Nevin Manimala

Appl Ergon. 2021 Mar 3;94:103385. doi: 10.1016/j.apergo.2021.103385. Online ahead of print.

ABSTRACT

OBJECTIVES: This systematic review and meta-analysis determined the effects of using an exoskeleton during occupational tasks on physical stress and strain compared to not using an exoskeleton.

METHODS: Systematic electronic database searches were performed and the review was prepared according to the PRISMA guidelines. Treatment effects on the predefined outcomes were calculated using standardized mean differences for continuous outcomes in several meta-analyses using Review Manager 5.3. Registration: PROSPERO (CRD42020168701).

RESULTS: 63 articles were included in qualitative syntheses and 52 in quantitative, but most of them did not extensively evaluate musculoskeletal stress and strain and the risk of bias was rated high for all included studies. Statistically significant effects of using back, upper-limb, or lower-limb exoskeletons have been observed in the supported body areas (e.g. reduced muscle activity, joint moments and perceived strain). Studies which did not exclusively focus on the supported body area also showed statistically significant effects in the non-supported areas (e.g. changed muscle activity and perceived strain) and in physiological outcomes (e.g. reduced energy expenditure).

CONCLUSIONS: Using an exoskeleton during occupational tasks seems to reduce user’s acute physical stress and strain in the exoskeleton’s target area. However, impact on workers’ health is still unknown, primarily because of missing long-term evaluations under real working conditions. Furthermore, this systematic review highlights a lack of studies (1) following high quality methodological criteria, (2) evaluating various inter-related stress and strain parameters instead of only focusing on one specific, and (3) evaluating non-target body areas instead of only the directly supported body area.

PMID:33676059 | DOI:10.1016/j.apergo.2021.103385

J Hum Evol. 2021 Mar 3;153:102950. doi: 10.1016/j.jhevol.2021.102950. Online ahead of print.

ABSTRACT

Archaeological remains have highlighted the fact that the interglacial Marine Isotope Stage (MIS) 11 was a threshold from the perspective of hominin evolution in Europe. After the MIS 12 glaciation, considered one of the major climate-driven crises experienced by hominins, the archaeological records show an increasing number of occupations, evidence of new subsistence behaviors, and significant technical innovations. Here, we used statistical and geographic techniques to analyze the amphibian- and reptile-based paleoclimate and habitat reconstructions generated from a large data set of the Iberian Peninsula to (1) investigate if temperature, precipitation, and/or forest cover may have impacted the hominin occupation of the territory during the Early and Middle Pleistocene, (2) propose an ‘Iberian’ ecological model before and after the MIS 12/11 transition, and (3) evaluate, based on this model, the potential hominin occupation at a European scale. The results indicate the existence of climatic constraints on human settlement related to rainfall and environmental humidity. The Early Pleistocene and the first half of the Middle Pleistocene are dominated by the occupation of relatively humid wooded areas, whereas during the second part of the Middle Pleistocene, a broadening of the earlier ecological niche is clearly observed toward the occupation of more open arid areas. Based on the estimated occupational niche for hominins, a maximum potential distribution for early hominins is proposed in Europe before and after 426 ka. Results also indicate that parts of the Iberian Peninsula may not have been suitable for early hominin occupation. Our ecological model is consistent with the pattern of hominin occupation observed in northern and central Europe, where the earliest evidence reflects only pioneering populations merely extending their ranges in response to the expansion of their preferred habitats, as compared with a more sustained occupation by 400 ka.

PMID:33676058 | DOI:10.1016/j.jhevol.2021.102950

Spine J. 2021 Mar 3:S1529-9430(21)00108-X. doi: 10.1016/j.spinee.2021.03.001. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Recent media coverage of overlapping surgery has led to several studies investigating public perception of concurrent and overlapping surgery, both of which involve a single attending surgeon working on two separate cases in two separate operating rooms. In concurrent surgery, the critical periods of the surgeries overlap, while in overlapping surgery they do not. The literature revealed a general lack of knowledge about these practices and strong disapproval of their use by the public.

PURPOSE: To determine the comfort level of spine surgery patients and their family members toward concurrent and overlapping surgery.

STUDY DESIGN/SETTING: This cross-sectional survey study was performed at an urban, adult academic spine surgery clinic.

PATIENT SAMPLE: Patients and their companions who were waiting to be seen at their initial clinic visit or follow-up visit were approached to participate in the study.

OUTCOME MEASURES: The survey queried respondents’ baseline knowledge of and comfort level with concurrent and overlapping surgery, in addition to comfort level with different levels of surgical trainees on a 5-point Likert scale.

METHODS: A five-section, 36-item questionnaire was administered by a research assistant to respondents over a three-month period spanning June 2019 – August 2019. A research assistant described the terms overlapping surgery and concurrent surgery to participants of the survey using diagrams and a pre-formulated script after self-reported knowledge questions. Statistical analysis was performed using the chi-square test for categorical variables, and Kendall’s tau-c rank correlation coefficient with ordinal independent variables for correlations.

RESULTS: Knowledge about concurrent and overlapping surgery was low in our study population (8.22% and 6.16%, respectively). Over half of respondents reported that they felt comfortable with overlapping surgery (58.22%). Most respondents reported that they would like their surgeon to disclose the participation of surgical trainees (residents and fellows) in their surgery (98%). In addition, the 4^th and 5^th years of surgical training were associated with a significant increase in patient comfort with surgical trainee participation. There was no difference in response distribution between patients versus non-patients.

CONCLUSIONS: Knowledge about concurrent and overlapping surgery remains poor in our study population. Lack of general knowledge about overlapping surgery can be a serious impediment to obtaining informed consent, and further study is required to determine the best methods to raising patient awareness.

PMID:33676019 | DOI:10.1016/j.spinee.2021.03.001

Infect Genet Evol. 2021 Mar 3:104801. doi: 10.1016/j.meegid.2021.104801. Online ahead of print.

ABSTRACT

Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) has first emerged from China in December 2019 and causes coronavirus induced disease 19 (COVID19). Since then researchers worldwide have been struggling to detect the possible pathogenesis of this disease. COVID19 showed a wide range of clinical behavior from asymptomatic to severe acute respiratory disease syndrome. However, the etiology of susceptibility to severe lung injury is not yet fully understood. Angiotensin-converting enzyme1 (ACE1) convert angiotensin I into Angiotensin II that was further metabolized by ACE 2 (ACE2). The binding ACE2 receptor to SARS-CoV-2 facilitate its enter into the host cell. The interaction and imbalance between ACE1 and ACE2 play a crucial role in the pathogenesis of lung injury. Thus, the aim of this study was to investigate the association of ACE1 I/D polymorphism with severity of Covid-19. The study included RT-PCR confirmed 269 cases of Covid-19. All cases were genotyped for ACE1 I/D polymorphism using polymerase chain reaction and followed by statistical analysis (SPSS, version 15.0). We found that ACE1 DD genotype, frequency of D allele, older age (≥46 years), unmarried status, and presence of diabetes and hypertension were significantly higher in severe COVID19 patient. ACE1 ID genotype was significantly independently associated with high socio-economic COVID19 patients (OR: 2.48, 95% CI: 1.331-4.609). These data suggest that the ACE1 genotype may impact the incidence and clinical outcome of COVID-19 and serve as a predictive marker for COVID-19 risk and severity.

PMID:33676010 | DOI:10.1016/j.meegid.2021.104801

Fish Shellfish Immunol. 2021 Mar 3:S1050-4648(21)00058-9. doi: 10.1016/j.fsi.2021.02.017. Online ahead of print.

ABSTRACT

Columnaris, a highly contagious bacterial disease caused by Flavobacterium columnare, is recognized as one of the most important infectious diseases in farmed tilapia, especially during the fry and fingerling stages of production. The disease is associated with characteristic lesions in the mucosa of affected fish, particularly their skin and gills. Vaccines delivered via the mucosa are therefore of great interest to scientists developing vaccines for this disease. In the present study, we characterized field isolates of F. columnare obtained from clinical columnaris outbreaks in red tilapia to select an isolate to use as a candidate for our vaccine study. This included characterizing its colony morphology, genotype and virulence status. The isolate was incorporated into a mucoadhesive polymer chitosan-complexed nanovaccine (CS-NE), the efficacy of which was determined by experimentally infecting red tilapia that had been vaccinated with the nanoparticles by immersion. The experimental infection was performed 30-days post-vaccination (dpv), which resulted in 89 % of the unvaccinated control fish dying, while the relative percentage survival (RPS) of the CS-NE vaccinated group was 78 %. Histology of the mucosal associated lymphoid tissue (MALT) showed a significantly higher presence of leucocytes and a greater antigen uptake by the mucosal epithelium in CS-NE vaccinated fish compared to control fish and whole cell vaccinated fish, respectively, and there was statistically significant up-regulation of IgT, IgM, TNF α, IL1-β and MHC-1 genes in the gill of the CS-NE vaccinated group. Overall, the results of our study confirmed that the CS-NE particles achieved better adsorption onto the mucosal surfaces of the fish, elicited great vaccine efficacy and modulated the MALT immune response better than the conventional whole cell-killed vaccine, demonstrating the feasibility of the mucoadhesive nano-immersion vaccine as an effective delivery system for the induction of a mucosal immune response against columnaris disease in tilapia.

PMID:33675991 | DOI:10.1016/j.fsi.2021.02.017

J Shoulder Elbow Surg. 2021 Mar 3:S1058-2746(21)00148-8. doi: 10.1016/j.jse.2021.02.007. Online ahead of print.

ABSTRACT

BACKGROUND: Amid rising healthcare costs and recent advances in surgical and anesthetic protocols, outpatient joint arthroplasty has risen steadily in recent years. While the safety of outpatient total knee arthroplasty (TKA) and total hip arthroplasty (THA) has been well-established, outpatient shoulder arthroplasty is still in its infancy. The purpose of this study is to synthesize the current literature and to provide further data regarding the outcomes and safety of outpatient shoulder arthroplasty.

METHODS: A systematic review was conducted following the standard PRISMA guidelines. Included were papers that evaluated the outcomes of patients undergoing outpatient total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). Meta-analysis was conducted using Mantel-Haenszel statistics to generate odds ratios and their corresponding 95% confidence intervals comparing outpatient and inpatient shoulder arthroplasty.

RESULTS: Twelve studies were included with a total of 194,513 patients, of which, 7,162 were outpatients. Of the studies, eight were level III studies and four were level IV. The average age of the outpatients was 66.6 years and the average age of the inpatients was 70.1 years. The overall odds ratio of complications was significantly lower in outpatients (OR=0.40 [0.35-0.45]) than inpatients. There was no significant difference in 90-day readmission (OR=0.88 [0.75-1.03]), revision (OR=0.96 [0.65-1.41]), and infection rates (OR=0.93 [0.64-1.35]) when comparing outpatients to inpatients.

CONCLUSION: Outpatient total shoulder arthroplasty, in an appropriately selected patient population, is safe and results in comparable patient outcomes when compared to inpatient shoulder arthroplasty. Due to the expected increase in patients requiring total shoulder arthroplasty, surgeons, hospital administrators, and insurance carriers should strongly consider the merits of a cost and care efficient approach to total shoulder replacement.

PMID:33675972 | DOI:10.1016/j.jse.2021.02.007

Ann Anat. 2021 Mar 3:151715. doi: 10.1016/j.aanat.2021.151715. Online ahead of print.

ABSTRACT

BACKGROUND: Severe craniofacial and dental abnormalities, typical for patients with progressive Duchenne muscular dystrophy (DMD), are an exellcent demonstration of Melvin L. Moss “functional matrix theory”, highlighting the influence of muscle tissue on craniofacial growth and morphology. However, the currently best approved animal model for investigation of this interplay is the mdx-mouse, which offers only a limited time window for research, due to the ability of muscle regeneration, in contrast to the human course of the disease. The aim of this study was to evaluate craniofacial morphology after BTX-A induced muscle paralysis in C57Bl- and mdx-mice, to prove the suitability of BTX-A intervention to inhibit muscle regeneration in mdx-mice and thus, mimicking the human course of the DMD disease.

METHODS: Paralysis of the right masseter muscle was induced in 100 days old C57Bl- and mdx-mice by a single specific intramuscular BTX-A injection. Mice skulls were obtained at 21 days and 42 days after BTX-A injection and 3D radiological evaluation was performed in order to measure various craniofacial dimensions in the sagittal, transversal and vertical plane. Statstical analysis were performed using SigmaStat®Version 3.5. In case of normal distribution, unpaired t-test and otherwise the Mann Whitney-U test was applied. A statistical significance was given in case of p ≤ 0.05.

RESULTS: In contrast to C57Bl-mice, in mdx-mice, three weeks after BTX-A treatment a significant decrease of skull dimensions was noted in most of the measurements followed by a significant increase at the second investigation period.

CONCLUSIONS: BTX-A can induce changes in craniofacial morphology and presumably partially inhibit muscle regeneration in mdx-mice, but cannot completely intensify craniofacial effects elicited by dystrophy. Further research is necessary in order to fully understand muscle-bone interplay after BTX-A injection into dystrophic muscles.

PMID:33675949 | DOI:10.1016/j.aanat.2021.151715

Physiother Res Int. 2021 Mar 6. doi: 10.1002/pri.1902. Online ahead of print.

ABSTRACT

OBJECTIVES: To study the effectiveness of mirror therapy along with a Stroke rehabilitation program on oedema, pain intensity and functional activities in patients with shoulder-hand syndrome (SHS) after stroke.

DESIGN: Randomized controlled trial.

SETTINGS: Out-patient rehabilitation center.

METHODS: Thirty-eight SHS patients after stroke, were randomly allocated into two groups; both the groups received a 4-week stroke rehabilitation program, 30 min a day for 5 days a week. Control group patients performed all the exercises of stroke rehabilitation program, while directly visualizing their both limbs. Experimental group patients performed same exercises of stroke rehabilitation program in front of the mirror.

OUTCOME MEASURES: Oedema (figure-of-eight measurement method), pain intensity (0-10 Numeric Pain Rating Scale [0-10 NPRS]), functional activities (Functional Independence Measure [FIM]).

RESULTS: After intervention, both groups showed statistically significant (p < 0.05) improvement for all measures (oedema measurement, 0-10 NPRS and FIM). Improvements were more significant (p < 0.05) in the experimental group with mirror therapy for all three measures compared to the control group. Mean differences between groups were 1.40 cm for oedema measurement, 0.87 for NPRS score and 12.20 for FIM score. At 2-week follow-up, the improvements were sustained.

CONCLUSION: The current study may indicate mirror therapy as an effective central neuromodulatory rehabilitative program to reduce pain, improves functional activities. More distinctively, this preliminary study suggests a decrease in oedema by mirror therapy for SHS after stroke. Improvement of upper limb in SHS after stroke will be more perceptible with the decrease in oedema, being the characteristic sign, following mirror therapy. Clinically, patients during their daily functional activities, shall be more confident to use their upper limb following mirror therapy after reduction in oedema along with pain.

PMID:33675672 | DOI:10.1002/pri.1902

Am J Clin Nutr. 2021 Mar 1:nqaa336. doi: 10.1093/ajcn/nqaa336. Online ahead of print.

ABSTRACT

BACKGROUND: Since December 2019, coronavirus disease 2019 (COVID-19) has been spreading steadily, resulting in overwhelmed health-care systems and numerous deaths worldwide. To counter these outcomes, many countries, including France, put in place strict lockdown measures, requiring the temporary closure of all but essential places and causing an unprecedented disruption of daily life.

OBJECTIVES: Our objective was to explore potential changes in dietary intake, physical activity, body weight, and food supply during the COVID-19 lockdown and how these differed according to individual characteristics.

METHODS: The analyses included 37,252 adults from the French web-based NutriNet-Santé cohort who completed lockdown-specific questionnaires in April-May 2020. Nutrition-related changes and their sociodemographic, lifestyle, and health-status correlates were investigated using multivariable logistic regression models. Clusters of participants were defined using an ascending hierarchical classification of change profiles derived from multiple correspondence analyses.

RESULTS: During the lockdown, trends of unfavorable changes were observed: decreased physical activity (reported by 53% of the participants), increased sedentary time (reported by 63%), increased snacking, decreased consumption of fresh food (especially fruit and fish), and increased consumption of sweets, cookies, and cakes. Yet, the opposite trends were also observed: increased home cooking (reported by 40%) and increased physical activity (reported by 19%). Additionally, 35% of the participants gained weight (mean weight gain in these individuals, 1.8 kg ± SD 1.3 kg) and 23% lost weight (2 kg ± SD 1.4 kg weight loss). All of these trends displayed associations with various individual characteristics.

CONCLUSIONS: These results suggest that nutrition-related changes occurred during the lockdown in both unfavorable and favorable directions. The observed unfavorable changes should be considered in the event of a future lockdown, and should also be monitored to prevent an increase in the nutrition-related burden of disease, should these diet/physical activity changes be maintained in the long run. Understanding the favorable changes may help extend them on a broader scale. This trial was registered at clinicaltrials.gov as NCT03335644.

PMID:33675635 | DOI:10.1093/ajcn/nqaa336

J Acquir Immune Defic Syndr. 2021 Feb 24. doi: 10.1097/QAI.0000000000002675. Online ahead of print.

ABSTRACT

BACKGROUND: Pillar 4 of the United States’ End the HIV Epidemic plan is to respond quickly to HIV outbreaks, but the utility of CDC’s tool for identifying HIV outbreaks via time-space cluster detection has not been evaluated. The objective of this evaluation is to quantify the ability of the CDC time-space cluster criterion to predict future HIV diagnoses and to compare it to a space-time permutation statistic implemented in SaTScan software.

SETTING: Washington state from 2017 to 2019.

METHODS: We applied both cluster criteria to incident HIV cases in Washington State to identify clusters. Using a repeated measures Poisson model, we calculated a rate ratio comparing the 6-months following cluster detection to a baseline rate from 24 to 12 months before the cluster was detected. We also compared the demographics of cases within clusters to all other incident cases.

RESULTS: The CDC criteria identified 17 clusters containing 192 cases in the 6-months following cluster detection, corresponding to a rate ratio of 1.25 (95% CI 0.95-1.65) relative to baseline. The time-space permutation statistic identified 5 clusters containing 25 cases with a rate ratio of 2.27 (95% CI 1.28-4.03). Individuals in clusters identified by the new criteria were more likely to be of Hispanic origin (61% vs 20%) and in rural areas (51% vs 12%).

CONCLUSIONS: The space time permutation cluster analysis is a promising tool for identification of clusters with the largest growth potential for whom interruption may prove most beneficial.

PMID:33675622 | DOI:10.1097/QAI.0000000000002675