus, and central nervous system demyelination. Although the neurological spectrum of SD's clinical phenotype is well defined, psychotic symptoms in SD remain unreported. We reviewed the presence of psychiatric symptoms in patients diagnosed with SD. Medical records of all SD patients at Oulu University Hospital during the years 1982-2015 were systematically reviewed to evaluate the presence of psychiatric symptoms. Psychiatric symptoms were frequently associated with SD (10/24, 42%), and two patients were described as developing psychosis as adolescents. We reported their clinical characteristics in detail and assessed the prevalence of psychiatric symptoms in a cohort of 24 patients. Other psychiatric factors associated with SD were sleeping disorders (8/24, 32%), aggressive behaviour disorders or restlessness (6/24, 25%), and off-label antipsychotic medication (4/24, 17%). This report expands the knowledge of the phenotypic spectrum of SD and demonstrates the importance of recognising the possibility of psychiatric symptoms, including psychosis, in persons with SD.

Long-term results of a prospective randomized trial comparing tension-free vaginal tape versus transobturator tape in stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

This study was aimed at investigating the long-term effectiveness of minimally invasive mid-urethral sling (MUS) surgery and at comparing the outcomes between retropubic (tension-free vaginal tape, TVT) and transobturator tape (TOT) methods in the treatment of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with a predominant stress component in a long-term follow-up of a randomized controlled trial.

METHODS

This work is a long-term follow-up study of a previous prospective randomized trial conducted in the Department of Obstetrics and Gynecology at Oulu University Hospital between January 2004 and November 2006. The original 100 patients were randomized into the TVT (n=50) or TOT (n=50) group. The median follow-up time was 16 years, and the subjective outcomes were evaluated using internationally standardized and validated questionnaires.

RESULTS

Long-term follow-up data were obtained from 34 TVT patients and 38 TOT patients. At 16 years after MUS surgery, the UISS significantly decreased from a preoperative score in the TVT (11.88 vs 5.00, p<0.001) and TOT (11.05 vs 4.95, p<0.001) groups, showing a good long-term success of the MUS surgery in both groups. In comparing the TVT and TOT procedures, the subjective cure rates did not differ significantly between the study groups in long-term follow-up according to validated questionnaires.

CONCLUSION

Midurethral sling surgery had good long-term outcomes in the treatment of SUI and MUI with a predominant stress component. The subjective outcomes of the TVT and TOT procedures were similar after a 16-year follow-up.

Reporting of costs and economic impacts in randomized trials of de-implementation interventions for low-value care: a systematic scoping review

BACKGROUND

De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research.

METHODS

We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool.

RESULTS

We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%).

CONCLUSION

De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-makers.

TRIAL REGISTRATION

OSF (Open Science Framework): https://osf.io/ueq32 .

Novel human lymph node-derived matrix supports the adhesion of metastatic oral carcinoma cells

BACKGROUND

3D culture is increasingly used in cancer research, as it allows the growth of cells in an environment that mimics in vivo conditions. Metastases are the primary cause of morbidity and mortality in cancer patients, and solid tumour metastases are mostly located in lymph nodes. Currently, there are no techniques that model the pre-metastatic lymph node microenvironment in vitro. In this study, we prepared a novel extracellular matrix, Lymphogel, which is derived from lymph nodes, mimicking the tumour microenvironment (TME) of metastatic carcinoma cells. We tested the suitability of the new matrix in various functional experiments and compared the results with those obtained using existing matrices.

METHODS

We used both commercial and patient-derived primary and metastatic oral tongue squamous cell carcinoma (OTSCC) cell lines. We characterized the functional differences of these cells using three different matrices (human uterine leiomyoma-derived Myogel, human pre-metastatic neck lymph node-derived Lymphogel (h-LG), porcine normal neck lymph node-derived Lymphogel (p-LG) in proliferation, adhesion, migration and invasion assays. We also performed proteomic analyses to compare the different matrices in relation to their functional properties.

RESULTS

OTSCC cells exhibited different adhesion and invasion patterns depending on the matrix. Metastatic cell lines showed improved ability to adhere to h-LG, but the effects of the matrices on cell invasion fluctuated non-significantly between the cell lines. Proteomic analyses showed that the protein composition between matrices was highly variable; Myogel contained 618, p-LG 1823 and h-LG 1520 different proteins. The comparison of all three matrices revealed only 120 common proteins. Analysis of cellular pathways and processes associated with proteomes of each matrix revealed similarities of Myogel with h-LG but less with p-LG. Similarly, p-LG contained the least adhesion-related proteins compared with Myogel and h-LG. The highest number of unique adhesion-related proteins was present in h-LG.

CONCLUSIONS

We demonstrated that human pre-metastatic neck lymph node-derived matrix is suitable for studying metastatic OTSCC cells. As a whole-protein extract, h-LG provides new opportunities for in vitro carcinoma cell culture experiments.

GATA2 co-opts TGFβ1/SMAD4 oncogenic signaling and inherited variants at 6q22 to modulate prostate cancer progression

BACKGROUND

Aberrant somatic genomic alteration including copy number amplification is a hallmark of cancer genomes. We previously profiled genomic landscapes of prostate cancer (PCa), yet the underlying causal genes with prognostic potential has not been defined. It remains unclear how a somatic genomic event cooperates with inherited germline variants contribute to cancer predisposition and progression.

METHODS

We applied integrated genomic and clinical data, experimental models and bioinformatic analysis to identify GATA2 as a highly prevalent metastasis-associated genomic amplification in PCa. Biological roles of GATA2 in PCa metastasis was determined in vitro and in vivo. Global chromatin co-occupancy and co-regulation of GATA2 and SMAD4 was investigated by coimmunoprecipitation, ChIP-seq and RNA-seq assays. Tumor cellular assays, qRT-PCR, western blot, ChIP, luciferase assays and CRISPR-Cas9 editing methods were performed to mechanistically understand the cooperation of GATA2 with SMAD4 in promoting TGFβ1 and AR signaling and mediating inherited PCa risk and progression.

RESULTS

In this study, by integrated genomics and experimental analysis, we identified GATA2 as a prevalent metastasis-associated genomic amplification to transcriptionally augment its own expression in PCa. Functional experiments demonstrated that GATA2 physically interacted and cooperated with SMAD4 for genome-wide chromatin co-occupancy and co-regulation of PCa genes and metastasis pathways like TGFβ signaling. Mechanistically, GATA2 was cooperative with SMAD4 to enhance TGFβ and AR signaling pathways, and activated the expression of TGFβ1 via directly binding to a distal enhancer of TGFβ1. Strinkingly, GATA2 and SMAD4 globally mediated inherited PCa risk and formed a transcriptional complex with HOXB13 at the PCa risk-associated rs339331/6q22 enhancer, leading to increased expression of the PCa susceptibility gene RFX6.

CONCLUSIONS

Our study prioritizes causal genomic amplification genes with prognostic values in PCa and reveals the pivotal roles of GATA2 in transcriptionally activating the expression of its own and TGFβ1, thereby co-opting to TGFβ1/SMAD4 signaling and RFX6 at 6q22 to modulate PCa predisposition and progression.

ePRO symptom follow-up of colorectal cancer patients receiving oxaliplatin-based adjuvant chemotherapy is feasible and enhances the quality of patient care: a prospective multicenter study

PURPOSE

Electronic (e) patient-reported outcomes (PROs) have been shown to improve the quality of life and survival in chemotherapy treated advanced cancer patients. We hypothesized that multidimensional ePRO centered approach could improve symptom management, streamline patient flow, and optimize the use of healthcare resources.

METHODS

In this multicenter trial (NCT04081558), colorectal cancer (CRC) patients receiving oxaliplatin-based chemotherapy as adjuvant or in the first- or second-line setting in advanced disease were included in the prospective ePRO cohort, while a comparative retrospective cohort was collected from the same institutes. The investigated tool consisted of a weekly e-symptom questionnaire integrated to an urgency algorithm and laboratory value interface, which generated semi-automated decision support for chemotherapy cycle prescription and individualized symptom management.

RESULTS

Recruitment to the ePRO cohort occurred 1/2019-1/2021 (n = 43). The comparator group (n = 194) consisted of patients treated in the same institutes 1-7/2017. The analysis was limited to adjuvant treated (n = 36 and n = 35). The feasibility of the ePRO follow-up was good with 98% reporting easy usage and 86% improved care, while health care personnel valued the easy use and logical workflow. In the ePRO cohort, 42% needed a phone call before planned chemotherapy cycles, while this was 100% in the retrospective cohort (p = 1.4e-8). Peripheral sensory neuropathy was detected significantly earlier with ePRO followed (p = 1e-5) but did not translate to earlier dose reduction, delays, or unplanned therapy termination compared to the retrospective cohort.

CONCLUSION

The results suggest that the investigated approach is feasible and streamlines workflow. Earlier symptom detection may improve the quality in cancer care.

Evaluating the role of CHEK2 p.(Asp438Tyr) allele in inherited breast cancer predisposition

CHEK2 is a well-established breast cancer susceptibility gene. The most frequent pathogenic CHEK2 variant is 1100delC, a loss-of-function mutation conferring 2-fold risk for breast cancer. This gene also harbors other rare variants encountered in the clinical gene panels for hereditary cancer. One of these is CHEK2 c.1312 G > T, p.(Asp438Tyr) in the kinase domain of the protein, but due to its rarity its clinical significance for breast cancer predisposition has remained unclear. Here, we tested the prevalence of CHEK2 p.(Asp438Tyr) allele showing enrichment in the Northern Finnish population, in a total of 2284 breast cancer patients from this geographical region. Genotyping was performed for DNA samples extracted from peripheral blood using high-resolution melt analysis. Fourteen CHEK2 p.(Asp438Tyr) carriers were identified (14/2284, 0.6%, P = 0.67): two in the cohort of breast cancer cases with the indication of inherited disease susceptibility (2/281, 0.7%, P = 1.00) and twelve in the breast cancer cohort unselected for the family history of disease and age at disease onset (12/2003, 0.6%, P = 0.66). This frequency did not differ from the frequency in the general population (10/1299, 0.8%). No CHEK2 p.(Asp438Tyr) homozygotes were identified. Our results indicate that CHEK2 p.(Asp438Tyr) carriers do not have an increased risk for breast cancer and the classification of the CHEK2 p.(Asp438Tyr) variant can be changed from the variant of uncertain significance (VUS) to likely benign for breast cancer.

Inflammation and Neutrophil Oxidative Burst in a Family with NFKB1 p.R157X LOF and Sterile Necrotizing Fasciitis

Loss-of-function (LOF) mutations in NFKB1, coding for p105, may cause common variable immunodeficiency due to dysregulation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κΒ) pathway. Monoallelic LOF variants of NFKB1 can predispose to uncontrolled inflammation including sterile necrotizing fasciitis or pyoderma gangrenosum. In this study, we explored the impact of a heterozygous NFKB1 c.C936T/p.R157X LOF variant on immunity in sterile fasciitis patients and their family members. The p50 or p105 protein levels were reduced in all variant carriers. Interleukin-1β (IL-1β) and interleukin-8 (IL-8) levels were elevated in vitro, potentially contributing to the very high neutrophil counts observed during fasciitis episodes. Phosphorylation of p65/RelA was reduced in p.R157X neutrophils suggesting defective activation of canonical NF-κB. Oxidative burst after NF-κB-independent phorbol 12-myristate 13-acetate (PMA) stimulation was similar in both p.R157X and control neutrophils. Comparable amounts of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex subunits were found in p.R157X and control neutrophils. However, a compromised oxidative burst was observed in p.R157X neutrophils following activation of NF-κB-dependent mechanisms following stimulation of toll-like receptor 2 (TLR2) and Dectin-1. Neutrophil extracellular trap formation was not affected by p.R157X. In summary, the NFKB1 c.C936T/p.R157X LOF variant has an impact on inflammation and neutrophil function and may play a role in the pathogenesis of sterile necrotizing fasciitis.

Educational Participatory Design in the Crossroads of Histories and Practices - Aiming for Digital Transformation in Language Pedagogy

Some level of digital technology design skills and competencies is important in any profession but in their education and work life this is often ignored. We explore the potential of Educational Participatory Design (EPD) in transforming work practices within diverse disciplines. This is done through a transdisciplinary case where EPD was used as an approach for transforming language teacher education seen to respond too slowly to technological advancements in society and work life. Based on our findings, we propose EPD as a useful approach for building the design agency of future professionals with various disciplinary and professional backgrounds. In the context of real-life work practice with students as future workers, EPD invites them to act as 'designers' envisioning novel practices and technologies for their own work, engaging their 'users' in the PD processes. EPD as a novel methodological approach integrates design with work practice learning and education and therefore, we suggest, belongs to the core expertise of CSCW research and design interested in the digital transformation of work practices.

Extensor carpi ulnaris tendon pathology and ulnar styloid bone marrow edema as diagnostic markers of peripheral triangular fibrocartilage complex tears on wrist MRI: a case-control study

OBJECTIVES

To evaluate extensor carpi ulnaris (ECU) tendon pathology and ulnar styloid process bone marrow edema (BME) as diagnostic MRI markers for peripheral triangular fibrocartilage complex (TFCC) tears.

METHODS

One hundred thirty-three patients (age range 21-75, 68 females) with wrist 1.5-T MRI and arthroscopy were included in this retrospective case-control study. The presence of TFCC tears (no tear, central perforation, or peripheral tear), ECU pathology (tenosynovitis, tendinosis, tear or subluxation), and BME at the ulnar styloid process were determined on MRI and correlated with arthroscopy. Cross-tabulation with chi-square tests, binary logistic regression with odds ratios (OR), and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were used to describe diagnostic efficacy.

RESULTS

On arthroscopy, 46 cases with no TFCC tear, 34 cases with central perforations, and 53 cases with peripheral TFCC tears were identified. ECU pathology was seen in 19.6% (9/46) of patients with no TFCC tears, in 11.8% (4/34) with central perforations and in 84.9% (45/53) with peripheral TFCC tears (p < 0.001); the respective numbers for BME were 21.7% (10/46), 23.5% (8/34), and 88.7% (47/53) (p < 0.001). Binary regression analysis showed additional value from ECU pathology and BME in predicting peripheral TFCC tears. The combined approach with direct MRI evaluation and both ECU pathology and BME yielded a 100% positive predictive value for peripheral TFCC tear as compared to 89% with direct evaluation alone.

CONCLUSIONS

ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to diagnose tears.

KEY POINTS

• ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to confirm the presence of TFCC tears. • If there is a peripheral TFCC tear on direct MRI evaluation and in addition both ECU pathology and BME on MRI, the positive predictive value is 100% that there will be a tear on arthroscopy compared to 89% with direct evaluation alone. • If there is no peripheral TFCC tear on direct evaluation and neither ECU pathology nor BME on MRI, the negative predictive value is 98% that there will be no tear on arthroscopy compared to 94% with direct evaluation alone.

Modeling non-linear changes in an urban setting: From pro-environmental affordances to responses in behavior, emissions and air quality

Interactions in urban environment were investigated using a multidisciplinary model combination, with focus on traffic, emissions and atmospheric particles. An agent-based model was applied to simulate the evolution of unsustainable human behavior (usage of combustion-based personal vehicles) as a function of pro-environmental affordances (opportunities for sustainable choices). Scenarios regarding changes in multi-pollutant emissions were derived, and the non-linear implications to atmospheric particles were simulated with a box model. Based on the results for a Nordic city, increasing pro-environmental affordances by 10%, 50% or 100% leads to emission reductions of 15%, 30% and 40% within 2 years. To reduce ambient particle mass, emissions from traffic should decrease by > 15%, while the lung deposited surface area decreases in all scenarios ([Formula: see text], [Formula: see text] and [Formula: see text], correspondingly). The presented case is representative of one season, but the approach is generic and applicable to simulating a full year, given meteorological and pollution data that reflects seasonal variation. This work emphasizes the necessity to consider feedback mechanisms and non-linearities in both human behavior and atmospheric processes, when predicting the outcomes of changes in an urban system.

Predisposing factors for a second fragile hip fracture in a population of 1130 patients with hip fractures, treated at Oulu University Hospital in 2013-2016: a retrospective study

OBJECTIVE

The life-time risk of a second fragile hip fracture is 8.4%, but the risk factors that predispose to a second hip fracture remain unresolved. This study aimed to define risk factors that predisposed patients to a second hip fracture.

METHODS

For this retrospective study, we retrieved clinical data on 1130 patients with fragile hip fractures (67.2% female, mean age: 79.3 years) that underwent surgery at the Oulu University Hospital in 2013-2016. These data included the fracture risk assessment score (measured with the FRAX tool), the bone-mass T-score, laboratory values, ambulatory capacity, and the time of death.

RESULTS

In this population, 12.4% of patients sustained a second hip fracture. The predisposing factors for a second hip fracture were: female (p = 0.016), a high FRAX score (p = 0.020), and low physical capacity (p < 0.001). The vitamin D level recommended for treating osteoporosis (i.e., vitamin D > 75 nmol/l) was observed in only 24% of patients, and 42% of patients had ionized calcium levels below the reference range. According to the level of the cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), 37% of patients did not have high bone turnover. We found a positive correlation between age and ICTP (p = 0.001). The risk of death was higher after the second hip fracture (p = 0.005), but we found no difference in age between patients with first and second hip fractures (p = 0.11).

CONCLUSION

After a hip fracture, a second hip fracture is a well-known risk. Nevertheless, we found that only one-third of patients with a second hip fracture had used anti-osteoporosis medication at any time previously. These findings suggested that second hip fractures were most likely to occur in patients with osteopenic T-score values, in women more often than men, and in patients with high FRAX scores and low ambulatory capacity.

A prognostic score based on B cell and plasma cell densities compared to T cell densities in colorectal cancer

PURPOSE

The purpose of this study was to compare a B cell/plasma cell-based scoring system to T cell score and evaluate their prognostic value in colorectal cancer.

METHODS

We used immunohistochemistry to analyze the expression of CD20, CD138, CD3, and CD8 in 221 colorectal cancer patients. CD20+ B cell and CD138+ plasma cell densities in the tumor center and invasive margin were calculated and converted into a B cell/plasma cell score. T cell score was defined similarly, using CD3+ and CD8+ T cell densities. Their associations with tumor and patient characteristics and survival were analyzed.

RESULTS

Kaplan-Meier analysis showed a high B cell/plasma cell score was associated with a tendency towards longer survival (p = 0.089), but no statistically significant association was found. High T cell score associated with longer cancer-specific survival in Kaplan-Meier analysis and multivariable Cox regression analysis (p < 0.001). Additionally, high T cell score associated with lower disease stage (p < 0.001) and lesser lymphovascular invasion (p = 0.020).

CONCLUSIONS

High T cell score is associated with longer survival and clinicopathological factors typical to less aggressive tumors. This study did not support the additional prognostic value of B cell/plasma cell quantification.

Removal of antimony from model solutions, mine effluent, and textile industry wastewater with Mg-rich mineral adsorbents

Naturally occurring layered double hydroxide mineral, brucite (BRU), was compared with hydromagnesite (HYD) and a commercial Mg-rich mineral adsorbent (trade name AQM PalPower M10) to remove antimony (Sb) from synthetic and real wastewaters. The BRU and HYD samples were calcined prior to the experiments. The adsorbents were characterized using X-ray diffraction, X-ray fluorescence, and Fourier transform infrared spectroscopy. Batch adsorption experiments were performed to evaluate the effect of initial pH, Sb concentration, adsorbent dosage, and contact time on Sb removal from synthetic wastewater, mine effluent, and textile industry wastewater. Several isotherm models were applied to describe the experimental results. The Sips model provided the best correlation for the BRU and M10. As for the HYD, three models (Langmuir, Sips, and Redlich-Peterson) fit well to the experimental results. The results showed that the adsorption process in all cases followed the pseudo-second-order kinetics. Overall, the most efficient adsorbent was the BRU, which demonstrated slightly higher experimental maximum adsorption capacity (27.6 mg g-1) than the HYD (27.0 mg g-1) or M10 (21.3 mg g-1) in the batch experiments. Furthermore, the BRU demonstrated also an efficient performance in the continuous removal of Sb from mine effluent in the column mode. Regeneration of adsorbents was found to be more effective under acidic conditions than under alkaline conditions.

The association between dental caries and physical activity, physical fitness, and background factors among Finnish male conscripts

Studies on measured physical fitness and oral health are sparse. The aim of this study was to investigate the associations between self-reported physical activity and measured physical fitness and oral health of young men. The study population consisted of 13,564 Finnish male conscripts who had mandatory clinical oral examinations and physical fitness tests at the beginning of military service in 2011. Finally, around 10,800 conscripts had physical fitness test outcomes available and a total of 8552 conscripts answered a computer-based questionnaire on background factors. Decayed Tooth (DT) and Decayed, Missing, or Filled Tooth (DMFT) indices, outcomes of surveys and fitness tests were used in analyses by cross-tabulation and multivariable logistic regression model (odds ratios [OR] with 95% confidence interval [CI]) were calculated. Regularly exercising conscripts had a reduced need for dental restorative treatment than those reporting no physical activity (p < 0.0001). The proportion of participants with sound dentition (DT = 0) increased steadily with increasing physical activity (39.0-59.4%). Good measured physical fitness was a protective factor against increased dental restorative treatment need. A low prevalence of smoking and low use of alcohol and energy drinks were associated with frequent exercise, whereas consumption of sport drinks and snuff use were common among those who exercised frequently. Good measured physical fitness and self-reported physical activity are associated with reduced caries burden. There is a need for information about the harms of tobacco products and the benefits of a healthy diet, even for the increased energy needs of the physically active.

The osteometric identification of castrated reindeer (Rangifer tarandus) and the significance of castration in tracing human-animal relationships in the North

Reindeer are the only domestic cervid and have formed the cosmologies and practical daily lives of numerous peoples in the Northern Hemisphere for thousands of years. The questions of when, how, and where reindeer domestication originated and how it developed remain one of the scientific enigmas of our time. The practice of reindeer castration is an essential feature of all communities practicing reindeer herding today. It has probably been one of the most important interventions in the reindeer's life cycle and biology that marked the start of domesticating human-reindeer relationships long ago. Castration is and has been essential for reindeer taming, control, training, herd management, and ritual practices. Unsuitably, to this present day, there are no methods zooarchaeologists can employ to distinguish a reindeer gelding from a reindeer bull in the archaeological record. In this current paper, we outline a new method that presents the possibility of differentiating between full males, castrated males, and females based on osteometric features. We measured the leg bones and pelvis of the complete or partial skeletons of 97 adult modern domestic reindeer individuals to determine the precise effects castration has on skeletal size and morphology. We explored our osteometric dataset with different statistical methods. We found a clear separation of the two male groups in the radioulna, humerus, and femur but in the tibia and metapodials to a lesser extent. Osteometric depth and width were generally more affected than the longitudinal axis. Females were easily distinguishable from castrates and full males based on nearly every bone measurement. Our analysis shows that reindeer castration can be proven through osteometric analysis.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12520-022-01696-y.

"Leave your smartphone out of bed": quantitative analysis of smartphone use effect on sleep quality

Smartphones have become an integral part of people's everyday lives. Smartphones are used across all household locations, including in the bed at night. Smartphone screens and other displays emit blue light, and exposure to blue light can affect one's sleep quality. Thus, smartphone use prior to bedtime could disrupt the quality of one's sleep, but research lacks quantitative studies on how smartphone use can influence sleep. This study combines smartphone application use data from 75 participants with sleep data collected by a wearable ring. On average, the participants used their smartphones in bed for 322.8 s (5 min and 22.8 s), with an IQR of 43.7-456. Participants spent an average of 42% of their time in bed using their smartphones (IQR of 5.87-55.5%). Our findings indicate that smartphone use in bed has significant adverse effects on sleep latency, awake time, average heart rate, and HR variability. We also find that smartphone use does not decrease sleep quality when used outside of bed. Our results indicate that intense smartphone use alone does not negatively affect well-being. Since all smartphone users do not use their phones in the same way, extending the investigation to different smartphone use types might yield more information than general smartphone use. In conclusion, this paper presents the first investigation of the association between smartphone application use logs and detailed sleep metrics. Our work also validates previous research results and highlights emerging future work.

Ethical principles for artificial intelligence in education

The advancement of artificial intelligence in education (AIED) has the potential to transform the educational landscape and influence the role of all involved stakeholders. In recent years, the applications of AIED have been gradually adopted to progress our understanding of students' learning and enhance learning performance and experience. However, the adoption of AIED has led to increasing ethical risks and concerns regarding several aspects such as personal data and learner autonomy. Despite the recent announcement of guidelines for ethical and trustworthy AIED, the debate revolves around the key principles underpinning ethical AIED. This paper aims to explore whether there is a global consensus on ethical AIED by mapping and analyzing international organizations' current policies and guidelines. In this paper, we first introduce the opportunities offered by AI in education and potential ethical issues. Then, thematic analysis was conducted to conceptualize and establish a set of ethical principles by examining and synthesizing relevant ethical policies and guidelines for AIED. We discuss each principle and associated implications for relevant educational stakeholders, including students, teachers, technology developers, policymakers, and institutional decision-makers. The proposed set of ethical principles is expected to serve as a framework to inform and guide educational stakeholders in the development and deployment of ethical and trustworthy AIED as well as catalyze future development of related impact studies in the field.

Automatic captioning for medical imaging (MIC): a rapid review of literature

Automatically understanding the content of medical images and delivering accurate descriptions is an emerging field of artificial intelligence that combines skills in both computer vision and natural language processing fields. Medical image captioning is involved in various applications related to diagnosis, treatment, report generation and computer-aided diagnosis to facilitate the decision making and clinical workflows. Unlike generic image captioning, medical image captioning highlights the relationships between image objects and clinical findings, which makes it a very challenging task. Although few review papers have already been published in this field, their coverage is still quite limited and only particular problems are addressed. This motivates the current paper where a rapid review protocol was adopted to review the latest achievements in automatic medical image captioning from the medical domain perspective. We aim through this review to provide the reader with an up-to-date literature in this field by summarizing the key findings and approaches in this field, including the related datasets, applications and limitations as well as highlighting the main competitions, challenges and future directions.

Activation of the hypoxia response protects mice from amyloid-β accumulation

Alzheimer's disease (AD) is the most common cause of dementia with limited treatment options affecting millions of people and the prevalence increasing with the aging population. The current knowledge on the role of the hypoxia/hypoxia-inducible factor (HIF) in the AD pathology is restricted and controversial. We hypothesized based on benefits of the genetic long-term inactivation of HIF prolyl 4-hydroxylase-2 (HIF-P4H-2) on metabolism, vasculature and inflammatory response that prolonged moderate activation of the hypoxia response could hinder AD pathology. We used an aging model to study potential spontaneous accumulation of amyloid-β (Aβ) in HIF-P4H-2-deficient mice and a transgenic APP/PSEN1 mouse model subjected to prolonged sustained environmental hypoxia (15% O2 for 6 weeks) at two different time points of the disease; at age of 4 and 10 months. In both settings, activation of the hypoxia response reduced brain protein aggregate levels and this associated with higher vascularity. In the senescent HIF-P4H-2-deficient mice metabolic reprogramming also contributed to less protein aggregates while in APP/PSEN1 mice lesser Aβ associated additionally with hypoxia-mediated favorable responses to neuroinflammation and amyloid precursor protein processing. In conclusion, continuous, non-full-scale activation of the HIF pathway appears to mediate protection against neurodegeneration via several mechanisms and should be studied as a treatment option for AD.

Human myelin proteolipid protein structure and lipid bilayer stacking

The myelin sheath is an essential, multilayered membrane structure that insulates axons, enabling the rapid transmission of nerve impulses. The tetraspan myelin proteolipid protein (PLP) is the most abundant protein of compact myelin in the central nervous system (CNS). The integral membrane protein PLP adheres myelin membranes together and enhances the compaction of myelin, having a fundamental role in myelin stability and axonal support. PLP is linked to severe CNS neuropathies, including inherited Pelizaeus-Merzbacher disease and spastic paraplegia type 2, as well as multiple sclerosis. Nevertheless, the structure, lipid interaction properties, and membrane organization mechanisms of PLP have remained unidentified. We expressed, purified, and structurally characterized human PLP and its shorter isoform DM20. Synchrotron radiation circular dichroism spectroscopy and small-angle X-ray and neutron scattering revealed a dimeric, α-helical conformation for both PLP and DM20 in detergent complexes, and pinpoint structural variations between the isoforms and their influence on protein function. In phosphatidylcholine membranes, reconstituted PLP and DM20 spontaneously induced formation of multilamellar myelin-like membrane assemblies. Cholesterol and sphingomyelin enhanced the membrane organization but were not crucial for membrane stacking. Electron cryomicroscopy, atomic force microscopy, and X-ray diffraction experiments for membrane-embedded PLP/DM20 illustrated effective membrane stacking and ordered organization of membrane assemblies with a repeat distance in line with CNS myelin. Our results shed light on the 3D structure of myelin PLP and DM20, their structure-function differences, as well as fundamental protein-lipid interplay in CNS compact myelin.

Designing learning technology collaboratively: Analysis of a chatbot co-design

Collaborative design approaches have been increasingly adopted in the design of learning technologies since they contribute to develop pedagogically inclusive and appropriate learning designs. Despite the positive reception of collaborative design strategies in technology-enhanced learning, little attention has been dedicated to analyzing the challenges faced in design processes using a collaborative approach. In this paper, we disclose the collaborative design of a chatbot for self-regulated learning in higher education using an action research approach. We analyze the design process of EDUguia chatbot, which includes diverse evidence from questionnaires and workshops with students and lecturers, as well as intermediary design objects. Based on the qualitative analysis, we identify several challenges that are transversal to the co-design work, as well as specific to the design phases. We critically reflect on the strategies deployed to overcome these challenges and how they relate to decision-making processes, highlighting the need to make stakeholders' tacit knowledge explicit, cultivate trust-building and support democratic decision-making in technology design processes. We believe that the recommendations we present in this paper contribute to developing best practices in the collaborative design of chatbots for the self-regulation of learning, as well as learning technology in general.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10639-022-11162-w.

Attention-based hybrid CNN-LSTM and spectral data augmentation for COVID-19 diagnosis from cough sound

COVID-19 pandemic has fueled the interest in artificial intelligence tools for quick diagnosis to limit virus spreading. Over 60% of people who are infected complain of a dry cough. Cough and other respiratory sounds were used to build diagnosis models in much recent research. We propose in this work, an augmentation pipeline which is applied on the pre-filtered data and uses i) pitch-shifting technique to augment the raw signal and, ii) spectral data augmentation technique SpecAugment to augment the computed mel-spectrograms. A deep learning based architecture that hybridizes convolution neural networks and long-short term memory with an attention mechanism is proposed for building the classification model. The feasibility of the proposed is demonstrated through a set of testing scenarios using the large-scale COUGHVID cough dataset and through a comparison with three baselines models. We have shown that our classification model achieved 91.13% of testing accuracy, 90.93% of sensitivity and an area under the curve of receiver operating characteristic of 91.13%.

Detecting hip osteoarthritis on clinical CT: a deep learning application based on 2-D summation images derived from CT

We developed and compared deep learning models to detect hip osteoarthritis on clinical CT. The CT-based summation images, CT-AP, that resemble X-ray radiographs can detect radiographic hip osteoarthritis and in the absence of large training data, a reliable deep learning model can be optimized by combining CT-AP and X-ray images.

INTRODUCTION

In this study, we aimed to investigate the applicability of deep learning (DL) to assess radiographic hip osteoarthritis (rHOA) on computed tomography (CT).

METHODS

The study data consisted of 94 abdominopelvic clinical CTs and 5659 hip X-ray images collected from Cohort Hip and Cohort Knee (CHECK). The CT slices were sequentially summed to create radiograph-like 2-D images named CT-AP. X-ray and CT-AP images were classified as rHOA if they had osteoarthritic changes corresponding to Kellgren-Lawrence grade 2 or higher. The study data was split into 55% training, 30% validation, and 15% test sets. A pretrained ResNet18 was optimized for a classification task of rHOA vs. no-rHOA. Five models were trained using (1) X-rays, (2) downsampled X-rays, (3) combination of CT-AP and X-ray images, (4) combination of CT-AP and downsampled X-ray images, and (5) CT-AP images.

RESULTS

Amongst the five models, Model-3 and Model-5 performed best in detecting rHOA from the CT-AP images. Model-3 detected rHOA on the test set of CT-AP images with a balanced accuracy of 82.2% and was able to discriminate rHOA from no-rHOA with an area under the receiver operating characteristic curve (ROC AUC) of 0.93 [0.75-0.99]. Model-5 detected rHOA on the test set at a balanced accuracy of 82.2% and classified rHOA from no-rHOA with an ROC AUC of 0.89 [0.67-0.97].

CONCLUSION

CT-based summation images that resemble radiographs can be used to detect rHOA. In addition, in the absence of large training data, a reliable DL model can be optimized by combining CT-AP and X-ray images.

Childhood chronic condition and subsequent self-reported internalizing and externalizing problems in adolescence: a birth cohort study

Chronic conditions are common in childhood. We investigated the associations of childhood chronic conditions reported by parents with subsequent self-reported internalizing and externalizing problems in adolescence. A sample of 6290 children (3142 boys and 3148 girls) with data on chronic condition reported by parents both at 7 and at 16 years of age was obtained from the Northern Finland Birth Cohort 1986 (NFBC 1986), which is a longitudinal 1-year birth cohort (n = 9432) from an unselected, regionally defined population. Internalizing and externalizing problems were measured at 8 years of age with Rutter Children's Behavioral Questionnaire by teachers and at 16 years of age with Youth Self-Report by adolescents. When studying the effects of history of chronic conditions on these problems at 16 years of age, childhood internalizing and externalizing problems and social relations were adjusted. A history of chronic condition predicted subsequent somatic complaints among all adolescents. Early-onset chronic conditions were related to subsequent externalizing (OR 1.35; 1.02-1.79) and attention problems (OR 1.33; 1.01-1.75) and later onset of chronic conditions with internalizing (OR 1.49; 1.22-1.82) and thought problems (OR 1.50; 1.18-1.92). The effect was specific for sex and the type of chronic condition.

CONCLUSION

Childhood chronic conditions predicted internalizing and externalizing problems in adolescence. To prevent poor mental health trajectories, children with chronic conditions during their growth to adolescence need early support and long-term monitoring.

WHAT IS KNOWN

• Childhood adversities increase the risk of mental disorders. • Internalizing and externalizing problems have been suggested for measuring childhood and adolescent psychopathologies.

WHAT IS NEW

• Having a chronic condition (CC) before the age of 7 or later but before the age of 16 had different outcomes in adolescence. The early onset predicted externalizing problems, whereas the late onset predicted internalizing problems and thought problems in adolescence. The risk of somatic complaints was increased regardless of CC onset time. These findings can reflect more restricted ability to mental processing in the younger children.

Abusive head trauma in small children - a single-centre experience in Finland

Shaken baby syndrome (SBS) is a challenging condition from both a medical and legal perspective. The path of the patients differs significantly from those with noninflicted traumas. While treating these cases, it is essential that all history, information and treatment are comprehensively documented. This article describes the investigations and interventions necessary as soon as SBS is suspected. The Oulu University Hospital protocol for suspected child abuse is described. Authors also give an overview of the SBS path in Finland from the police and prosecution's point of view.

Survival trends in gastric cancer patients between 1987 and 2016: a population-based cohort study in Finland

BACKGROUND

Gastric cancer is the fourth leading cause of cancer-related deaths globally. There is a paucity of national studies examining gastric cancer mortality in relation to treatment status. This study evaluated the survival trends in gastric adenocarcinoma and all gastric cancers stratified by treatment in Finland during 1987-2016.

METHODS

This population-based, nationwide, retrospective cohort study included all gastric cancer patients registered in the Finnish Cancer Registry and Patient Registry. The survival rates were calculated for 1, 3, and 5 years, stratified by treatment. Prognostic factors were determined using Cox regression.

RESULTS

A total of 18,713 non-cardia gastric adenocarcinoma, and 3617 cardia adenocarcinoma patients were included. Surgical treatment decreased for non-cardia adenocarcinoma and remained constant for cardia adenocarcinoma. In non-cardia adenocarcinoma, the 5-year survival declined from 17% to 16% from 1987-1991 to 2012-2016. In surgically treated patients, survival increased from 29% to 38%, while an increase from 4% to 7% in those undergoing chemotherapy and decrease from 6% to 3% in those not receiving any treatment were observed. In cardia adenocarcinoma, the 5-year survival increased from 10% to 18% in all patients, 16% to 40% in surgical patients, 0% to 5% in patients receiving chemotherapy, and from 5% to 9% in patients receiving no treatment. Earlier calendar periods, older age, male sex, and higher comorbidity were risk factors for poor prognosis.

CONCLUSIONS

Gastric non-cardia adenocarcinoma survival declined, limited to advanced stage patients not receiving any treatment. Gastric cardia cancer survival seems to have improved over time in Finland. This study evaluated survival trends of gastric cancer in Finland during 1987-2016 and established that the 5-year survival is declining in non-cardia adenocarcinoma but improving in all gastric cancers.

How personality affects reaction. A mental health behavioral insight review during the Pandemic

The fear caused by the Covid-19 pandemic is changing our psychology and behavior. This ongoing negative event, imposing restrictions such as home isolation and social distancing, can result in heightened anxiety, depression and a sense of loneliness, with immediate effects on mental health. This study investigates adolescents’ reaction to the pandemic, by analyzing the behavioral mental health trends of depression, anxiety and sense of loneliness, in relation to personality traits. After controlling for demographics and family background, our results reveal strong relationships between several personality traits and psychological health indicators, during the pandemic in Greece. A total of 419 secondary school students (aged 12–18) were administered the State-Trait Anxiety Inventory for Children (STAIC), the Child Depression Inventory (CDI), the Big Five Inventory for measuring personality (BFI) and the Children’s Loneliness Questionnaire (CLS) during two time periods within pandemic. Overall, it appears that depression increased significantly in line with the escalation of the pandemic, while anxiety decreased, with the strongest predictors being the personality variables of extraversion, neuroticism and openness. Surprisingly, the study also revealed that the level of extraversion has a positive effect on changes in anxiety, while a negative one on changes in depression. On the other hand, neuroticism and openness seem to negatively correlate with anxiety changes and positively with depression changes. These findings highlight the importance of considering these variables in addressing individuals’ mental health behavior during the Covid-19 pandemic and elucidate the literature by offering a deeper understanding of the strong relationship between personality, depression and anxiety.

A White Paper on Collagen Hydrolyzates and Ultrahydrolyzates: Potential Supplements to Support Joint Health in Osteoarthritis?

PURPOSE OF REVIEW

Osteoarthritis (OA) is the most common forms of arthritis in the general population, accounting for more pain and functional disability than any other musculoskeletal disease. There are currently no approved disease modifying drugs for OA. In the absence of effective pharmacotherapy, many patients with OA turn to nutritional supplements and nutraceuticals, including collagen derivatives. Collagen hydrolyzates and ultrahydrolyzates are terms used to describe collagens that have been broken down into small peptides and amino acids in the presence of collagenases and high pressure.

RECENT FINDINGS

This article reviews the relevant literature and serves as a White Paper on collagen hydrolyzates and ultrahydrolyzates as emerging supplements often advertised to support joint health in OA. Collagen hydrolyzates have demonstrated some evidence of efficacy in a handful of small scale clinical trials, but their ability to treat and reverse advanced joint disease remains highly speculative, as is the case for other nutritional supplements. The aim of this White Paper is to stimulate research and development of collagen-based supplements for patients with OA and other musculoskeletal diseases at academic and industrial levels. This White Paper does not make any treatment recommendations for OA patients in the clinical context, but simply aims to highlight opportunities for scientific innovation and interdisciplinary collaboration, which are crucial for the development of novel products and nutritional interventions based on the best available and published evidence.

Decline in Mast Cell Density During Diffuse Alveolar Damage in Idiopathic Pulmonary Fibrosis

Mast cells (MCs) are known to be involved in the pathogenesis of idiopathic pulmonary fibrosis (IPF), although their role in acute exacerbations of IPF has not been investigated. The aims of the study were to evaluate the numbers of MCs in fibrotic and non-fibrotic areas of lung tissue specimens of idiopathic pulmonary fibrosis (IPF) patients with or without an acute exacerbation of IPF, and to correlate the MC density with clinical parameters. MCs of IPF patients were quantified from surgical lung biopsy (SLB) specimens (n = 47) and lung tissue specimens taken at autopsy (n = 7). MC density was higher in the fibrotic areas of lung tissue compared with spared alveolar areas or in controls. Female gender, low diffusion capacity for carbon monoxide, diffuse alveolar damage, and smoking were associated with a low MC density. MC densities of fibrotic areas had declined significantly in five subjects in whom both SLB in the stable phase and autopsy after an acute exacerbation of IPF had been performed. There were no correlations of MC densities with survival time or future acute exacerbations. The MC density in fibrotic areas was associated with several clinical parameters. An acute exacerbation of IPF was associated with a significant decline in MC counts. Further investigations will be needed to clarify the role of these cells in IPF and in the pathogenesis of acute exacerbation as this may help to identify some potential targets for medical treatment for this serious disease.

Discourses in Subjective Experience on Rehabilitation

In Finland, youth workshops support participants’ everyday management, social empowerment and employability skills, facilitating their access to education and work. In this study, we analysed conversations with ten participants about their experiences in non-formal learning workshops in Northern Finland. We explore how participants described personal transformation borne by workshop participation and how the prevalent discourses on youth (un)employment manifest in participants’ reasons for action. In the analysis, we identified (1) how participants assessed their situations; (2) their thoughts, feelings and actions in relation to their situations; and (3) their grounds for these thoughts, feelings and actions. The societal dimension of subjective experience is articulated by identifying the prevalent societal discourses featured in participants’ descriptions. The analysis showed that participants described themselves as vulnerable prior to the intervention and motivated after the intervention. Participants experienced tailored support as being significant in fostering the change. Individual descriptions of how the learning and training conditions were experienced constitute valuable knowledge about the possible ways of acting and experiencing in relation to common structures. With the help of these descriptions, it would be valuable for researchers and participants to continue the conversation about the discourses to enhance the participants’ conscious participation in maintaining and changing their living conditions.

Teleguidance-based remote navigation assistance for visually impaired and blind people-usability and user experience

This paper reports the development of a specialized teleguidance-based navigation assistance system for the blind and the visually impaired. We present findings from a usability and user experience study conducted with 11 blind and visually impaired participants and a sighted caretaker. Participants sent live video feed of their field of view to the remote caretaker's terminal from a smartphone camera attached to their chest. The caretaker used this video feed to guide them through indoor and outdoor navigation scenarios using a combination of haptic and voice-based communication. Haptic feedback was provided through vibrating actuators installed in the grip of a Smart Cane. Two haptic methods for directional guidance were tested: (1) two vibrating actuators to guide left and right movement and (2) a single vibrating actuator with differentiating vibration patterns for the same purpose. Users feedback was collected using a meCUE 2.0 standardized questionnaire, interviews, and group discussions. Participants' perceptions toward the proposed navigation assistance system were positive. Blind participants preferred vibrational guidance with two actuators, while partially blind participants preferred the single actuator method. Familiarity with cane use and age were important factors in the choice of haptic methods by both blind and partially blind users. It was found that smartphone camera provided sufficient field of view for remote assistance; position and angle are nonetheless important considerations. Ultimately, more research is needed to confirm our preliminary findings. We also present an expanded evaluation model developed to carry out further research on assistive systems.

Adolescence Predictors for Drug Crime Offending: A Follow-up Study of Former Adolescent Psychiatric Inpatients

Our aim was to examine adolescent predictors (family- and school-related factors, substance use, and psychiatric disorders) for drug crime offending. The initial study population consisted of 508 former adolescent psychiatric inpatients aged between 13 and 17 years. Of them, 60 (12%) had committed a drug crime by young adulthood and they were matched with 120 (24%) non-criminal controls by sex, age and family type. During adolescent hospitalization, study participants were interviewed using valid semi-structured research instruments. Criminal records were obtained from the Finnish Legal Register Centre up to young adulthood. A distant relationship with a father, lying, and thieving, moderate/high nicotine dependence and weekly use of stimulants were shown to be the most prominent predictors for drug crime offending. Our findings encourage the use of modern child- and family-centered approaches in preventing youth involvement in illegal drug use and drug crimes.

Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve

OBJECTIVES

To compare the outcomes after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) for severe stenosis of bicuspid aortic valve (BAV).

METHODS

We evaluated the early and mid-term outcome of patients with stenotic BAV who underwent SAVR or TAVR for aortic stenosis from the nationwide FinnValve registry.

RESULTS

The FinnValve registry included 6463 AS patients and 1023 (15.8%) of them had BAV. SAVR was performed in 920 patients and TAVR in 103 patients with BAV. In the overall series, device success after TAVR was comparable to SAVR (94.2% vs. 97.1%, p = 0.115). TAVR was associated with increased rate of mild-to-severe paravalvular regurgitation (PVR) (19.4% vs. 7.9%, p < 0.0001) and of moderate-to-severe PVR (2.9% vs. 0.7%, p = 0.053). When newer-generation TAVR devices were evaluated, mild-to-severe PVR (11.9% vs. 7.9%, p = 0.223) and moderate-to-severe PVR (0% vs. 0.7%, p = 1.000) were comparable to SAVR. Type 1 N-L and type 2 L-R/R-N were the BAV morphologies with higher incidence of mild-to-severe PVR (37.5% and 100%, adjusted for new-generation prostheses p = 0.025) compared to other types of BAVs. Among 75 propensity score-matched cohorts, 30-day mortality was 1.3% after TAVR and 5.3% after SAVR (p = 0.375), and 2-year mortality was 9.7% after TAVR and 18.7% after SAVR (p = 0.268) CONCLUSIONS: In patients with stenotic BAV, TAVR seems to achieve early and mid-term results comparable to SAVR. Type 1 N-L and type 2 L-R/R-N BAV morphologies had higher incidence of PVR. Larger studies evaluating different phenotypes of BAV are needed to confirm these findings.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03385915.

Paradoxical home temperatures during cold weather: a proof-of-concept study

There is substantial epidemiological evidence on the associations between cold weather and adverse health effects. Meteorological alarm systems are being developed globally, and generalized protective advice is given to the public based on outdoor exposure parameters. It is not clear how these shared outdoor exposure parameters relate to the individual-level thermal exposure indoors, where the majority of time is spent. We hypothesized a priori that there are opposite correlations between indoor and outdoor temperatures in residential apartments. Apartments were classified into 3 categories according to their response to declining outdoor temperature: under-controlled apartments cool down, controlled apartments maintain constant indoor temperature level, and over-controlled apartments warm up. Outdoor and indoor temperatures were measured in 30-min intervals in 417 residential apartments in 14 buildings in Kotka, Finland, between February and April 2018 with outdoor temperatures ranging from - 20.4 °C to + 14.0 °C. Different apartment types were present in all buildings. Floor and orientation did not explain the divergence. Indoor temperatures below the limit value + 20 °C by building code occurred in 26.2%, 7.9%, and 23.6% of the under-controlled, controlled, and over-controlled apartments, some in conjunction with increasing outdoor temperatures. Indoor temperatures above the limit + 25 °C occurred but were more rare. This proof-of-concept study demonstrates that while the home environment may be a source of thermal stress during cold weather, generalized advice for adjusting the heating may lead to paradoxical exposures in some cases. More elaborate conceptualizations of everyday thermal exposures are needed to safely reduce weather-related health risks using shared meteorological alarm systems.

Redo ventral rectopexy: is it worthwhile?

BACKGROUND

Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP).

METHODS

This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life.

RESULTS

A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation.

CONCLUSIONS

Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.

Nanotechnological Strategies for Osteoarthritis Diagnosis, Monitoring, Clinical Management, and Regenerative Medicine: Recent Advances and Future Opportunities

PURPOSE OF REVIEW

In this review article, we discuss the potential for employing nanotechnological strategies for the diagnosis, monitoring, and clinical management of osteoarthritis (OA) and explore how nanotechnology is being integrated rapidly into regenerative medicine for OA and related osteoarticular disorders.

RECENT FINDINGS

We review recent advances in this rapidly emerging field and discuss future opportunities for innovations in enhanced diagnosis, prognosis, and treatment of OA and other osteoarticular disorders, the smart delivery of drugs and biological agents, and the development of biomimetic regenerative platforms to support cell and gene therapies for arresting OA and promoting cartilage and bone repair. Nanotubes, magnetic nanoparticles, and other nanotechnology-based drug and gene delivery systems may be used for targeting molecular pathways and pathogenic mechanisms involved in OA development. Nanocomposites are also being explored as potential tools for promoting cartilage repair. Nanotechnology platforms may be combined with cell, gene, and biological therapies for the development of a new generation of future OA therapeutics. Graphical Abstract.

Steam activation of waste biomass: highly microporous carbon, optimization of bisphenol A, and diuron adsorption by response surface methodology

Highly microporous carbons were prepared from argan nut shell (ANS) using steam activation method. The carbons prepared (ANS@H2O-30, ANS@H2O-90, and ANS@H2O-120) were characterized using X-ray diffraction, scanning electron microscopy, Fourier-transform infrared, nitrogen adsorption, total X-ray fluorescence, and temperature-programmed desorption (TPD). The ANS@H2O-120 was found to have a high surface area of 2853 m2/g. The adsorption of bisphenol A and diuron on ANS@H2O-120 was investigated. The isotherm data were fitted using Langmuir and Freundlich models. Langmuir isotherm model presented the best fit to the experimental data suggesting micropore filling of ANS@H2O-120. The ANS@H2O-120 adsorbent demonstrated high monolayer adsorption capacity of 1408 and 1087 mg/g for bisphenol A and diuron, respectively. The efficiency of the adsorption was linked to the porous structure and to the availability of the surface adsorption sites on ANS@H2O-120. Response surface method was used to optimize the removal efficiency of bisphenol A and diuron on ANS@H2O-120 from aqueous solution. Graphical abstract ᅟ.