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Bone generally displays a high intrinsic capacity to regenerate. Nonetheless, large osseous defects sometimes fail to heal. The treatment of such large segmental defects still represents a considerable clinical challenge. The regeneration of large bone defects often proves difficult, since it relies on the formation of large amounts of bone within an environment impedimental to osteogenesis, characterized by soft tissue damage and hampered vascularization. Consequently, research efforts have concentrated on tissue engineering and regenerative medical strategies to resolve this multifaceted challenge. In this review, we summarize, critically evaluate, and discuss present approaches in light of their clinical relevance; we also present future advanced techniques for bone tissue engineering, outlining the steps to realize for their translation from bench to bedside. The discussion includes the physiology of bone healing, requirements and properties of natural and synthetic biomaterials for bone reconstruction, their use in conjunction with cellular components and suitable growth factors, and strategies to improve vascularization and the translation of these regenerative concepts to in vivo applications. We conclude that the ideal all-purpose material for scaffold-guided bone regeneration is currently not available. It seems that a variety of different solutions will be employed, according to the clinical treatment necessary.
Background: Fatigue, dyspnea, and lack of energy and concentration are commonly interpreted as indicative of symptomatic anemia and may thus play a role in diagnostic and therapeutic decisions. Objective: To investigate the association between symptoms commonly attributed to anemia and the actual presence of anemia. Methods: Data from two independent cohorts of the Study of Health in Pomerania (SHIP) were analyzed. Interview data, laboratory data, and physical examination were individually linked with claims data from the Association of Statutory Health Insurance Physicians. A complete case analysis using logistic regression models was performed to evaluate the association of anemia with symptoms commonly attributed to anemia. The models were adjusted for confounders such as depression, medication, insomnia, and other medical conditions. Results: A total of 5979 participants (53% female, median age 55) were included in the analysis. Of those, 30% reported fatigue, 16% reported lack of energy, 16% reported lack of concentration, and 29% reported dyspnea and/or weakness. Anemia was prevalent in about 6% (379). The symptoms were more prevalent in participants with anemia. However, participants with anemia were older and had a poorer health status. There was no association in multivariate logistic regression models between the symptoms fatigue, lack of concentration, dyspnea, and/or weakness and anemia. Anemia was associated (OR: 1.45; 95% CI: 1.13–1.86) with lack of energy in the multivariate analysis. Other factors such as depression, insomnia, and medication were more strongly associated with the symptoms. Conclusion: The clinical symptoms commonly attributed to anemia are unspecific and highly prevalent both in non-anemic and anemic persons. Even in the presence of anemia, other diagnoses should be considered as causes such as depression, heart failure, asthma, and COPD, which are more closely associated with the symptoms. Further diagnostic research is warranted to explore the association of symptoms in different subgroups and settings in order to help clinical decision making.
Background: General clinical perception suggests a decline in the diagnosis and treatment of lung cancer during the SARS-CoV-2 pandemic. Early diagnosis of non-small cell lung cancer (NSCLC) is crucial in therapeutic regimes as early stages are potentially curable by operation alone or with combined therapy. Pandemic-triggered overload of the healthcare system may have prolonged the diagnosis of NSCLC, possibly leading to higher tumor stages at first diagnosis. This study aims to identify how COVID-19 affected the distribution of the Union for International Cancer Control (UICC) stage in NSCLC at first diagnosis.
Methods: A retrospective case-control study was conducted, including all patients receiving their first diagnosis of NSCLC in the regions of Leipzig and Mecklenburg-Vorpommern (MV) between January 2019 and March 2021. Patient data were retrieved from the clinical cancer registries of the city of Leipzig and the federal state of MV. Ethical approval for this retrospective evaluation of archived, anonymized patient data was waived by the Scientific Ethical Committee at the Medical Faculty, Leipzig University. Three investigation periods were defined to study the effects of high incidences of SARS-COV-2: the curfew period as an enacted security measure, the period of high incidence rates and the period of the aftermath of high incidences. Differences in the UICC stages between these pandemic periods were studied by Mann-Whitney-U-Test. Pearson’s correlation was calculated to examine changes in operability.
Results: The number of patients diagnosed with NSCLC dropped substantially during investigation periods. There was a significant difference in the UICC status in the aftermath of high incidences and imposed security measures in Leipzig (P=0.016). N-status differed significantly in the aftermath of high incidences and imposed security measures (P=0.022) with a decrease of N0- and an increase of N3-status, respectively, while N1- and N2-status remained relatively unaffected. No pandemic phase showed a significant difference in operability.
Conclusions: The pandemic led to a delay in the diagnosis of NSCLC in the two examined regions. This resulted in higher UICC stages upon diagnosis. However, no increase in inoperable stages was shown. It remains to be seen, how this will affect the overall prognosis of the involved patients.
The influence of the Madden–Julian oscillation (MJO) on the middle atmosphere (MA) and particularly on MA temperature is of interest for both the understanding of MJO-induced teleconnections and research on the variability of the MA. We analyze statistically the connection of the MJO and the MA zonal mean temperature based on observations by the Microwave Limb Sounder (MLS) satellite instrument. We consider all eight MJO phases, different seasons and the state of the quasi-biennial oscillation (QBO). We show that MA temperature anomalies are significantly related to the MJO and its temporal development. The MJO signal in the zonal mean MA temperature is characterized by a particular spatial pattern in the MA, which we link to the interhemispheric coupling (IHC) mechanism, as a major outcome of this study. The signal with the largest magnitude is found in the polar MA during boreal winter with temperature deviations on the order of ±10 K when the QBO at 50 hPa is in its easterly phase. Other atmospheric conditions and locations also exhibit temperature signals, which are, however, weaker or noisier. We also analyze the change in the temperature signal while the MJO progresses from one phase to the next. We find a gradual altitude shift in parts of the IHC pattern, which can be seen more or less clearly depending on the atmospheric conditions.
The statistical link between the MJO and the MA temperature highlights illustratively the far-reaching connections across different atmospheric layers and geographical regions in the atmosphere. Additionally, it highlights close linkages of known dynamical features of the atmosphere, particularly the MJO, the IHC, the QBO and sudden stratospheric warmings (SSWs). Because of the wide coverage of atmospheric regions and included dynamical features, the results might help to further constrain the underlying dynamical mechanisms and could be used as a benchmark for the representation of atmospheric couplings on the intraseasonal timescale in atmospheric models.
The stratospheric aerosol layer plays an important role in the radiative balance of Earth primarily through scattering of solar radiation. The magnitude of this effect depends critically on the size distribution of the aerosol. The aerosol layer is in large part fed by volcanic eruptions strong enough to inject gaseous sulfur species into the stratosphere. The evolution of the stratospheric aerosol size after volcanic eruptions is currently one of the biggest uncertainties in stratospheric aerosol science. We retrieved aerosol particle size information from satellite solar occultation measurements from the Stratospheric Aerosol and Gas Experiment III mounted on the International Space Station (SAGE III/ISS) using a robust spectral method. We show that, surprisingly, some volcanic eruptions can lead to a decrease in average aerosol size, like the 2018 Ambae and the 2021 La Soufrière eruptions. In 2019 an intriguing contrast is observed, where the Raikoke eruption (48∘ N, 153∘ E) in 2019 led to the more expected stratospheric aerosol size increase, while the Ulawun eruptions (5∘ S, 151∘ E), which followed shortly after, again resulted in a reduction in the values of the median radius and absolute distribution width in the lowermost stratosphere. In addition, the Raikoke and Ulawun eruptions were simulated with the aerosol climate model MAECHAM5-HAM. In these model runs, the evolution of the extinction coefficient as well as of the effective radius could be reproduced well for the first 3 months of volcanic activity. However, the long lifetime of the very small aerosol sizes of many months observed in the satellite retrieval data could not be reproduced.
Facial expressions play a crucial role in human interactions. Typically, a positive (negative) expression evokes a congruent positive (negative) reaction within the observer. This congruent behavior is inverted, however, when the same positive (negative) expression is displayed by an outgroup member. Two approaches provide an explanation for this phenomenon. The social intentions account proposes underlying social messages within the facial display, whereas the processing conflict account assumes an affective conflict triggered by incongruent combinations of emotion and the affective connotation of group membership. In three experiments, we aimed at further substantiating the processing conflict account by separating the affective conflict from potential social intentions. For this, we created a new paradigm, in which the participant was an outside observer of a social interaction scene between two faces. Participants were required to respond to the emotional target person that could represent an ingroup or outgroup member. In all three experiments, irrespective of any social intention, responses were consistently affected by the group relation between participant and emotional target, i.e., the affective (in)congruency of the target seen by participants. These results further support the processing conflict account. The implications for the two theoretical accounts are discussed.
Burnout among high school students is linked to their telomere length and relatedness with peers
(2023)
School burnout is a serious concern, as it impairs students’ health and academic success. According to the Conservation of Resources Theory, burnout results from the depletion of personal coping resources and can be counteracted by supportive social relationships. However, it is not yet clear how students’ relatedness with their peers is linked to their burnout. Next to students’ self-reported fatigue, biomarkers such as telomere length (TL), which presents an indicator of aging, complement stress research. To identify school-related factors that may prevent students from experiencing burnout and to link TL to students’ self-reported burnout, the current study investigated how relatedness with peers as well as TL at the beginning of the school year explained students’ burnout at the end of the school year. The sample included 78 students (Mage = 13.7 ± 0.7 years; 48% girls). Results of multilevel analysis in Mplus indicate that, over the school year, students with higher TL and those who experienced relatedness with their peers reported lower levels of burnout. Moreover, students who felt related to their peers exhibited a longer TL. The study implies that students’ relatedness with their peers may be a promising setscrew to prevent students’ burnout and support their physical health. This is one of the first studies to link TL with school-related variables such as burnout and relatedness to peers in a non-clinical student sample, providing a baseline for interventions and future interdisciplinary studies in the field of education and stress.
Explosive volcanic eruptions emitting large amounts of sulfur can alter the temperature of the lower stratosphere and change the circulation of the middle atmosphere. The dynamical response of the stratosphere to strong volcanic eruptions has been the subject of numerous studies. The impact of volcanic eruptions on the mesosphere is less well understood because of a lack of large eruptions in the satellite era and only sparse observations before that period. Nevertheless, some measurements indicated an increase in mesospheric mid-latitude temperatures after the 1991 Pinatubo eruption. The aim of this study is to uncover potential dynamical mechanisms that may lead to such a mesospheric temperature response. We use the Upper-Atmospheric ICOsahedral Non-hydrostatic (UA-ICON) model to simulate the atmospheric response to an idealized strong volcanic injection of 20 Tg S into the stratosphere (about twice as much as the eminent 1991 Pinatubo eruption). Two experiments with differently parameterized effects of sub-grid-scale orography are compared to test the impact of different atmospheric background states. The simulations show a significant warming of the polar summer mesopause of up to 15–21 K in the first November after the eruption. We argue that this is mainly due to intrahemispheric dynamical coupling in the summer hemisphere and is potentially enhanced by interhemispheric coupling with the winter stratosphere. This study focuses on the first austral summer after the eruption because mesospheric temperature anomalies are especially relevant for the properties of noctilucent clouds, whose season peaks around January in the Southern Hemisphere.
The relationship between Alzheimer's-related brain atrophy patterns and sleep macro-architecture
(2022)
Introduction
Sleep is increasingly recognized as a major risk factor for neurodegenerative disorders such as Alzheimer's disease (AD).
Methods
Using an magnetic resonance imaging (MRI)–based AD score based on clinical data from the Alzheimer's Disease Neuroimaging Initiative 1 (ADNI1) case-control cohort, we investigated the associations between polysomnography-based sleep macro-architecture and AD-related brain atrophy patterns in 712 pre-symptomatic, healthy subjects from the population-based Study of Health in Pomerania.
Results
We identified a robust inverse association between slow-wave sleep and the AD marker (estimate: −0.019; 95% confidence interval: −0.03 to −0.0076; false discovery rate [FDR] = 0.0041), as well as with gray matter (GM) thicknesses in typical individual cortical AD-signature regions. No effects were identified regarding rapid eye movement or non–rapid eye movement (NREM) stage 2 sleep, and NREM stage 1 was positively associated with GM thickness, mainly in the prefrontal cortical regions.
Discussion
There is a cross-sectional relationship between AD-related neurodegenerative patterns and the proportion of sleep spent in slow-wave sleep.
Neuroinflammatory mechanisms and maladaptive neuroplasticity underlie the progression of complex regional pain syndrome (CRPS), which is prototypical of central neuropathic pain conditions. While cortical maladaptive alterations are well described, little is known about the contribution of the brainstem to the pathophysiology. This study investigates the role of pain-modulatory brainstem pathways in CRPS using the nociceptive blink reflex (nBR), which not only provides a direct read-out of brainstem excitability and habituation to painful stimuli but may also be suitable for use as a diagnostic biomarker for CRPS. Thirteen patients with CRPS and thirteen healthy controls (HCs) participated in this prospective case-control study investigating the polysynaptic trigemino-cervical (R2) nBR response. The R2 area and its habituation were assessed following repeated supraorbital electrical stimulation. Between-group comparisons included evaluations of diagnostic characteristics as a potential biomarker for the disease. Patients with CRPS showed a substantial decrease in habituation on the stimulated (Cohen’s d: 1.3; p = 0.012) and the non-stimulated side (Cohen’s d: 1.1; p = 0.04). This is the first study to reveal altered nBR habituation as a pathophysiological mechanism and potential diagnostic biomarker in CRPS. We confirmed previous findings of altered nBR excitability, but the diagnostic accuracy was inferior. Future studies should investigate the nBR as a marker of progression to central mechanisms in CRPS and as a biomarker to predict treatment response or prognosis.