Correlations between Retinal Arterial Morphometric Parameters and Neurodegeneration in Patients with Type 2 Diabetes Mellitus with No or Mild Diabetic Retinopathy

Background and Objectives: In patients with diabetes mellitus (DM), the neural retina is starting to degenerate before the development of vascular lesions. Our purpose was to investigate the correlation between the retinal arterial morphometric parameters and structural neurodegeneration in patients with type 2 DM with no or mild diabetic retinopathy (DR). Materials and Methods: This is a prospective study including 53 eyes of patients with type 2 DM and 32 eyes of healthy controls. Based on SD-OCT (spectral domain—optical coherence tomography) images, using a micro-densitometry method, we measured the outer and luminal diameter of retinal arteries and calculated the AWT (arterial wall thickness), WLR (wall-to-lumen ratio), and WCSA (wall cross-sectional area). GCL (ganglion cell layer) and RNFL (retinal nerve fiber layer) thickness were analyzed in correlation with the retinal arterial morphometric parameters mentioned above. Results: GCL was thinner in the inner quadrants in the NDR (no DR) group compared to controls (p <0.05). RAOD (retinal artery outer diameter), RALD (retinal artery lumen diameter), AWT, WLR, and WCSA were similar between groups. A regression model considering age, gender, duration of DM, and HbA1C was carried out. Central GCL thickness was correlated positively with RAOD (coefficient 0.360 per µm, p = 0.011), RALD (coefficient 0.283 per µm, p = 0.050), AWT (coefficient 0.304 per µm, p = 0.029), and WCSA (coefficient 3.90 per µm, p = 0.005). Duration of DM was positively correlated with WCSA (coefficient 0.311 per one year duration of diabetes, p = 0.043). Conclusions: Significant GCL thinning in the inner quadrants preceded the morphological retinal arterial morphometric changes, supporting the neurodegeneration as primary pathogenic mechanism in DR.

Inequalities in Life Expectancy by Education and Its Changes in Lithuania during 2001–2014

Background and Objectives: Reduction of health inequalities is a highly important task in public health policies worldwide. In Lithuania, inequalities in life expectancy (LE) by education level are among the greatest, compared to other European countries. However, studies on inequalities in LE by level of education over a long-term period are quite scarce in Lithuania. The aim of the study was to analyze inequalities in life expectancy by education and its changes in Lithuania during 2001–2014. Materials and Methods: Information on deaths (in population aged ≥30 years) was obtained from Statistics Lithuania. Life expectancy at age 30 (LE30) and 95% confidence intervals (CIs) were calculated using life tables. Inequalities in LE30 were assessed using rate differences. Joinpoint regression analysis was used to assess the trends and inequalities of LE30 during 2001–2014. Results: During 2001–2014, LE30 in males and females with post-secondary education was higher than in those with up-to-secondary education (p < 0.05). Among males and females, LE30 increased in both education groups, except for males with up-to-secondary education. Among individuals with post-secondary education, LE30 started increasing earlier and more quickly than in those with up-to-secondary education. Over the analyzed period, greater differences in LE30 between post-secondary and up-to-secondary education groups were found among males. Differences in LE30 due to different educational background were statistically significantly, increasing across the sexes with a more rapid increase for females than for males. During 2001 and 2014, the highest number of years of LE30 lost in both education groups was due to cardiovascular diseases. Conclusions: Throughout the period of 2001–2014, life expectancy in Lithuania in the post-secondary education group was statistically significantly longer and was increasing more rapidly compared to the up-to secondary education group. Inequalities in life expectancy by level of education significantly increased among both males and females.

The Relationship between the Glenohumeral Joint Internal Rotation Deficit and the Trunk Compensation Movement in Baseball Pitchers

Background and objectives: Glenohumeral joint internal rotation deficit (GIRD) is commonly observed in the dominant arm of baseball pitchers and is limited by horizontal adduction motions. We inferred that when pitchers’ generation of internal shoulder rotation and horizontal adduction activity is limited, they may generate compensation movements in other body parts. This study aims to investigate whether pitchers with GIRD generates trunk compensation during pitching where pitching targets were on the lower corner of their non-dominant side. Design: Case-control study. Setting: Elite senior high school baseball. Participants: Twenty-five senior high school baseball pitchers participated in this study. Twelve pitchers with GIRD were assigned to the experiment group, and the remaining 13 participants to the control group. Main outcome measures: Glenohumeral internal/external rotation of both arms and internal/external rotation of the bilateral hip joints were measured. The kinematic values of the trunk when pitching to a target were measured using high-speed infrared cameras. Results: Pitchers with GIRD exhibited significantly greater upper trunk rotation toward the non-dominant side when a baseball was released from their hand (27.39 ± 6.62 degrees), compared with non-GIRD pitchers (20.42 ± 5.97 degrees) (p < 0.05). The total rotation of the pivot leg of pitchers with GIRD (67.54 ± 7.84 degrees) was significantly smaller than that of pitchers without GIRD (74.00 ± 7.07 degrees) (p < 0.05). Conclusions: GIRD in the dominant arm affected upper trunk rotation during pitching and was associated with the hip range of motion. Future studies could conduct a longitudinal study regarding the relationship between GIRD and other joint injuries of the lower limbs.

What We Should Consider in Point of Care Blood Glucose Test; Current Quality Management Status of a Single Institution

Background and Objectives: Point of care test (POCT) is generally performed by non-laboratory staff who often lack an understanding on the quality control and quality assurance programs. The purpose of this study was to understand the current status of quality management of point of care (POC) blood glucose testing in a single institution where non-laboratory staff perform the tests. Materials and Methods: From July to August 2020, management status of glucometer, test strips, quality control (QC) materials, quality assurance program, and operators’ response to processing of displayed results was monitored in all Soonchunhyang University Bucheon hospital departments that performed POC blood glucose test. Results of the POC blood glucose test conducted from January 2019 to May 2020 were analyzed retrospectively. Results: A total 124 glucometers were monitored in 47 departments. Insufficient management of approximately 50% of blood sugar, test strips, and QC materials was observed. Although daily QC was conducted by 95.7% of the departments, the QC records were inaccurate. The method of recording test results varied with departments and operators. Various judgments and troubleshooting were performed on the unexpected or out of measurable range results, including some inappropriate processes. In POC blood glucose test results review, 4568 atypical results were identified from a total of 572,207 results. Conclusions: Sufficient training of the non-laboratory staff and ongoing assessment of competency through recertification is needed to maintain acceptable levels of POCT quality. In this study, various problems were identified in glucometer and reagent management, QC and post-analytic phase. We believe that these results provide meaningful basal information for planning effective operators’ training and competency evaluation, and the development of an efficient POCT quality management system.

A Roadmap towards Precision Periodontics

Periodontitis is among the most common health conditions and represents a major public health issue related to increasing prevalence and seriously negative socioeconomic impacts. Periodontitis-associated low-grade systemic inflammation and its pathological interplay with systemic conditions additionally raises awareness on the necessity for highly performant strategies for the prevention and management of periodontitis. Periodontal diagnosis is the backbone of a successful periodontal strategy, since prevention and treatment plans depend on the accuracy and precision of the respective diagnostics. Periodontal diagnostics is still founded on clinical and radiological parameters that provide limited therapeutic guidance due to the multifactorial complexity of periodontal pathology, which is why biomarkers have been introduced for the first time in the new classification of periodontal and peri-implant conditions as a first step towards precision periodontics. Since the driving forces of precision medicine are represented by biomarkers and machine learning algorithms, with the lack of periodontal markers validated for diagnostic use, the implementation of a precision medicine approach in periodontology remains in the very initial stage. This narrative review elaborates the unmet diagnostic needs in periodontal diagnostics, the concept of precision periodontics, periodontal biomarkers, and a roadmap toward the implementation of a precision medicine approach in periodontal practice.

Comparison of the Allelic Alterations between InDel and STR Markers in Tumoral Tissues Used for Forensic Purposes

Background and objectives: Over the last two decades, human DNA identification and kinship tests have been conducted mainly through the analysis of short tandem repeats (STRs). However, other types of markers, such as insertion/deletion polymorphisms (InDels), may be required when DNA is highly degraded. In forensic genetics, tumor samples may sometimes be used in some cases of human DNA identification and in paternity tests. Nevertheless, tumor genomic instability related to forensic DNA markers should be considered in forensic analyses since it can compromise genotype attribution. Therefore, it is useful to know what impact tumor transformation may have on the forensic interpretation of the results obtained from the analysis of these polymorphisms. Materials and Methods: The aim of this study was to investigate the genomic instability of InDels and STRs through the analysis of 55 markers in healthy tissue and tumor samples (hepatic, gastric, breast, and colorectal cancer) in 66 patients. The evaluation of genomic instability was performed comparing InDel and STR genotypes of tumor samples with those of their healthy counterparts. Results: With regard to STRs, colorectal cancer was found to be the tumor type affected by the highest number of mutations, whereas in the case of InDels the amount of genetic mutations turned out to be independent of the tumor type. However, the phenomena of genomic instability, such as loss of heterozygosity (LOH) and microsatellite instability (MSI), seem to affect InDels more than STRs hampering genotype attribution. Conclusion: We suggest that the use of STRs rather than InDels could be more suitable in forensic genotyping analyses given that InDels seem to be more affected than STRs by mutation events capable of compromising genotype attribution.

A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches

Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant progress in the field of tissue engineering has led to the development of promising therapeutic approaches. However, scientific advances in the field of allografting and transplant immunology are of great importance. The achievement of various milestones over the past decades has provided thought-provoking impulses in the field of skin allotransplantation. Thus, biologically viable skin allotransplantation is still not a part of the clinical routine. The purpose of this article is to review the achievements in burn surgery with regards to skin allotransplantation in recent years.

The Influence of EMG-Triggered Robotic Movement on Walking, Muscle Force and Spasticity after an Ischemic Stroke

Background and Objectives: Application of the EMG-driven robotic training in everyday therapeutic processes is a modern and innovative form of neurorehabilitation among patients after stroke. Active participation of the patient contributes to significantly higher activation of the sensorimotor network during active motor control rather than during passive movement. The study objective was to determine the effect of electromyographic triggering (EMG-triggered) robotic rehabilitation device treatment on walking, muscle force, and spasticity after an ischemic stroke. Materials and Methods: A total of 60 participants with impaired motor function and gait after subacute stroke were included in the study. Each patient was randomly assigned to an intervention or control group (IG or CG). All patients, except standard therapy, underwent 1 additional session of therapy per day, 5 days a week for 6 weeks. IG had 30 min of training on the robot, while CG received exercises on the lower limb rotor. The subjects were assessed with Timed Up and Go Test (TUG), Ashworth scale, knee range of motion (ROM), Lovett Scale, and tight circumference at baseline and at weeks 2, 4, and 6. Results: For seven parameters, the values credibly increased between consecutive measurements, and for the Ashworth scale, they credibly decreased. The biggest changes were observed for the measurements made with Lovett scale. The average thigh circumference as measured 5 and 15 cm above the knee increased credibly more in the robot condition, as compared to control condition. Additionally, the decrease in Ashworth values over time, although statistically credible in both groups, was credibly higher in the robot condition. Conclusion: The inclusion of the EMG-triggered neurorehabilitation robot in the patient’s daily rehabilitation plan has a positive effect on outcomes of the treatment. Both proposed rehabilitation protocols significantly improved patients’ condition regarding all measured outcomes, but the spasticity and thigh circumference improved significantly better in the robotic group in comparison to controls.

Observer Influence with Other Variables on the Accuracy of Ultrasound Estimation of Fetal Weight at Term

Background and Objectives: The accuracy with which the estimation of fetal weight (EFW) at term is determined is useful in order to address obstetric complications, since it is a parameter that represents an important prognostic factor for perinatal and maternal morbidity and mortality. The aim of this study was to determine the role of the experienced observers with other variables that could influence the accuracy of the ultrasound used to calculate EFW at term, carried out within a period of seven days prior to delivery, in order to assess interobserver variability. Materials and Methods: A cross-sectional study was performed including 1144 pregnancies at term. The validity of the ultrasound used to calculate EFW at term was analyzed using simple error, absolute error, percentage error and absolute percentage error, as well as the percentage of predictions with an error less than 10 and 15% in relation to maternal, obstetric and ultrasound variables. Results: Valid predictions with an error less than 10 and 15% were 74.7 and 89.7% respectively, with such precision decreasing according to the observer as well as in extreme fetal weights. The remaining variables were not significant in ultrasound EFW at term. The simple error, absolute error, percentage error and absolute percentage error were greater in cases of extreme fetal weights, with a tendency to overestimate the low weights and underestimate the high weights. Conclusions: The accuracy of EFW with ultrasound carried out within seven days prior to birth is not affected by maternal or obstetric variables, or by the time interval between the ultrasound and delivery. However, accuracy was reduced by the observers and in extreme fetal weights.

Antiviral and Immunomodulation Effects of Artemisia

Background and Objectives: Artemisia is one of the most widely distributed genera of the family Astraceae with more than 500 diverse species growing mainly in the temperate zones of Europe, Asia and North America. The plant is used in Chinese and Ayurvedic systems of medicine for its antiviral, antifungal, antimicrobial, insecticidal, hepatoprotective and neuroprotective properties. Research based studies point to Artemisia’s role in addressing an entire gamut of physiological imbalances through a unique combination of pharmacological actions. Terpenoids, flavonoids, coumarins, caffeoylquinic acids, sterols and acetylenes are some of the major phytochemicals of the genus. Notable among the phytochemicals is artemisinin and its derivatives (ARTs) that represent a new class of recommended drugs due to the emergence of bacteria and parasites that are resistant to quinoline drugs. This manuscript aims to systematically review recent studies that have investigated artemisinin and its derivatives not only for their potent antiviral actions but also their utility against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Materials andMethods: PubMed Central, Scopus and Google scholar databases of published articles were collected and abstracts were reviewed for relevance to the subject matter. Conclusions: The unprecedented impact that artemisinin had on public health and drug discovery research led the Nobel Committee to award the Nobel Prize in Physiology or Medicine in 2015 to the discoverers of artemisinin. Thus, it is clear that Artemisia’s importance in indigenous medicinal systems and drug discovery systems holds great potential for further investigation into its biological activities, especially its role in viral infection and inflammation.