In-person home-based rehabilitation and telerehabilitation can be as effective as clinic-based rehabilitation after total knee arthroplasty (TKA), but require heavy logistics and are highly dependent ...on human supervision. New technologies that allow independent home-based rehabilitation without constant human supervision may help solve this problem. This was a single-center, feasibility study comparing a digital biofeedback system that meets these needs against conventional in-person home-based rehabilitation after TKA over an 8-week program. Primary outcome was the change in the Timed Up and Go score between the end of the program and baseline. Fifty-nine patients completed the study (30 experimental group; 29 conventional rehabilitation). The study demonstrated a superiority of the experimental group for all outcomes. Adverse events were similar in both groups. This is the first study to demonstrate that a digital rehabilitation solution can achieve better outcomes than conventional in-person rehabilitation, while less demanding in terms of human resources.
Quantifying the genetic diversity of riparian trees is essential to understand their chances to survive hydroclimatic alterations and to maintain their role as foundation species modulating fluvial ...ecosystem processes. However, the application of suitable models that account for the specific dendritic structure of hydrographic networks is still incipient in the literature. We investigate the roles of ecological and spatial factors in driving the genetic diversity of Salix salviifolia, an Iberian endemic riparian tree, across the species latitudinal range. We applied spatial stream-network models that aptly integrate dendritic features (topology, directionality) to quantify the impacts of multiple scale factors in determining genetic diversity. Based on the drift hypothesis, we expect that genetic diversity accumulates downstream in riparian ecosystems, but life history traits (e.g. dispersal patterns) and abiotic or anthropogenic factors (e.g. drought events or hydrological alteration) might alter expected patterns. Hydrological factors explained the downstream accumulation of genetic diversity at the intermediate scale that was likely mediated by hydrochory. The models also suggested upstream gene flow within basins that likely occurred through anemophilous and entomophilous pollen and seed dispersal. Higher thermicity and summer drought were related to higher population inbreeding and individual homozygosity, respectively, suggesting that increased aridity might disrupt the connectivity and mating patterns among and within riparian populations.
Immune-mediated myelopathy (IMM) diagnosis is challenging, and its etiology may remain unclear despite extensive investigation. We evaluated diagnostic changes in IMM patients during follow-up. We ...included 80 patients, 61.3% female, with median follow-up time 62.5 months. Diagnoses at discharge were: 48.8% Multiple Sclerosis-IMM (MS-IMM), 32.5% I-IMM, 11.3% Neuromyelitis Optica Spectrum Disorders-IMM (NMOSD-IMM), 1.3% MOG encephalomyelitis (MOGAD), and 6.2% Others IMM (O-IMM). Twenty-two patients (27.5%) changed diagnosis (median 15.5 months): 68.8% MS-IMM, 12.5% NMOSD-IMM, 3.8% MOGAD, 10.0% I-IMM, and 5.0% O-IMM. Most patients that changed diagnosis were I-IMM. Predictive factors for diagnostic change in I-IMM were: autonomous gait (p = 0.029), lesions suggestive of MS (p = 0.039), higher number of lesions (p = 0.043), lesions length < 3 vertebral bodies (p = 0.033), cervical involvement (p = 0.038), and lower EDSS at admission (p = 0.013). Etiologic reclassifications in IMM are common, therefore patients require an appropriate follow-up time to increase diagnostic accuracy.
•Immune-mediated myelopathy is frequently classified as idiopathic at discharge.•Diagnostic changes during follow-up are frequent in idiopathic patients.•Most patients with idiopathic immune-mediated myelopathy change diagnosis to multiple sclerosis.•Higher lesions load and lower EDSS at admission predict later diagnostic change in idiopathic immune-mediated myelopathy.
Calcium carbonate is one of the most used raw materials in various industries, such as construction materials, food supplement, pharmaceutics, animal feed, plastic production, and others. Calcium ...carbonate can derive from marine wastes, like crustaceans and bivalve’s shells. The worldwide demand for new sources of food has increased exponentially, and following that tendency, the mariculture—especially the oyster culture—has been increasingly resorting to farming techniques. In 2016, 438 billion tons of oysters were produced. The majority of the shells were unduly discarded, presenting a public health problem. This article offers a solution based on the reuse and recycling of oyster shell residues in the production region of Florianópolis, SC, Brazil. The presented solution is an oyster shell by-product developed by a local company which produces artificial stone. The main component of the artificial stone is a composite material made of oyster shells incorporated in a polymeric resin. The mechanical properties, such as its flexural strength, hardness, Weibull modulus, and fracture analysis, were held in the artificial stone. The mechanical results of the new artificial stone were compared with other natural stones, such as granite and marble, and other commercial artificial stones. This material owns suitable mechanical properties for table tops and workbenches. Using this product as an artificial stone represents an innovation in the development of a new product and adds commercial value to local waste. This product is an excellent example of a circular economy for local producers who care about the environment, and it encourages the reduction of extraction of natural stone, such as granite and marble.
Understanding the risks of COVID-19 in patients with Multiple Sclerosis (MS) receiving disease-modifying therapies (DMTs) and their immune reactions is vital to analyze vaccine response dynamics. A ...systematic review on COVID-19 course and outcomes in patients receiving different DMTs was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Emerging data on SARS-CoV-2 vaccines was used to elaborate recommendations. Data from 4417 patients suggest that MS per se do not portend a higher risk of severe COVID-19. As for the general population, advanced age, comorbidities, and higher disability significantly impact COVID-19 outcomes. Most DMTs have a negligible influence on COVID-19 incidence and outcome, while for those causing severe lymphopenia and hypogammaglobulinemia, such as anti-CD20 therapies, there might be a tendency of increased hospitalization, worse outcomes and a higher risk of re-infection. Blunted immune responses have been reported for many DMTs, with vaccination implications. Clinical evidence does not support an increased risk of MS relapse or vaccination failure, but vaccination timing needs to be individually tailored. For cladribine and alemtuzumab, it is recommended to wait 3–6 months after the last cycle until vaccination. For the general anti-CD20 therapies, vaccination must be deferred toward the end of the cycle and the next dose administered at least 4–6 weeks after completing vaccination. Serological status after vaccination is highly encouraged. Growing clinical evidence and continuous surveillance are extremely important to continue guiding future treatment strategies and vaccination protocols.
Vitamin D has immunomodulatory effects, and its deficiency has been implicated in the autoimmune process of type 1 diabetes. Serum vitamin D levels are influenced by variants in genes involved in the ...synthesis, transport, hydroxylation and degradation of vitamin D. The aim of this study was to assess if single nucleotide polymorphisms (SNPs) at the
(rs12785878),
(rs2282679),
(rs2060793) and
(rs6013897) loci are associated with type 1 diabetes in the Portuguese population. Genotype and allele frequencies were determined in 350 cases of type 1 diabetes and in 490 controls. The frequency of each SNP alone was not significantly different between patients and controls. However, the combined analysis of the four SNPs showed that minor alleles of these variants clustered more frequently in patients. The proportion of individuals with three or more minor alleles was significantly higher in patients than in controls (56.3% vs. 48.5; odds ratio (OR) 1.37; 95% confidence interval (CI) 1.04-1.81;
-value 0.027). These results suggest a cumulative effect of SNPs at the
,
,
and
loci on the susceptibility to type 1 diabetes, due to the roles of these genes in the vitamin D metabolic pathway.
Alzahrani–Kuwahara syndrome (ALKUS) is a neurodevelopmental disorder that includes microcephaly, facial dysmorphism, and variable congenital and eye malformations. We present the first case of ALKUS ...described in the European population caused by two variants in compound heterozygosity of the gene SMG8. We present a patient with two variants in compound heterozygosity in the SMG8 gene identified by in trio whole exome sequencing based in next generation sequencing (xGEN® Exome Research Panel, Nextseq550 platform). International case reporting (CARE) criteria were followed. Patient written consent was obtained through legal responsible persons. We describe a 27‐year‐old male, the second child of a healthy and non‐consanguineous couple, whose genetic analysis showed two variants in compound heterozygosity, c.1159C > T (p.Arg387*) and c.2407del (p.Arg803Glyfs*10), in the SMG8 gene, both classified as likely pathogenic. As described by Fatema Alzahrani et al. in a series of eight patients, our patient had global developmental delay with impaired intellectual development, facial dysmorphism, and limb disproportion. Additionally, our patient had lower limb spastic paraparesis, marked osteotendinous hyperreflexia with extensor plantar response bilaterally and paretic gait. Our patient resembles the phenotype described by Fatema Alzahrani et al., however, he is the first patient with two SMG8 deleterious variants in compound heterozygosity, and the first to exhibit pyramidal signs and gait disorder as part of the phenotype.
Purpose
This study aims to explore the role of infertility-psychosocial variables on treatment discontinuation after controlling for demographic and biomedical variables in couples seeking reimbursed ...fertility treatment.
Methods
A prospective study was conducted in 139 couples seeking fertility treatment. Between February 2010 and March 2011, participants completed measures of anxiety (STAI-State), depression (BDI-II), infertility-stress (FPI), and infertility coping strategies (COMPI-CSS). Medical data related to diagnosis, treatment, and discontinuation were collected in December 2013. A multiple logistic regression was performed to identify the predictors of discontinuation.
Results
The discontinuation rate was 29.5%. Female education level, engagement in ART procedures, and female causation decreased the likelihood of treatment discontinuation, whereas female age and depression increased the likelihood of discontinuation. Female depression was the strongest predictor in this model. The model correctly identified 75.5% of cases.
Conclusions
Female age and female depression are associated with a higher likelihood of treatment discontinuation in couples seeking treatment. Reproductive health professionals should therefore inform couples about the link between the fertility treatment discontinuation and both female age and female depression. Couples in which female partners present clinically relevant depression should be referred to a mental health professional to prevent premature abandonment of fertility treatments and thus increase success rates.
Giant parathyroid adenomas (GPA) are a benign cause of primary hyperparathyroidism (PHPT) that might present similarly to parathyroid carcinomas (PC). Rarely, PHPT can present with a parathyroid ...crisis, a life-threatening decompensation with severe hypercalcemia. A 77-year-old woman presented with lethargy and muscle weakness. Investigation revealed parathyroid hormone-dependent hypercalcemia and an enlarged parathyroid measuring 31x24 mm. The patient was submitted for parathyroidectomy. Histology showed no evidence of malignancy, confirming a GPA. We report a GPA presenting with a parathyroid crisis. The clinical picture mimicked that of a PC. There are no clinical, analytical, or imagiological features pathognomonic of PC.
PDF
