Mental Health of Medical Students Combating the COVID-19 Epidemic: A Cross-sectional Study in Vietnam.

Objectives: This study was conducted to investigate the prevalence of mental health (MH) symptoms and associated factors among medical students who were engaged in combating the coronavirus disease 2019 (COVID-19) epidemic in 4 provinces/cities of Vietnam. Methods: A cross-sectional study with 580 participants was conducted at a medical university in Northern Vietnam. MH was assessed using the 21-item Depression, Anxiety, and Stress Scale, which was previously standardized in Vietnam. Data were collected through a structured self-administered questionnaire. Multivariate logistic regression was employed to examine the association between MH symptoms and relevant factors. Results: Of 2,703 total medical students, 21.5% responded to the questionnaire. Among the 580 respondents, the prevalence rates of depression, anxiety, and stress were 43.3%, 44%, and 24.7%, respectively. Factors significantly associated with self-reported depression included female sex and infection with COVID-19. Similarly, female sex and COVID-19 infection were significantly associated with self-reported anxiety. Factors linked to self-reported stress included female sex, a personal or family history of MH symptoms, working more than 8 hours per day, and COVID-19 infection. Conclusion: COVID-19 has adversely impacted the MH of medical students. Our findings are valuable in their potential to motivate universities, MH professionals, and authorities to offer mental healthcare services to this group. Furthermore, there is a pressing need for training courses designed to equip future healthcare workers with the skills to manage crises effectively.

Epigenetic silencing of HTATIP2 in glioblastoma contributes to treatment resistance by enhancing nuclear translocation of the DNA repair protein MPG.

Glioblastoma, the most malignant brain tumor in adults, exhibits characteristic patterns of epigenetic alterations that await elucidation. The DNA methylome of glioblastoma revealed recurrent epigenetic silencing of HTATIP2, which encodes a negative regulator of importin ß-mediated cytoplasmic-nuclear protein translocation. Its deregulation may thus alter the functionality of cancer-relevant nuclear proteins, such as the base excision repair (BER) enzyme N-methylpurine DNA glycosylase (MPG), which has been associated with treatment resistance in GBM. We found that induction of HTATIP2 expression in GBM cells leads to a significant shift of predominantly nuclear to cytoplasmic MPG, whereas depletion of endogenous HTATIP2 results in enhanced nuclear MPG localization. Reduced nuclear MPG localization, prompted by HTATIP2 expression or by depletion of MPG, yielded less phosphorylated-H2AX-positive cells upon treatment with an alkylating agent. This suggested reduced MPG-mediated formation of apurinic/apyrimidinic sites, leaving behind unrepaired DNA lesions, reflecting a reduced capacity of BER in response to the alkylating agent. Epigenetic silencing of HTATIP2 may thus increase nuclear localization of MPG, thereby enhancing the capacity of the glioblastoma cells to repair treatment-related lesions and contributing to treatment resistance.

The Effectiveness of Ultraviolet-C (UV-C) Irradiation on the Viability of Airborne Pseudomonas aeruginosa.

Pseudomonas aeruginosa (Pa) is the predominant bacterial pathogen in people with cystic fibrosis (CF) and can be transmitted by airborne droplet nuclei. Little is known about the ability of ultraviolet band C (UV-C) irradiation to inactivate Pa at doses and conditions relevant to implementation in indoor clinical settings. We assessed the effectiveness of UV-C (265 nm) at up to seven doses on the decay of nebulized Pa aerosols (clonal Pa strain) under a range of experimental conditions. Experiments were done in a 400 L rotating sampling drum. A six-stage Andersen cascade impactor was used to collect aerosols inside the drum and the particle size distribution was characterized by an optical particle counter. UV-C effectiveness was characterized relative to control tests (no UV-C) of the natural decay of Pa. We performed 112 tests in total across all experimental conditions. The addition of UV-C significantly increased the inactivation of Pa compared with natural decay alone at all but one of the UV-C doses assessed. UV-C doses from 246-1968 µW s/cm2 had an estimated effectiveness of approximately 50-90% for airborne Pa. The effectiveness of doses ≥984 µW s/cm2 were not significantly different from each other (p-values: 0.365 to ~1), consistent with a flattening of effectiveness at higher doses. Modelling showed that delivering the highest dose associated with significant improvement in effectiveness (984 µW s/cm2) to the upper air of three clinical rooms would lead to lower room doses from 37-49% of the 8 h occupational limit. Our results suggest that UV-C can expedite the inactivation of nebulized airborne Pa under controlled conditions, at levels that can be delivered safely in occupied settings. These findings need corroboration, but UV-C may have potential applications in locations where people with CF congregate, coupled with other indoor and administrative infection control measures.

Efficacy of Dry Needling Under EMG Guidance for Myofascial Neck and Shoulder Pain: A Randomized Clinical Trial.

Purpose: To determine the difference in maintenance of improvement of pain and disability for dry needling (DN) under needle electromyography (EMG) guidance technique in myofascial neck and shoulder pain patients, compared with DN alone. Patients and Methods: In this randomized single-blind clinical trial, 30 participants with myofascial pain in the neck and shoulder were randomly allocated to two groups: myofascial trigger points (MTrPs) DN with EMG guided (DN-EMG) group and MTrPs DN without EMG (DN) group. Needling treatment lasted for 2 weeks, twice a week. The primary outcome was pain intensity as assessed by visual analogue scale (VAS) and neck disability index (NDI). A number of mappings referred to pain and spontaneous muscle activity (SEA) were considered secondary outcomes. VAS and NDI were measured before treatment, after 2 weeks of intervention and at 4-, 6- and 12-week follow-up periods after the intervention. Secondary outcomes were assessed before each treatment (T1-T4). Data were analysed using mixed-model analyses of variance (ANOVA) with time as a within-subject variable and groups as between-subject variables followed by Bonferroni's post-hoc test. Results: Mixed-model ANOVA revealed significant time-by-group interaction effects (F = 3.49, P = 0.01) for VAS. Post-hoc analysis showed a significant decrease in VAS and NDI after 2 weeks of intervention and at all follow-up periods compared with baseline in both groups (p < 0.01). The DN-EMG group exhibited higher improvements in VAS at 6- and 12-week follow-up period than the DN group (p < 0.05). In the SEA of MTrPs, we found positive sharp waves, fibrillation and fascicular potentials. DN-EMG group exhibited lower amplitudes at T2-T4 and frequencies at T2 and T3. Conclusion: DN under needle EMG guidance technique exhibited greater improvements in maintenance of improvement of pain and lower SEA value than the DN group due to sufficient MTrPs inactivation.

Effectiveness of Interventions to Prevent Musculoskeletal Disorders among District Hospital Nurses in Vietnam.

Background: Nurses are one of the population groups with the highest prevalence of musculoskeletal disorders (MSDs). Preventive measures in Vietnamese hospitals on the job have not been proposed to study their effectiveness due to barriers related to the lack of knowledge about MSDs by health care administrators and the lack of human resources with expertise in MSD management in hospitals. Objectives: This study is aimed at evaluating the effectiveness of basic interventions (education, physical exercise) to prevent MSDs among district hospital nurses in Vietnam. Material and Methods. A quasi-experimental study was carried out before/after over a period of one year among two groups of nurses, one receiving the intervention (n = 162) and the other the control group (n = 128). The intervention includes 3 components: training on MSDs, ergonomics training, and instructions for physical exercise. The pre- and postintervention assessment tools included the Modified Nordic, Quality of Life Enjoyment and Satisfaction Short-Form (Q-LES-Q-SF), and the Kessler Psychological Distress Questionnaire (K6). A generalized estimating equation analysis was performed to assess the difference between the two groups at two points in time (before and after the intervention) on some indicators (prevalence of MSDs in the last 12 months and 7 days, score for quality of life and psychological distress). Results: There was a significant difference of the test on the prevalence of MSDs in the last 7 days between the 2 groups before and after the intervention with the p value = 0.016. This difference occurred in 4 anatomical sites: neck, shoulder/upper arm, wrists/hand, and lower back, with p values being 0.013, 0.011, 0.038, and 0.009, respectively. Conclusions: The intervention measures are probably effective in reducing the prevalence of MSDs at 4 anatomical sites in the last 7 days. More in-depth studies are needed with a combination of measures over a longer period of time to obtain stronger evidence of interventions.

A Systematic Literature Review of Indoor Air Disinfection Techniques for Airborne Bacterial Respiratory Pathogens.

Interrupting the transmission of airborne (<≈5 µm) respiratory pathogens indoors is not a new challenge, but it has attracted unprecedented interest due to the COVID-19 pandemic during 2020-2021. However, bacterial respiratory pathogens with known or potential airborne transmission account for an appreciable proportion of the communicable disease burden globally. We aimed to systematically review quantitative, laboratory-based studies of air disinfection techniques for airborne respiratory bacteria. Three databases (PubMed, Web of Science, Scopus) were searched, following PRISMA guidelines. A total of 9596 articles were identified, of which 517 were assessed in detail and of which 26 met the inclusion and quality assessment criteria. Seven air disinfection techniques, including UV-C light, filtration, and face masks, among others, were applied to 13 different bacterial pathogens. More than 80% of studies suggested that air disinfection techniques were more effective at inactivating or killing bacteria than the comparator or baseline condition. However, it was not possible to compare these techniques because of methodological heterogeneity and the relatively small number of the studies. Laboratory studies are useful for demonstrating proof-of-concept and performance under controlled conditions. However, the generalisability of their findings to person-to-person transmission in real-world settings is unclear for most of the pathogens and techniques we assessed.

Zoogeographical barriers causing discontinuous osteometrical variations in the northern treeshrew skulls.

Morphological variation of the skull was examined in the northern treeshrew (Tupaia belangeri) from various localities across Southeast Asia. Through a multivariate analysis, the treeshrews from South Vietnam exhibited distinct morphological characteristics compared to other populations from Thailand and Laos, and Malaysia. The plots of the specimens of North Vietnam are not randomly mixed with Thailand plots segregation in the scatteregrams of canonical discriminant analysis. Since the skulls of the population from North Vietnam were morphologically similar to those form central Laos and northern and northeastern Thailand, the zoogeographical barrier effect of Mekong River was not clearly confirmed. The population of the Kanchanaburi in western Thailand is clearly smaller in size compared to the other populations. The southern border of the distribution of this species is determined by the Isthmus of Kra or Kangar-Pattani Line. In the northern treeshrew, which is distributed from southern China to Bangladesh and southern Thailand, we have detected osteometrical geographical variation driven by geography. These results indicate that the skull morphology in the Tupaia glis-belangeri complex distinctively differs in South Vietnam, western Thailand, and southern Thailand. The zoogeographical barrier and factor separating these districts are expected to clarify in the future.

Relationship between muscle spindles and myofascial trigger spots according to Hoffmann reflex pathway and tissue morphology characteristics in a rat model.

OBJECTIVES: To determine how muscle spindles are involved in the pathophysiology of chronic myofascial trigger spots (MTrSs, similar to myofascial trigger points) in a rat injury model according to the characteristics of the Hoffmann reflex (H-reflex) and the anatomical relationship between muscle spindles and MTrSs. METHODS: 16 male Sprague-Dawley rats (7 weeks old) were randomly divided into experimental and control groups. A blunt strike injury and eccentric exercise were applied to the gastrocnemius muscle of rats in the experimental group once a week for 8 weeks as a MTrS modelling intervention. Subsequently, the rats were reared normally and rested for 4 weeks. At the end of the 12th week, the rats were examined for the presence of MTrSs defined by the detection of a palpable taut band exhibiting both a local twitch response and spontaneous electrical activity. After modelling, evocation of the H-reflex and morphological examination of muscle spindles and MTrSs were conducted. RESULTS: The threshold (0.35±0.04 mA) of the H-reflex and latency (1.24±0.18 ms) of the M wave recorded at MTrSs were not significantly different to those at non-MTrSs (P>0.05). Compared with non-MTrSs, a lower Mmax (4.28±1.27 mV), higher Hmax (median (IQR) 0.95 (0.80-1.08) mV) and Hmax/Mmax (median (IQR) 0.21 (0.16-0.40)), and shorter H wave latency (4.60±0.89 ms) were recorded at MTrSs (P<0.05). Morphologically, there was a close anatomical relationship between the MTrS cells and the muscle spindles. DISCUSSION: Compared with normal muscles, the H-reflex myoelectrical activity was enhanced and some muscle spindles might have been influenced by active MTrSs. Thus, muscle spindles may play an important role in the pathological mechanism underlying myofascial trigger points.

Structural and functional abnormalities of motor endplates in rat skeletal model of myofascial trigger spots.

Myofascial trigger points (MTrPs) are defined as hyperirritable spots in a palpable taut band (TB) of skeletal muscle fibers. Knowing the formation and location of MTrPs is a great help to prevent their development and inactivate existing MTrPs. This study aimed to obtain new evidence that myofascial trigger spots (MTrSs), which are similar to human MTrPs, are found in dysfunctional motor endplates by observing the morphological characteristics of muscles and changes in biochemical substances. A total of 32 male Sprague Dawley rats were randomly divided into four groups: two control groups (i.e., C1 and C2) and two model groups (i.e., M1 and M2). C1 and M1 were used for acetylcholine (ACh) content measurement, while C2 and M2 were utilized for acetylcholinesterase (AChE) staining. In the model groups, blunt striking injury was induced and eccentric exercise was applied to the left gastrocnemius for 8 weeks. After 1 month, spontaneous electrical activity(SEA), AChE optical density (OD), muscle fiber diameter, and ACh content were measured. The results showed that extensive abnormal endplate noise (aEPN), including positive neurons, fibrillation potentials, fasciculation potential, and high amplitude (endplate spikes [EPS]), is present at MTrSs in M1. Quantitative electromyography results showed that the amplitudes of aEPN and frequency of EPS in M1 were significantly higher than those of C1. The ACh content of MTrSs in M1 was significantly higher than that in C1. The AChE OD value of M2 was significantly lower than that of C2. In addition, the diameter of the muscle fibers in the AChE-stained area was longer in M2 than in C2. In conclusion, MTrSs formed at the motor endplate with a larger diameter of muscle fibers. Excessive ACh release and decreased AChE activity at MTrSs stimulated muscle action potential and muscle contraction.

Quantitative proteomics analysis to identify biomarkers of chronic myofascial pain and therapeutic targets of dry needling in a rat model of myofascial trigger points.

BACKGROUND: Proteomics analysis may provide important information regarding the pathogenesis of chronic myofascial pain and the mechanisms underlying the treatment effects of dry needling. MATERIALS AND METHODS: This study used a rat model of myofascial trigger points (MTrPs) to perform a proteomics analysis. Three biological replicate experiments were used to compare the proteomes of healthy control rats, a rat model of MTrP, MTrP model rats following dry needling of MTrPs, and MTrP model rats following dry needling of non-MTrPs. Tandem mass tag (TMT) labeling technology based on nanoscale liquid chromatography-tandem mass spectrometry was used. Hierarchical clustering, gene ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and protein-protein interaction network analysis were performed to characterize the proteins. To validate the TMT results, three candidate biomarker proteins were verified using parallel reaction monitoring and Western blot analysis. RESULTS: A total of 2,635 proteins were identified. GO and KEGG enrichment analyses showed that the glycolysis/gluconeogenesis pathways played dominant roles in the pathogenesis of chronic myofascial pain. The three candidate biomarker proteins were the pyruvate kinase muscle isozyme (encoded by the PKM gene), the muscle isoform of glycogen phosphorylase (encoded by the PYGM gene), and myozenin 2 (encoded by the MYOZ2 gene). The validation results were consistent with the TMT results. CONCLUSION: This is the first proteomics study that has investigated the pathogenesis of chronic myofascial pain and the mechanisms underlying the treatment effects of dry needling in an in vivo rat model of MTrPs, which might promote our understanding of the molecular mechanisms underlying chronic myofascial pain.

Decreased Spontaneous Electrical Activity and Acetylcholine at Myofascial Trigger Spots after Dry Needling Treatment: A Pilot Study.

OBJECTIVE: The aims of this study are to investigate the changes in spontaneous electrical activities (SEAs) and in acetylcholine (ACh), acetylcholine receptor (AChR), and acetylcholine esterase (AChE) levels after dry needling at myofascial trigger spots in model rats. MATERIALS AND METHODS: Forty-eight male Sprague-Dawley rats were divided into four groups. Thirty-six rats were assigned to three model groups, which underwent MTrSs modeling intervention. Twelve rats were assigned to the blank control (BC) group. After model construction, the 36 model rats were randomly subdivided into three groups according to treatment: MTrSs model control (MC) and two dry needling groups. One dry needling group received puncturing at MTrSs (DN-M), whereas the other underwent puncturing at non-MTrSs (DN-nM). Dry needling treatment will last for two weeks, once a week. SEAs and ACh, AChR, and AChE levels were measured after one-week rest of dry needling treatment. RESULTS: The amplitudes and frequencies of endplate noise (EPN) and endplate spike (EPS) significantly decreased after dry needling treatment in the DN-M group. Moreover, ACh and AChR levels significantly decreased, whereas AChE significantly increased after dry needling treatment in the DN-M group. CONCLUSION: Dry needling at the exact MTrSs is more effective than dry needling at non-MTrSs.

[Clinical observation of effectiveness in the treatment of senile knee osteoarthritis with the inactivation of myofascial trigger points---108 cases reports].

OBJECTIVE: To study clinical treatment effects of inactivating myofascial trigger points with needling and muscle stretching for the treatment of knee osteoarthritis(OA). METHODS: Retrospective analyses were made to investigate the clinical data of pain clinic outpatient in our hospital from 2010 to 2014, and 108 patients with knee OA, including 35 males and 73 females, were treated with acupuncturing of myofascial trigger points and stretching of muscles and structure around knee. The puncturing of trigger points, and the back and forth movement of needle were required to elicit local twitch response of muscle. After acupuncture treatment, muscle stretch around the knee joint was performed by a therapist. All patients must do homework of self stretching exercise. The extent of stretching should be to gradually increased under a tolerable pain. The ROM and walking pain VAS scores were measured before and after whole therapy and were statistically analyzed during 1 year of follow up. RESULTS: All the patients were followed up, and 95 patients had no pain after 1 year. The VAS scores were improved from preoperative severe 7.6±0.5, moderate 4.9±0.7, to mild 1.9±0.6 and painless 0.3±0.2. CONCLUSIONS: The walking pain of knee OA might be alleviated by the acupuncture and stretch to inactivate the myofascial trigger point.

Maximization of the supportable number of sensors in QoS-aware cluster-based underwater acoustic sensor networks.

This paper proposes a practical low-complexity MAC (medium access control) scheme for quality of service (QoS)-aware and cluster-based underwater acoustic sensor networks (UASN), in which the provision of differentiated QoS is required. In such a network, underwater sensors (U-sensor) in a cluster are divided into several classes, each of which has a different QoS requirement. The major problem considered in this paper is the maximization of the number of nodes that a cluster can accommodate while still providing the required QoS for each class in terms of the PDR (packet delivery ratio). In order to address the problem, we first estimate the packet delivery probability (PDP) and use it to formulate an optimization problem to determine the optimal value of the maximum packet retransmissions for each QoS class. The custom greedy and interior-point algorithms are used to find the optimal solutions, which are verified by extensive simulations. The simulation results show that, by solving the proposed optimization problem, the supportable number of underwater sensor nodes can be maximized while satisfying the QoS requirements for each class.