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Rebecca Hui Shan Ong,1 Milawaty Nurjono,1 Hong Choon Oh,1– 3 Christopher Tsung Chien Lien,4 Junisha Jumala,5 Raymond Choon Chye Teo,6 Peiying Gan,7 Karen Lai Ming Kan,8 Lina Farhana Rosle,8 Moi Kim Wee,8 Shou Lin Low4 1Health Services Research, Changi General Hospital, Singapore; 2Centre for Population Health Research and Implementation, Singapore Health Services, Singapore; 3Health Services & Systems Research, Duke-NUS Medical School, Singapore; 4Geriatric Medicine, Changi General Hospital, Singapore; 5Rehabilitative Services, Changi General Hospital, Singapore; 6Singapore Sport & Exercise Medicine Centre, Changi General Hospital, Singapore; 7Community Nursing, Changi General Hospital, Singapore; 8Community and Mental Health, Changi General Hospital, SingaporeCorrespondence: Rebecca Hui Shan Ong, Health Services Research, Changi General Hospital, 2 Simei Street 3, 529889, Singapore, Tel +65 6788 8833, Fax +65 67826049, Email Rebecca.ong.h.s@singhealth.com.sgPurpose: Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of “Steady Feet” (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore.Material and Methods: This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors.Results: Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation.Conclusion: Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers’ capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.Keywords: falls prevention, community-dwelling, older adults, exercise, qualitative, precede-proceed

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate whether acupuncture is more effective than 'sham' (placebo) acupuncture, no preventative treatment or routine care only, or other interventions, in reducing headache frequency in people with episodic migraine., (Copyright © 2025 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)

Understanding the intricate dynamics of sediment-mediated microbial interactions and their impact on plant tissue preservation is crucial for unraveling the complexities of leaf decay and preservation processes. To elucidate the earliest stages of leaf preservation, a series of decay experiments was carried out for three months on Nymphaea water lily leaves in aquariums with pond water and one of three distinctly different, sterilized, fine-grained substrates-commercially purchased kaolinite clay or fine sand, or natural pond mud. One aquarium contained only pond water as a control. We use 16S and ITS rRNA gene amplicon sequencing to identify and characterize the complex composition of the bacterial and fungal communities on leaves. Our results reveal that the pond mud substrate produces a unique community composition in the biofilms compared to other substrates. The mud substrate significantly influences microbial communities, as shown by the correlation between high concentrations of minerals in the water and bacterial abundance. Furthermore, more biofilm formers are observed on the leaves exposed to mud after two months, contrasting with declines on other substrates. The mud substrate also enhanced leaf tissue preservation compared to the other sediment types, providing insight into the role of sediment and biofilms in fossilization processes. Notably, leaves on kaolinite clay have the fewest biofilm formers by the end of the experiment. We also identify key biofilm-forming microbes associated with each substrate. The organic-rich mud substrate emerges as a hotspot for biofilm formers, showing that it promotes biofilm formation on leaves and may increase the preservation potential of leaves better than other substrates. The mud's chemical composition, rich in minerals such as silica, iron, aluminum, and phosphate, may slow or suspend decay and facilitate biomineralization, thus paving the way toward leaf preservation. Our study bridges the information gap between biofilms observed on modern leaves and the mineral encrustation on fossil leaves by analyzing the microbial response in biofilms to substrate types in which fossil leaves are commonly found., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Palmer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Little is known about dentists' preparedness in managing oral side effects in patients undergoing cancer therapy (CTx). The purpose of this systematic review is to identify barriers and facilitators of dentists in managing oral health of cancer patients (CPs)., Methods: The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was Prospero registered (CRD42022333055). CINAHL, Embase, Medline, PsycInfo and Scopus databases were searched using keywords and MeSH terms: dentists, oral health, cancer. The outcomes were analysed descriptively and thematically., Results: Of the 2303 articles screened 53 met eligibility criteria. Most of articles (n = 50) reported on head and neck cancer (HNC) management. Dentists' oral cancer (OC) knowledge varied across studies (27% to 81%, n = 35). Regardless of their knowledge level, the majority of dentists expressed interest in further cancer education. Across studies, dentists perceived that their role included providing dental treatment for OC patients. However, of the few studies (n = 3) that explored dentists' confidence in managing CPs, less than half of dentists felt confident providing advice to patients with HNC. More barriers than facilitators are identified in providing dental care provision to CPs., Conclusion: This review demonstrates gap in dental care for patients with non-HNCs and highlights a need for methods to involve dentists in managing dental health of CPs., (© 2024. The Author(s).)

Background: Dengue is a global public health challenge which requires accurate diagnostic methods for surveillance and control. The gold standard for detecting dengue neutralizing antibodies (nAbs) is the plaque reduction neutralization test (PRNT), which is both labor-intensive and time-consuming. This study aims to evaluate three alternative approaches, namely, the MTT-based (or (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) microneutralization assay, the xCELLigence real-time cell analysis (RTCA), and the immuno-plaque assay-focus reduction neutralization test (iPA-FRNT)., Methods: Twenty-two residual serum samples were tested for DENV-2 nAbs using all four assays at three neutralization endpoints of 50%, 70% and 90% inhibition in virus growth. For each neutralization endpoint, results were compared using linear regression and correlation analyses. Test performance characteristics were further obtained for iPA-FRNT using 38 additional serum samples., Results: Positive correlation of DENV-2 neutralization titers for the MTT-based microneutralization assay and the PRNT assay was only observed at the neutralization endpoint of 50% (r = 0.690). In contrast, at all three neutralization end points, a linear trend and positive correlation of DENV-2 neutralization titers for the xCELLigence RTCA and the PRNT assays were observed, yielding strong or very strong correlation (r = 0.829 to 0.967). This was similarly observed for the iPA-FRNT assay (r = 0.821 to 0.916), which also offered the added advantage of measuring neutralizing titers to non-plaque forming viruses., Conclusion: The xCELLigence RTCA and iPA-FRNT assays could serve as suitable alternatives to PRNT for dengue serological testing. The decision to adopt these methods may depend on the laboratory setting, and the utility of additional applications offered by these technologies., (© 2024. The Author(s).)

The information of biochemical methane potential (BMP) of wasted sludge is essential to ensure the stable operation of sludge management processes. However, conventional anaerobic digestion (AD) approach for BMP test is time-consuming and labour-intensive. Currently, the technique of Near Infrared Spectroscopy (NIRS) is gaining prominence in the biogas production within AD process. Previous studies mostly focused on predicting BMP values for fibrous plant biomass and solid waste, with only a limited number of studies attempting to apply NIRS to obtain BMP values across a wide array of wasted sludge types. To obtain BMP values for this diverse range of wasted sludge efficiently and accurately, it is imperative to develop precise models for assessing BMP values using NIRS. In this study, the possibility of using NIRS to predict the BMP values of wasted sludge was evaluated. A total of 70 sludge samples from different sources were investigated to develop a BMP-prediction model by correlating the measured BMP values with the obtained NIR spectra. As a result, a reliable and successful BMP-prediction model was established with the determination coefficient of 0.90, residual prediction deviation of 3.50 and low root mean square error of prediction of 36.8 mL CH 4 /g VS. This BMP-prediction model is satisfactory for predicting BMP values of various types of sludge. It could provide support for plant operators to make decisions rapidly, thereby improving the process efficiency and optimizing sludge management procedures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The role of the coronoid process in elbow instability has been established. When necessary, coronoid fixation can be challenging. Placing fixation perpendicular to the fracture requires achieving a trajectory as close as possible to the midline axis of the proximal ulna, either from anterior to posterior or vice versa. The aim of this study was to determine whether coronoid exposure-and the ability to place fixation from anterior to posterior-is improved via a lateral extensor-splitting approach with forearm supination, that is, the "spin move," with progressive stages of lateral elbow instability., Methods: The lateral extensor-splitting approach was performed on 9 cadaveric upper extremities. A 0.157-mm (0.062-inch) wire was drilled perpendicularly into the lateral aspect of the humerus just proximal to the lateral epicondyle. A second wire was drilled into the tip of the coronoid, aiming for a drill trajectory as close as possible to the midline axis. The angle between the 2 wires was measured as the initial angle. Three stages of progressive lateral elbow instability were produced by sequential release of the lateral ulnar collateral ligament (LUCL), common extensor origin (CEO), and posterior capsule. At each stage, the spin move was performed and the angle between the 2 wires was measured. The difference between this angle and the initial angle was calculated, with the average value reported as the Δ angle for each stage. The average difference between each stage and the next stage was reported., Results: The spin move resulted in Δ angles of 10.3° with the LUCL released, 20° with the CEO released, and 29.1° with the posterior capsule released. Progressing from LUCL release to CEO release to posterior capsule release, the Δ angle between the K-wires increased an average of 9.6° from the LUCL stage to the CEO stage and 9.1° from the CEO stage to the posterior capsule stage., Conclusion: The spin move is a simple maneuver that can improve exposure of the coronoid process regardless of the degree of elbow instability. This may facilitate a more perpendicular screw, bone tunnel, or suture anchor trajectory via the lateral approach, reducing the need for posterior-to-anterior fixation. The improved exposure is inferred from the differences in the K-wire angles with and without the spin move. This study has also quantified the change in coronoid exposure using the angles of the wires with progressive release of the LUCL, CEO, and posterior capsule. If necessary, releasing the CEO or posterior capsule with eventual repair may allow improved coronoid fixation from the lateral approach., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.)

Introduction: ProSeal-Laryngeal Mask Airway™ (P-LMA™) is one of the commonly used laryngeal mask airways. Despite the proper insertion technique, suboptimal positioning and airway morbidity still occurs. This study explored the possibility of the operating table height position affecting successful P-LMA™ placement., Methods: A total of 138 patients aged between 18 and 65 years old with the American Society of Anesthesiologists (ASA) I or II status, who required general anaesthesia and had no contraindication towards the use of P-LMA™, were recruited. They were randomly positioned into three anatomical landmarks, which were umbilicus, lowest rib margin, and xiphoid. P-LMA™ was inserted following muscle paralysis, and the first successful placement was evaluated using positional and performance tests. Duration, ease of P-LMA™ insertion, and airway complications were compared., Results: Demographic and airway features were comparable among all groups. The P-LMA™ placement success rate improved when the table height was positioned at the lowest rib margin ( p =0.002). All three positions were comparable in terms of duration, ease of insertion, and airway morbidities., Conclusion: The lowest rib margin anatomical landmark can be used as a guide in achieving the optimal operating table height for successful P-LMA™ placement., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Song Lin Low et al.)

Background: Falls and fall-related injuries in older adults are a leading cause of disability and death. Evidence has shown the benefits of exercises in improving functional outcomes and reducing fall rates among community-dwelling older adults. However, there is lack of effective community-based single exercise intervention for a broad population of older adults who are at high risk for falls. We aim to evaluate the effectiveness of Steady Feet (SF), a 6-month tailored community fall prevention exercise programme for improving functional outcomes. SF classes are facilitated by community fitness instructors and an exercise video. The main outcome is between-group changes in short physical performance battery (SPPB) scores. Secondary outcomes include balance confidence, fear of falling, quality of life, fall rates, and cost effectiveness., Methods: We present the design of a 6-month randomised controlled trial of 260 older adults (≥ 60 years old). Individuals will be randomised in a 1:1 allocation ratio to the SF group or usual care group. Participants will be assessed at baseline, 3-month, and 6-month. Data on socio-demographics, co-morbidities, balance confidence, fear of falling, quality of life, physical activity level, rate of perceived exertion, fall(s) history, healthcare utilisation and cost, and satisfaction levels will be collected. Participants will also undergo functional assessments such as SPPB. Moreover, providers' satisfaction and feedback will be obtained at 3-month., Discussion: An effective community fall prevention programme may lead to improved functional outcomes and reduced fall rates. Findings will also help inform the implementation and scaling of SF nation-wide., Trial Registration: Clinicaltrials.gov registration: NCT04801316. Registered on 15th March 2021., Competing Interests: The authors declare that they have no competing interests.

Engelhardia , a genus of Juglandaceae (the walnut family), is endemic to tropical and subtropical Asia. The rich Cenozoic fossil records and distinctive morphological characters of the living plants have been used to explore the evolutionary history and geographic distribution of Juglandaceae. However, the taxonomy of this genus has been suffered from a lack of in-depth investigation and good specimens across its distribution ranges. Species delimitation of Engelhardia was defined with seven species in 2020, but detailed information on the circumscription of the species still remains poorly understood. In this study, two new species are described from Sulawesi and Borneo, Engelhardia anminiana and E. borneensis . We also revised and reconstructed the phylogeny within Engelhardia using morphological, molecular (plastid and ribosomal), and distribution data. We sampled 787 individuals in 80 populations, and all the samples were genotyped using plastid regions, trn S- trn G, rps 16, trn L- trn F, psb A- trn H, and rpl 32- trn L; one ribosomal region, nuclear ribosomal internal transcribed spacer (nrITS). The all datasets were used to reconstruct the phylogenetic relationships. Then, the molecular analyses were combined for 738 sheets of specimens with 15 morphological characteristics to further explore the morphological clusters of Engelhardia . Cluster analysis using morphological data confirmed the delimitation of nine Engelhardia species. Also, phylogenetic analysis based on molecular data (i.e., plastid and ribosomal) supported the monophyly of Engelhardia and generated phylogenetic trees that included E. fenzelii , E. roxburghiana , E. borneensis , E. hainanensis , E. anminiana , E. serrata , E. villosa , E. apoensis and the varieties of E. spicata (i.e., E. spicata var. spicata , E. spicata var. rigida , E. spicata var. aceriflora , and E. spicata var. colebrookeana ). Our comprehensive taxonomic revision of Engelhardia will provide an insight into understanding the plant diversity in tropical and subtropical Asia., Competing Interests: We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (© 2022 Kunming Institute of Botany, Chinese Academy of Sciences. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.)

Wastewater-based surveillance has been widely used as a non-intrusive tool to monitor population-level transmission of COVID-19. Although various approaches are available to concentrate viruses from wastewater samples, scalable methods remain limited. Here, we sought to identify and evaluate SARS-CoV-2 virus concentration protocols for high-throughput wastewater testing. A total of twelve protocols for polyethylene glycol (PEG) precipitation and four protocols for ultrafiltration-based approaches were evaluated across two phases. The first phase entailed an initial evaluation using a small sample set, while the second phase further evaluated five protocols using wastewater samples of varying SARS-CoV-2 concentrations. Permutations in the pre-concentration, virus concentration and RNA extraction steps were evaluated. Among PEG-based methods, SARS-CoV-2 virus recovery was optimal with 1) the removal of debris prior to processing, 2) 2 h to 24 h incubation with 8% PEG at 4 °C, 3) 4000 xg or 14,000 xg centrifugation, and 4) a column-based RNA extraction method, yielding virus recovery of 42.4-52.5%. Similarly, the optimal protocol for ultrafiltration included 1) the removal of debris prior to processing, 2) ultrafiltration, and 3) a column-based RNA extraction method, yielding a recovery of 38.2%. This study also revealed that SARS-CoV-2 RNA recovery for samples with higher virus concentration were less sensitive to changes in the PEG method, but permutations in the PEG protocol could significantly impact virus yields when wastewater samples with lower SARS-CoV-2 RNA were used. Although both PEG precipitation and ultrafiltration methods resulted in similar SARS-CoV-2 RNA recoveries, the former method is more cost-effective while the latter method provided operational efficiency as it required a shorter turn-around-time (PEG precipitation, 9-23 h; Ultrafiltration, 5 h). The decision on which method to adopt will thus depend on the use-case for wastewater testing, and the need for cost-effectiveness, sensitivity, operational feasibility and scalability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

In the late December of 2019, a novel coronavirus was discovered in Wuhan, China. In March 2020, WHO announced this epidemic had become a global pandemic and that the novel coronavirus may be mild to most people. However, some people may experience a severe illness that results in hospitalization or maybe death. COVID-19 classification remains challenging due to the ambiguity and similarity with other known respiratory diseases such as SARS, MERS, and other viral pneumonia. The typical symptoms of COVID-19 are fever, cough, chills, shortness of breath, loss of smell and taste, headache, sore throat, chest pains, confusion, and diarrhoea. This research paper suggests the concept of transfer learning using the deterministic algorithm in all binary classification models and evaluates the performance of various CNN architectures. The datasets of 746 CT images of COVID-19 and non-COVID-19 were divided for training, validation, and testing. Various augmentation techniques were applied to increase the number of datasets except for testing images. The images were then pretrained using CNN to obtain a binary class. ResNeXt101 and ResNet152 have the best F1 score of 0.978 and 0.938, whereas GoogleNet has an F1 score of 0.762. ResNeXt101 and ResNet152 have an accuracy of 97.81% and 93.80%. ResNeXt101, DenseNet201, and ResNet152 have 95.71%, 93.81%, and 90% sensitivity, whereas ResNeXt101, ResNet101, and ResNet152 have 100%, 99.58%, and 98.33 specificity, respectively., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2022 Serena Low Woan Ching et al.)

Wastewater-based surveillance for SARS-CoV-2 has been used for the early warning of transmission or objective trending of the population-level disease prevalence. Here, we describe a new use-case of conducting targeted wastewater surveillance to complement clinical testing for case identification in a small community at risk of COVID-19 transmission. On 2 July 2020, a cluster of COVID-19 cases in two unrelated households residing on different floors in the same stack of an apartment building was reported in Singapore. After cases were conveyed to healthcare facilities and six healthy household contacts were quarantined in their respective apartments, wastewater surveillance was implemented for the entire residential block. SARS-CoV-2 was subsequently detected in wastewaters in an increasing frequency and concentration, despite the absence of confirmed COVID-19 cases, suggesting the presence of fresh case/s in the building. Phone interviews of six residents in quarantine revealed that no one was symptomatic (fever/respiratory illness). However, when nasopharyngeal swabs from six quarantined residents were tested by PCR tests, one was positive for SARS-CoV-2. The positive case reported episodes of diarrhea and the case's stool sample was also positive for SARS-CoV-2, explaining the SARS-CoV-2 spikes observed in wastewaters. After the case was conveyed to a healthcare facility, wastewaters continued to yield positive signals for five days, though with a decreasing intensity. This was attributed to the return of recovered cases, who had continued to shed the virus. Our findings demonstrate the utility of wastewater surveillance as a non-intrusive tool to monitor high-risk COVID-19 premises, which is able to trigger individual tests for case detection, highlighting a new use-case for wastewater testing., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Crossostephium chinense is a traditional Chinese medicinal herb and it is often cultivated as an ornamental plant. Previous studies on this species mainly focused on its chemical composition and it was rarely represented in genetic studies, and thus genomic resources remain scarce., Methods and Results: Both chloroplast and nuclear polymorphic microsatellites of C. chinense were screened from genome skimming data of two individuals. 64 and 63 cpSSR markers were identified from two chloroplast genomes of C. chinense. A total of 133 polymorphic nSSRs were developed. Ten nSSRs were randomly selected to test their transferability across 35 individuals from three populations of C. chinense, and 20 individuals each of Artemisia stolonifera and A. argyi. Cross-amplifications were successfully done for C. chinense and were partially amplified for both Artemisia species. The number of alleles varied from two to nine. The observed heterozygosity and expected heterozygosity per locus ranged from 0.000 to 0.286 and from 0.029 to 0.755, respectively., Conclusions: In this study, we developed polymorphic cpSSRs and nSSRs markers for C. chinense based on genome skimming sequencing. These genomic resources will be valuable for population genetics and conservation studies in C. chinense and Artemisia., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Premise: Within a broader study on leaf fossilization in freshwater environments, a long-term study on the development and microbiome composition of biofilms on the foliage of aquatic plants has been initiated to understand how microbes and biofilms contribute to leaf decay and preservation. Here, water lily leaves are employed as a study model to investigate the relationship between bacterial microbiomes, biodegradation, and fossilization. We compare four DNA extraction kits to reduce biases in interpretation and to identify the most suitable kit for the extraction of DNA from bacteria associated with biofilms on decaying water lily leaves for 16S rRNA amplicon analysis., Methods: We extracted surface-associated DNA from Nymphaea leaves in early stages of decay at two water depth levels using four commercially available kits to identify the most suitable protocol for bacterial extraction, applying a mock microbial community standard to enable a reliable comparison of the kits., Results: Kit 4, the FastDNA Spin Kit for Soil, resulted in high DNA concentrations with better quality and yielded the most accurate depiction of the mock community. Comparison of the leaves at two water depths showed no significant differences in community composition., Discussion: The success of Kit 4 may be attributed to its use of bead beating with a homogenizer, which was more efficient in the lysis of Gram-positive bacteria than the manual vortexing protocols used by the other kits. Our results show that microbial composition on leaves during early decay remains comparable and may change only in later stages of decomposition., (© 2021 The Authors. Applications in Plant Sciences published by Wiley Periodicals LLC on behalf of Botanical Society of America.)

Several commercial Zika virus (ZIKV) serology assays have been developed since the recognition of ZIKV outbreaks as a Public Health Emergency of International Concern in 2016. However, test interpretation for ZIKV serology can be challenging due to antibody cross-reactivity with other flaviviruses like dengue virus (DENV). Therefore, we sought to evaluate the performance of eight commercially available ZIKV IgM and IgG assays across three testing platforms, namely, immunochromatographic tests (ICT), ELISAs and immunofluorescence tests (IIFT). The test panel comprised of 278 samples, including acute and convalescent sera or plasma from ZIKV-confirmed, DENV-confirmed, non-ZIKV and non-DENV patients, and residual sera from healthy blood donors. The ZIKV IgM and IgG serology assays yielded higher test sensitivities of 23.5% - 97.1% among ZIKV convalescent samples as compared to 5.6% - 27.8% among ZIKV acute samples; the test specificities were 63.3% - 100% among acute and convalescent DENV, non-DENV samples. Among the ELISAs and IIFTs, the Diapro ZIKV IgM ELISA demonstrated high test sensitivity (96%) and specificity (80%) when tested on early convalescent samples, while the Euroimmun ZIKV IgG ELISA yielded the highest test specificity of 97% - 100% on samples from non-ZIKV patients and healthy blood donors. For rapid ICTs, the LumiQuick IgM rapid ICT yielded low test sensitivity, suggesting its limited utility. We showed that commercial ZIKV IgM and IgG serology assays have differing test performances, with some having moderate to high test sensitivities and specificities when used in a dengue endemic setting, although there were limitations in IgG serology., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Distal oblique bundle (DOB) reconstruction for distal radioulnar joint (DRUJ) instability is an alternative to the Adams 2-incision distal radioulnar ligament reconstruction. The DOB reconstruction offers a single incision and is a technically less demanding procedure requiring a shorter tendon autograft. The DOB and Adams reconstruction may provide similar stability. This study sought to compare the biomechanical stability of the 2 DRUJ reconstructions. We hypothesized that DOB reconstruction would result in equivalent DRUJ translation, cyclic loading to failure, and maximal load to failure compared with the Adams reconstruction., Methods: Ten fresh-frozen cadaver arms underwent DOB or Adams reconstructions. Volar, dorsal, and total translation of the radius relative to the ulna at the DRUJ were measured before and after each reconstruction. Translation was measured with a 20-N force in neutral position and 60° in pronation and supination. Measurements were obtained using a custom jig and electromagnetic motion-tracking system sensors. Total cycles and maximal load to failure of each reconstruction were measured and recorded using an electromechanical testing machine., Results: There was a DOB incidence of 70%. Distal radioulnar joint translation, total cycles, and failure load were similar for the 2 reconstructions. On average, the DOB reconstruction had less dorsal translation than did the Adams in supination. Translation in the DOB reconstruction was similar to that of native DRUJs. In supination, on average, the Adams reconstruction had greater total, volar, and dorsal translation compared with native DRUJs., Conclusions: In terms of translation, cyclical loading, and maximal load to failure, the DOB reconstruction for DRUJ instability is similar to the Adams reconstruction., Clinical Relevance: This pilot study supports the DOB reconstruction as a possible alternative to the Adams reconstruction for DRUJ instability. The DOB reconstruction may theoretically reduce patient morbidity because it requires only one incision and a shorter tendon graft. However, further clinical and cadaveric studies are required to determine biomechanical equivalence and impact on patient morbidity., (Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Introduction: Open reduction with internal fixation (ORIF) and intramedullary nailing (IMN) have similar union rates for treating humerus shaft fractures, but IMN leads to increased incidence of shoulder impingement and reoperation. The difference in 30-day readmission rate and length of stay (LOS) between these procedures is unknown. The objective of the study was to compare 30-day unplanned readmissions and length of stay between humeral shaft fractures fixed with either ORIF or IMN., Methods: The nationwide readmissions database (NRD) was queried for patients with humeral shaft fractures treated with ORIF or IMN between 2015-2016. IMN cases were propensity matched to ORIF cases based on demographic and co-morbid variables. Multivariable logistic regression determined if treatment modality was an independent risk factor for 30-day readmission or length of stay >3 days., Results: There were 406 patients treated with IMN matched to 406 patients treated with ORIF. The 30-day readmission rate was 6.4% for IMN and 4.9% for ORIF (p = 0.45), and the median LOS was 3 days for each group (p = 0.45). Congestive heart failure (CHF)(OR=2.7, p = 0.04), depression (OR=3.3, p = 0.0008), and electrolyte abnormality (OR=3.6, p = 0.0003) were independent risk factors for readmission. Older age (OR=1.02, p = 0.03), CHF (OR=2.4, p = 0.03), electrolyte abnormality (OR=2.6, p = 0.0001), obesity (OR=2.8, p<0.0001), Medicaid (OR=2.1, p = 0.04), discharge to a facility (OR = 5.2, p<0.0001), discharge with home health services (OR=2.4, p = 0.0003), and open fracture (OR=2.3, p = 0.01) were independent risk factors for LOS >3 days. Procedure (ORIF vs. IMN) was not a predictor of 30-day readmission or LOS >3 days., Conclusion: Comorbid conditions are risk factors for 30-day readmission and increased LOS. Comorbidity, discharge disposition, and open fractures are risk factors for increased LOS. Treating humeral shaft fractures with either ORIF or IMN did not affect readmission or length of stay., Competing Interests: Declaration of Competing Interest The authors have no relevant conflicts of interest. The senior author, Emmanuel M. Illical, was a paid consultant for Biocomposits Inc. (Wilmington, NC, USA). This does not pose a conflict of interest relevant to the submitted work., (Copyright © 2020. Published by Elsevier Ltd.)

Introduction Expeditious and accurate diagnosis of septic wrist arthritis is essential to prevent further cartilage damage, systemic infection, osteomyelitis, and loss of limb. There is limited literature on the incidence and clinical factors that are predictive of septic wrist arthritis. Objective We aimed to investigate the incidence of septic wrist arthritis and identify risk factors and laboratory values associated with septic wrist arthritis. Materials and Methods Data were collected on adult patients presenting with a painful, swollen wrist to two level 1 urban hospitals from 2004 to 2014. Demographics, comorbidities, and laboratory values of patients who had wrist aspiration were collected. Results There was an overall incidence of 0.4%. Increased synovial white blood cells (WBC), being febrile, positive blood cultures, and smoking were significantly associated with septic wrist arthritis on univariate analysis. Synovial WBC was also found to be significant on multivariate analysis. A synovial WBC of 87,750 cells/µL had an optimal sensitivity and specificity of 73% and 86%, respectively, for diagnosing septic wrist arthritis. Conclusion Synovial WBC can be a useful diagnostic tool for septic wrist arthritis. In addition, positive blood cultures, being febrile, and smoking history can help predict septic wrist arthritis in patients with presenting with painful, swollen wrists., Competing Interests: Conflict of Interest None declared., (© Thieme Medical Publishers.)

Purpose: The results of spinal accessory to suprascapular nerve transfers have been less reliable than other nerve transfers in the upper limb, possibly owing to compression of the nerve by the suprascapular ligament. The posterior approach has been advocated to allow for release of the ligament. The purpose of this study was to determine whether a ligament release is possible from the anterior approach., Methods: Nine fresh-frozen cadavers were dissected to determine whether the ligament could be approached and released from the anterior approach. Complete ligament release was demonstrated by subluxation of the nerve out of the suprascapular notch., Results: Ligament release was achieved in all specimens, although in one, confirmation of complete release required a posterior approach., Conclusions: Release of the suprascapular ligament to eliminate a potential source of compression of the suprascapular nerve during spinal accessory to suprascapular nerve transfer is possible through an anterior approach., Clinical Relevance: Release of the suprascapular ligament through an anterior approach allows this procedure to be performed through the same approach as brachial plexus exploration and spinal accessory nerve to suprascapular nerve transfer. This method could reduce surgical time and patient repositioning and avoid additional incisions., (Copyright © 2019 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

National data on dengue notifications do not capture all dengue infections and do not reflect the true intensity of disease transmission. To assess the true dengue infection rate and disease control efforts in Singapore, we conducted age-stratified serosurveys among residents after a 2013 outbreak that was the largest dengue outbreak on record. The age-weighted prevalence of dengue immunoglobulin G among residents was 49.8% (95% confidence interval: 48.4, 51.1) in 2013 and 48.6% (95% confidence interval: 47.0, 50.0) in 2017; prevalence increased with age. Combining these data with those from previous serosurveys, the year-on-year estimates of the dengue force of infection from 1930 to 2017 revealed a significant decrease from the late 1960s to the mid-1990s, after which the force of infection remained stable at approximately 10 per 1,000 persons per year. The reproduction number (R0) had also declined since the 1960s. The reduction in dengue transmission may be attributed to the sustained national vector program and partly to a change in the age structure of the population. The improved estimated ratio of notified cases to true infections, from 1:14 in 2005-2009 to 1:6 in 2014-2017, signifies that the national notification system, which relies on diagnosed cases, has improved over time. The data also suggest that the magnitudes of dengue epidemics cannot be fairly compared across calendar years and that the current disease control program remains applicable., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Background: The purpose of this study was to compare short-term side effects of aspirin (ASA) 325 mg vs ASA 81 mg orally twice daily (PO BID) when used as thromboembolic prophylaxis following primary total joint arthroplasty., Methods: A 1-year prospective cohort study was performed on 643 primary unilateral total joint arthroplasty patients operated on by a single surgeon. Two hundred eighty-two patients were administered ASA 325 mg PO BID and 361 patients were administered ASA 81 mg PO BID for 1 month. A questionnaire assessing the side effects of ASA intake was administered 1 month postoperatively., Results: The overall rate of gastrointestinal side effects (GI upset and nausea) was 1.9%, but ASA 325 mg had a higher rate 9/282 (3.2%) than ASA 81 mg 3/361 (0.8%), P = .04. Overall GI bleeding was 0.9%, with 2/282 (0.7%) in the ASA 325 mg group, vs 4/361 (1.1%) in the ASA 81 mg group, P = .70. One patient in the ASA 81 mg group (0.3%) developed a deep vein thrombosis. No patient developed pulmonary embolism, periprosthetic joint infection, tinnitus, wheezing and/or shortness of breath, chest pain, or headaches. In the ASA 325 mg group, 9/282 (3.2%) discontinued ASA and in the ASA 81 mg group, 8/361 (2.2%) discontinued ASA, P = .47. Four patients in the ASA 325 group (1.4%) changed to ASA 81 mg., Conclusion: ASA 81 mg is associated with significantly less GI distress and nausea compared with ASA 325 mg. GI bleeding was equally prevalent between the 2 dosing regimens, so patients need to be informed of this risk regardless of the ASA dose., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Lumbar scoliosis affects patients' quality of life and will increasingly burden the health-care system as the population ages, yet there have been few reports of its prevalence in Asians. The aim of this study was to identify the prevalence of scoliosis, curve characteristics, and risk factors for development of scoliosis in an Asian population., Methods: A retrospective cross-sectional study was conducted using spinal images obtained from dual x-ray absorptiometry (DXA) scans of individuals ≥40 years of age. Scoliosis was defined as a curvature of >10°. A multivariate analysis for risk factors for development of lumbar scoliosis was performed., Results: Of 7,075 patients studied, 645 (9.1%) were identified as having scoliosis. The average age of the patients with scoliosis was 61 years (range, 40 to 98 years). The mean curve prevalence was 9.4% in women and 6.5% in men. The average Cobb angle was 16.5° (range, 10° to 66°). Multivariate analysis showed an increased risk of scoliosis in women (relative risk [RR] = 2.4, 95% CI =1.4 to 4.3), Chinese patients (RR = 2.4, 95% CI = 1.4 to 4.3), Malay patients (RR = 2.5, 95% CI = 1.3 to 4.9), and patients with spinal fracture (RR = 5.1, 95% CI = 3.0 to 8.8). The risk of scoliosis was found to increase as patients progressed through each decade of life after the age of 40 years (6th decade: RR = 1.6, 95% CI = 1.1 to 2.4, p = 0.026; 7th decade: RR = 2.7, 95% CI = 1.8 to 4.1, p < 0.001; 8th decade: RR = 5.0, 95% CI = 3.2 to 7.9, p < 0.001; and 9th decade: RR = 8.8, 95% CI = 4.3 to 17.9, p < 0.001)., Conclusions: The prevalence of lumbar scoliosis in Asian adults was found to be 9.1%. A nearly exponential increase in scoliosis prevalence from the 5th decade of life (4%) to the ≥9th decade (25%) and a majority of left-sided scoliotic curves, measuring between 10° and 19° with an L2 apex, was found. Older age, female sex, Chinese or Malay race, and vertebral fracture increased the risk of scoliosis developing., Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence., (Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.)

Homoplastic evolution of 'unique' morphological characteristics in the Schismatoglottideae - many previously used to define genera - prompted this study to compare morphology and function in connection with pollination biology for Aridarum nicolsonii, Phymatarum borneense and Schottarum sarikeense. Aridarum nicolsonii and P. borneense extrude pollen through a pair of horned thecae while S. sarikeense sheds pollen through a pair of pores on the thecae. Floral traits of spathe constriction, presence and movement of sterile structures on the spadix, the comparable role of horned thecae and thecae pores, the presence of stamen-associated calcium oxalate packages, and the timing of odour emission are discussed in the context of their roles in pollinator management. Pollinators for all investigated species were determined to be species of Colocasiomyia (Diptera: Drosophilidae)., (© 2015 German Botanical Society and The Royal Botanical Society of the Netherlands.)

Purpose: To review records of 2702 patients with osteoporotic hip fractures in a Singaporean hospital., Methods: Medical records of 1905 women and 797 men, aged 50 to 112 (median, 78) years, who were admitted to a Singaporean hospital with an osteoporotic hip fracture (ICD9 820) between January 2000 and December 2010 were reviewed., Results: Female patients were significantly older than male patients (p<0.0005). The trend for the median patient age over the 10-year period has increased significantly in women (r=0.826, p=0.002) but not in men. Of the hip fractures, 49.4% were femoral neck fractures and 50.6% were intertrochanteric/ basicervical fractures. The rate of intertrochanteric/ basicervical fractures was higher in men than women (61.2% vs. 46.1%, p<0.0005). Increased age, ischaemic heart disease, Parkinson's disease, and being Malay or Caucasian or Sikh were more likely to have intertrochanteric/basicervical fractures than femoral neck fractures. Femoral neck fractures were usually treated with hemiarthroplasty (68.8%), cancellous screw fixation (20.6%), and conservative methods (20.5%), whereas intertrochanteric/basicervical fractures were usually treated with dynamic hip screw fixation (76.3%) and conservative methods (15.6%). 84 women and 26 men sustained a subsequent osteoporotic hip fracture on the contralateral side after a median interval of 2 (range, 0-8) years. 11 of these 110 patients were already on osteoporosis medication., Conclusion: The rate of osteoporotic hip fractures has increased, particularly among women, over the 10- year period. The rate of intertrochanteric/basicervical fractures was higher in men than women.

Routine national notifications of dengue cases typically do not reflect the true dengue situation due to large proportion of unreported cases. Serosurveys, when conducted periodically, could shed light on the true dengue infections in the population. To determine the magnitude of dengue infections of the adult population in Singapore following the outbreak in 2007, we performed a cross-sectional study on blood donor samples from December 2009 to February 2010. The residual blood of 3,995 donors (aged 16-60 years) was screened for the presence of dengue-specific immunoglobulin G (IgG) and IgM using enzyme-linked immunosorbent assay (ELISA) kits. The age-weighted IgG prevalence of residents was 50.8% (N = 3,627, 95% confidence interval [CI] = 49.4-52.3%). Dengue IgG prevalence increased with age, with the lowest in 16-20 years age group (16.1%) and the highest in 56-60 years age group (86.6%). Plaque reduction neutralization test (PRNT) on samples of young resident adults (aged 16-30 years) revealed lower prevalence of neutralizing antibodies to each serotype, ranging from 5.4% to 20.3% compared with the older age groups. The level of exposure to dengue among the young adults is relatively low despite the endemicity of the disease in Singapore. It partially explains the population's susceptibility to explosive outbreaks and the high incidence rate among young adults., (© The American Society of Tropical Medicine and Hygiene.)

Francis Daniels Moore was a pioneer ahead of his time who made numerous landmark contributions to the field of surgery, including the understanding of metabolic physiology during surgery, liver and kidney transplant, and the famous Study on Surgical Services of the United States (SOSSUS) report of 1975 that served for decades as a guideline for development of surgical residencies. He was the epitome of what a physician should be, a compassionate and dedicated surgeon, innovative scientist, and a medical professional dedicated to quality medical education across all specialties.

Low-density lipoprotein cholesterol (LDL-C) is a major risk factor for atherosclerotic disease. Despite its limitations, Friedewald-calculated LDL-C (F-LDL-C) remains widely used for LDL-C determination. In this observational study of 1999 adults with type 2 diabetes mellitus (T2DM), we compare the accuracy of F-LDL-C to directly measured LDL-C (M-LDL-C) and derived and validated a new [SMART2D (Singapore Study of MAcro-angiopathy and Micro-Vascular Reactivity in Type 2 Diabetes)] formula to estimate LDL-C. From 1000 randomly selected patients, M-LDL-C was compared to F-LDL-C. Using multiple linear regression to identify independent predictors for M-LDL-C, the SMART2D equation was derived and subsequently validated in the next 981 patients. F-LDL-C was 0.367 (0.216) mmol/L lower than M-LDL-C. This difference was -0.009 (0.189) for SMART2D-LDL-C. Using F-LDL-C, 27% with M-LDL-C ≥2.6 mmol/L were classified as LDL-C <2.6 mmol/L, reduced to 2.1% when using SMART2D-LDL-C. With F-LDL-C, misclassification was greater when triglycerides were ≥2.2 mmol/L, especially for the lower LDL-C cut-offs (1.8 and 2.6 mmol/L), and this was markedly improved with SMART2D-LDL-C. In conclusion, in T2DM, F-LDL-C underestimates M-LDL-C, with misclassifications that may potentially have an impact on therapeutic decisions in T2DM. The SMART2D equation improves accuracy of estimate, reducing misclassifications. Trials will be needed to ascertain the clinical significance of these findings., (© The Author(s) 2014.)

Microalgae in three submerged ceramic membrane photobioreactors (SCMPBRs) with different hydraulic retention times (HRTs) were fed with permeate of a submerged ceramic membrane bioreactor for a period of 3 months to investigate the lipid content and also the biodiesel quality produced at different HRTs. The lipid content, lipid productivity and fatty acid compositions for all three SCMPBRs were not significantly different at the 95% confidence level. These results suggested that insignificant change in the amount of fatty acids was observed at different HRTs that supplied varying concentration of nitrate in the medium. Among the fatty acids, palmitic acid, palmitoleic acid, oleic acid and linoleic acid were the main components, whereas stearic acid was a minor fatty acid. Since there was insignificant effect of HRT on lipid content, lipid productivity and fatty acid compositions, the optimum HRT for SCMPBRs can then be designed based on optimum nutrient removal performance and low membrane fouling propensity.

Chikungunya virus (CHIKV) is an arthropod-borne virus responsible for recent epidemics in the Asia Pacific regions. A customized gene expression microarray of 18,760 transcripts known to target Aedes mosquito genome was used to identify host genes that are differentially regulated during the infectious entry process of CHIKV infection on C6/36 mosquito cells. Several genes such as epsin I (EPN1), epidermal growth factor receptor pathway substrate 15 (EPS15) and Huntingtin interacting protein I (HIP1) were identified to be differentially expressed during CHIKV infection and known to be involved in clathrin-mediated endocytosis (CME). Transmission electron microscopy analyses further revealed the presence of CHIKV particles within invaginations of the plasma membrane, resembling clathrin-coated pits. Characterization of vesicles involved in the endocytic trafficking processes of CHIKV revealed the translocation of the virus particles to the early endosomes and subsequently to the late endosomes and lysosomes. Treatment with receptor-mediated endocytosis inhibitor, monodansylcadaverine and clathrin-associated drug inhibitors, chlorpromazine and dynasore inhibited CHIKV entry, whereas no inhibition was observed with caveolin-related drug inhibitors. Inhibition of CHIKV entry upon treatment with low-endosomal pH inhibitors indicated that low pH is essential for viral entry processes. CHIKV entry by clathrin-mediated endocytosis was validated via overexpression of a dominant-negative mutant of Eps15, in which infectious entry was reduced, while siRNA-based knockdown of genes associated with CME, low endosomal pH and RAB trafficking proteins exhibited significant levels of CHIKV inhibition. This study revealed, for the first time, that the infectious entry of CHIKV into mosquito cells is mediated by the clathrin-dependent endocytic pathway.

By disrupting microRNA (miRNA) biogenesis, we previously showed that this pathway is critical for the differentiation and function of T cells. Although various cloning studies have shown that many miRNAs are expressed during T cell development, and in a dynamic manner, it was unclear how comprehensive these earlier analyses were. We therefore decided to profile miRNA expression by next generation sequencing. Furthermore, we profiled miRNA expression starting from the hematopoietic stem cell. This analysis revealed that miRNA expression during T cell development is extremely dynamic, with 645 miRNAs sequenced, and the expression of some varying by as much as 3 orders of magnitude. Furthermore, changes in precursor processing led to altered mature miRNA sequences. We also analyzed the structures of the primary miRNA transcripts expressed in T cells and found that many were extremely long. The longest was pri-mir-29b-1/29a at ∼168 kb. All the long pri-miRNAs also displayed extensive splicing. Our findings indicate that miRNA expression during T cell development is both a highly dynamic and a highly regulated process.

The laminar fluid diffusion interface (LFDI) is a microfluidic tool that manipulates the composition of liquid mixtures by exploiting differences among diffusion coefficients of the dissolved components. One application is the preprocessing of (bio)fluids prior to spectroscopic characterization. For example, in the case of infrared (IR) spectroscopy, the technique can improve sensitivity to low-concentration serum metabolites. The practical benefit is "metabolic fingerprinting" measurements that are more sensitive to low-concentration metabolites than are the counterpart measurements for the original serum sample. Optimal use of the LFDI technique has proven elusive, since the composition of the product of interest is very sensitive to the choice of flow rates for the liquid streams entering and emerging from the LFDI channel. To provide the basis for optimal use, this study had the objective of developing a simulation package that predicts the composition of the LFDI product, given the LFDI structural and operating parameters. To demonstrate the utility of the simulations, composition of the LFDI products predicted for two illustrative sets of trials were compared with experimental data. The flow rates thus derived provided a LFDI product that is relatively rich in serum metabolites, while largely depleted of protein, and very well suited for subsequent IR spectroscopic characterization.

Infrared (IR) spectroscopy has previously been established as a means to accurately quantify several serum and urine metabolites, based upon spectroscopy of dry films. The same technique has also provided the basis to develop certain diagnostic tests, developed in the 'metabolomics' spirit. Here, we report on the further development of an integrated microfluidic-IR technology and technique, customized with the aim of dramatically extending the capabilities of IR spectroscopy in both analytical and diagnostic (metabolomic) applications. By exploiting the laminar fluid diffusion interface (LFDI), serum specimens are processed to yield product streams that are better suited for metabolic fingerprinting; metabolites are captured within the aqueous product stream, while proteins (which otherwise dominate the spectra of films dried from serum) are present in much reduced concentration. Spectroscopy of films dried from the aqueous stream then provides enhanced diagnostic and analytical sensitivity. The manuscript introduces an LFDI card design that is customized for integration with IR spectroscopy, and details the development of a quantitative assay for serum creatinine--based upon LFDI-processed serum samples--that is substantially more accurate (standard error of calibration, SEC = 43 micromol/L) than the corresponding assay based upon unprocessed serum specimens (SEC = 138 micromol/L). Preliminary results of diffusion modeling are reported, and the prospects for further optimization of the technique, guided by accurate modeling, are discussed.

Bayesian statistical modeling has several benefits within an ecological context. In particular, when observed data are limited in sample size or representativeness, then the Bayesian framework provides a mechanism to combine observed data with other "prior" information. Prior information may be obtained from earlier studies, or in their absence, from expert knowledge. This use of the Bayesian framework reflects the scientific "learning cycle," where prior or initial estimates are updated when new data become available. In this paper we outline a framework for statistical design of expert elicitation processes for quantifying such expert knowledge, in a form suitable for input as prior information into Bayesian models. We identify six key elements: determining the purpose and motivation for using prior information; specifying the relevant expert knowledge available; formulating the statistical model; designing effective and efficient numerical encoding; managing uncertainty; and designing a practical elicitation protocol. We demonstrate this framework applies to a variety of situations, with two examples from the ecological literature and three from our experience. Analysis of these examples reveals several recurring important issues affecting practical design of elicitation in ecological problems.

Background and Objective: The purpose of this study was to determine any difference between Porphyromonas gingivalis isolates from periodontally healthy sites as compared to those from diseased sites with respect to the ability to invade host cells., Material and Methods: Subgingival plaque samples were obtained from periodontally healthy and diseased sites using paper points. P. gingivalis colonies were isolated and tested, using an antibiotic protection assay, for their ability to invade KB cells. P. gingivalis 381 and Escherichia coli MC1061 were used as controls., Results: Mean values of 16.79 +/- 0.86 x 10(3) colony-forming units/mL and 26.14 +/- 2.11 x 10(3) colony-forming units/mL were observed in invasion assays for isolates from periodontally healthy and diseased sites, respectively. P. gingivalis present in diseased sites had significantly greater invasive abilities than strains isolated from healthy sites. No statistical difference was noted between male or female subjects concerning the degree of invasion; isolates from diseased sites from both genders had significantly greater invasion abilities than those from healthy sites. A significant correlation was found between the increased invasive capabilities of P. gingivalis isolates vs. an increased probing depth., Conclusion: The increased invasion noted with P. gingivalis isolates from diseased sites vs. healthy sites, and the increased invasive capabilities with increasing probing depth, indicate that P. gingivalis isolates have a varying ability to invade host cells in the periodontal pocket.

Introduction: Pertussis is a worldwide, highly communicable, vaccine-preventable respiratory disease and is a frequent but often underestimated cause of prolonged cough illness in adults. Immunity from childhood pertussis immunization is thought to last only up to 10 years. The incidence of adult pertussis has been estimated to be 200 to 500 per 100,000 persons-years. Acellular pertussis vaccines have been evaluated in adults and confer safe and effective protection and now exist as combination vaccine together with tetanus and diphtheria., Methods: We did a questionnaire survey to assess the knowledge, attitude, and practices toward pertussis in adult travelers. We consecutively enrolled all travelers who presented at the Travellers' Health & Vaccination Centre in Singapore in 1 month., Results: Of 218 consecutively enrolled travelers, 184 (84.4%) completed the questionnaire; of which 80% were Singaporeans. Seventy persons (38%) did not know or gave a wrong answer for the mode of transmission of pertussis, 147 (83%) had never heard of a pertussis vaccine for adults, and almost none had received an adult pertussis vaccine booster. Travelers from Western countries were seven times [95% confidence interval (CI): 2-27] more likely than Asians to have knowledge about pertussis; women were 4.27 times (95% CI: 1.59-11.53) more likely than men to be aware of the booster vaccine, after adjusting for nationality ( p= 0.004)., Conclusions: Knowledge about pertussis was poor among adult travelers. Although pertussis was viewed as a serious illness by the majority of participants, and 38% expressed the desire to be vaccinated, almost no one had received the pertussis vaccine booster. Awareness about pertussis, its risks, and prevention via vaccination need to be increased among adult travelers. Studies are needed to quantify the risk of pertussis in adult travelers.

We investigated the prospective associations between attitudes about sacrifice and marital outcomes in 38 married couples. Specifically, a measure of satisfaction with sacrifice was proposed to be a potent longitudinal predictor of marital adjustment and distress based on existing cross-sectional studies and also to mediate the association between commitment and marital adjustment. Results demonstrated that attitudes about sacrifice discriminated between couples who would become distressed versus nondistressed over time. Sacrifice attitudes also predicted the maintenance of relationship adjustment over time even better than earlier relationship adjustment. Finally, sacrifice attitudes mediated the link between commitment and relationship adjustment for husbands, but not wives. Implications for intervention are discussed.

Osteoporosis might be due to defects in mesenchymal stem cells (MSCs) that lead to reduced proliferation and osteoblast differentiation. We hypothesized that transplantation of MSCs into sites at risk for developing osteoporotic bone could improve bone structure and biomechanics. The aim of this study was to establish an osteoporosis rabbit model by ovariectomy (OVX), characterize the autologous MSCs from the OVX rabbits, and transplant the autologous MSCs into the OVX rabbits. MSCs harvested from bone marrow of normal and OVX rabbits were culture expanded and differentiated in osteogenic medium. Phenotypes were evaluated by collagen I immunostaining, von Kossa staining, and quantitative assays of bone-specific alkaline phosphatase (B-ALP) and osteocalcin (OCN). MSCs were transfected with green fluorescence protein (GFP) and implanted in the gluteus muscle to trace their fate in vivo. Cultured autologous MSCs from OVX rabbits were constructed in calcium alginate gels and then transplanted in the distal femurs. At 4 and 8 weeks after implantation, histomorphometrical and biomechanical analyses were performed on the samples. MSCs from OVX rabbits displayed higher B-ALP activity, but had similar OCN levels as compared to those from sham rabbits. After 8 weeks of implantation, more bone apposition was found in the MSC-alginate-treated group. Histomorphometry indicated increased trabecular thickness. Histology also illustrated improved microstructures with newly formed osteoids and enhanced trabecular thickness. In addition, biomechanical testing revealed stronger stiffness in the MSC-alginate treatment group. Therefore, this study implies that transplantation of MSCs can help to strengthen osteoporotic bone in rabbits.

Ethnic differences in bone density and hip geometry are known to exist, even within the same population. A recent study in Singapore showed that there were significant racial differences in hip fracture rates, with Chinese having the highest incidence of hip fractures. The aim of this study was to compare the bone mineral density (BMD) and hip axis length in Chinese, Malay, and Indian women. A total of 1575 women aged 20-59 yr were recruited, of which 77.6% (1222) were Chinese, 7.7% (122) Malays, and 14.7% (231) Indians. There was no significant difference in peak BMD of both lumbar spine and femoral neck among the three ethnic groups. However, in the older age group (50-59 yr), both Chinese and Malay women had significantly lower femoral neck BMD compared to Indian women. There was no significant loss in BMD of the lumbar spine between the second and fifth decades in all the three races. Between the second and fifth decade, Chinese and Malay women had significant bone loss in the femoral neck of 6.6% and 8.2%, respectively, whereas Indian women did not show any significant bone loss. Chinese women had significantly longer hip axis length compared to either Malay or Indian women (9.87 +/- 0.52 cm vs 9.67 +/- 0.49 cm; p < 0.005; and 9.69 +/- 0.55 cm, p < 0.05, respectively). The initial findings suggest racial differences in bone density and hip geometry exist in the local community. Future research should include prospective, longitudinal studies to determine the age-related bone loss in these three racial groups. It is also important to investigate the differences of spine and hip fracture rates and their relationship with bone density and hip axis length.

Weakness is recognized as a major problem after stroke. This study examined the torque-angle curves of stroke individuals and compared them with those of neurologically normal controls to determine (i) if stroke patients were selectively weak when their muscles were placed in a shortened range and (ii) whether contracture influenced any selective weakness. This descriptive research study measured elbow flexor and extensor torque-angle curves and contracture. Twenty-two stroke subjects who had suffered a stroke 5 months to 6 years ago and 11 neurologically normal controls of similar age participated. Torque-angle curves of the elbow flexors and extensors were determined by measuring maximum isometric torque at 0, 20, 40, 60, 80, 100 and 120 degrees of elbow flexion (0 degrees being full elbow extension), where possible. Contracture of the elbow flexors and extensors was measured as the loss of passive elbow joint range of motion. Repeated measures analysis of variance revealed that the torque-angle curves of stroke subjects (with or without contracture) were significantly different from those of the control subjects for both the elbow flexors (P < 0.05) and extensors (P < 0.05). The stroke subjects appeared relatively weaker when the muscles were in their shortened range. This study confirms that selective weakness exists at short muscle lengths after stroke. The findings of this study help to explain why people after stroke have difficulty functioning when their muscles are in their shortened range. Therefore, strength training should be targeted specifically at muscles at their shortened lengths in order to promote the recovery of function after stroke.

Unlabelled: A prospective open study was performed to determine the efficacy and safety of pamidronate in improving bone mineralisation and reducing fracture incidence in osteogenesis imperfecta (OI). Intravenous pamidronate was administered at 1.5 mg/kg bi-monthly to six children with OI, over 12-23 months. The number of fractures decreased from median of 3 (range 1-12) to 0 fractures/year (range 0-4) (P<0.05). After 12 months of treatment, there was significant improvement in areal bone mineral density (BMD) z-scores of the lumbar spine from median of -2.40 (range -3.20 to -1.67) to -1.90 (range -2.38 to -0.91) (P<0.05) and in the volumetric BMD which increased from median of 0.095 to 0.146 g/cm3 (P<0.05). Urine N-telopeptide levels (bone resorption marker) decreased from a median of 461.5 bone collagen equivalent/creatinine (BCE/Cr) (range 129-721 BCE/Cr) to 223.5 BCE/Cr (range 107-312 BCE/Cr) (P<0.05) and serum alkaline phosphatase (ALP) (bone formation marker) from a median of 230.0 U/l (range 148-305 U/l) to 133.5 U/l (range 79-233 U/l) (P<0.05), reflecting reduced bone turnover. This may represent a net reduction in bone resorption and provides a biochemical explanation for the increase in bone mineralisation. Height standard deviation scores were not affected and there were no significant adverse effects., Conclusion: 1 year cyclical pamidronate is effective and safe in improving bone mineralisation and reducing fracture incidence in osteogenesis imperfecta.

The placement of most spinal interbody devices is above the cancellous region of the vertebral bodies. Dual X-ray absorptiometry (DXA) scans of patients are usually taken from the anterior-posterior or the lateral projection. DXA scans taken in vitro from the axial direction would most closely indicate the bone mineral density (BMD) of the bone at this region. So far, in vitro studies have not been conducted to determine the correlation between axial and lateral scans. Because lateral DXA BMD scans are noninvasive and have low radiation dosage, they could be used as a predictive tool to determine the quality of cancellous bone at the centrum of the vertebral bodies, where spinal interbody devices are commonly placed.

In a prospective study of 14 patients undergoing total hip replacement we have used dual-energy X-ray absorptiometry (DEXA) to investigate remodelling of the bone around two different designs of cementless femoral prosthesis. The bone mineral density (BMD) was measured at 12-weekly intervals for a year. Eight patients (group A) had a stiff, collarless implant and six (group B) a flexible isoelastic implant. Patients in group A showed a decrease in BMD from 14 weeks after operation. By 12 months, the mean loss in BMD was 27%, both medially and laterally to the proximal part of the implant. Those in group B showed an overall increase in BMD which reached a mean of 12.6% on the lateral side of the distal portion of the implant. Our results support the current concepts of the effects of stem stiffness and flexibility on periprosthetic remodelling.

Precision in femoral neck scans with dual energy X-ray absorptiometry (DXA) is affected by variability in positioning and subsequent repositioning of the femur for repeated scans. To study the in vitro effect of femoral rotation on the bone mineral density (BMD), four fresh-frozen cadaveric femurs were fixed in a specially designed jig which allows for rotation of the femurs. BMD measurements of the femurs were done in neutral position (0 degrees) i.e., with the femoral neck axis parallel to the surface of the couch and at 15 degrees, 30 degrees, and 45 degrees of internal and external rotation. In vivo precision of the femoral neck scan was determined in five normal male subjects. The scans were first done with the legs positioned using the manufacturer's foot block. Five scans were performed, with repositioning, on the left hip of each subject. The procedure was then repeated with the legs positioned using a custom-designed positioning jig to minimize the rotation of the hips during a scan. In the in vitro study, the femoral neck BMD value was minimum at neutral position (0 degrees) and increased when the femur was rotated internally or externally. In vivo precision error of the femoral neck scan was reduced by almost 50% with the use of the positioning jig when compared with the manufacturer's foot block. Femoral rotation was shown to have a significant effect on BMD measurements, and proper positioning of the femur during a scan can improve precision significantly.

The relationships between bone mineral content (BMC), bone calcium, and bone strength were studied in fractionally demineralized feline femurs. In 44 pairs of cat femurs, the right bones were decalcified in ethylene diaminetetra acetic acid (EDTA) to 20%, 40%, 60%, 80%, and 100% of the mineral content of the intact left bone (= control). The bones were then loaded to failure, and maximum strength values were recorded. The data were then used to calculate the percentage strength of the right relative to the left femurs. A correlation coefficient (r) of 0.970 was found between the percentage decalcification and percentage bending strength. A direct relationship (r = 0.876) was also observed between the total calcium extracted and total loss in BMC. The EDTA solutions were spot checked for protein content to determine if the organic matrices had been altered by demineralization. Protein was never detected. Nor did the demineralized tissues display histologic evidence of gross microscopic damage. This study has shown that in cat femurs, 20% decalcification led to about 35% loss in bending strength, and 60% decalcification caused 75% loss in strength. These values are significant as they highlight the importance of calcium to the strength of osteopenic bone.

The bone mineral density (BMD) was measured in 61 women with compression fractures of the spine and 66 normal pre-menopausal women. Radiographs of the lateral spine were also obtained and the vertebral body index (VBI) was measured in the region L2-L4. Women with spinal fractures had lower BMD and VBI values. Using both BMD and VBI, 3 regions of fracture risk were defined. All but 2 of the fracture patients were in the moderate- or high-risk region for fracture.