HtrA1, Ddr-2, and Mmp-13 are reliable biomarkers for osteoarthritis (OA), yet the exact mechanism for the upregulation of HtrA-1 is unknown. Some have shown that chondrocyte hypertrophy is associated with early indicators of inflammation including TGF-β and the Receptor for Advanced Glycation End-products (RAGE). To examine the correlation of inflammation with the expression of biomarkers in OA, we performed right knee destabilization surgery on 4-week-old-wild type and RAGE knock-out (KO) mice. We assayed for HtrA-1, TGF-β1, Mmp-13, and Ddr-2 in articular cartilage at 3, 7, 14, and 28 days post-surgery by immunohistochemistry on left and right knee joints. RAGE KO and wild type mice both showed staining for key OA biomarkers. However, RAGE KO mice were significantly protected against OA compared to controls. We observed a difference in the total number of chondrocytes and percentage of chondrocytes staining positive for OA biomarkers between RAGE KO and control mice. The percentage of cells staining for OA biomarkers correlated with severity of cartilage degradation. Our results indicate that the absence of RAGE did protect against the development of advanced OA. We conclude that HtrA-1 plays a role in lowering TGF-β1 expression in the process of making articular cartilage vulnerable to damage associated with OA progression.

Purpose: We sought to determine the success rate of VBAC and factors associated with achieving VBAC at a referral hospital in the Democratic Republic of Congo in women with a subsequent pregnancy greater than or equal to 18 months from their primary cesarean section (CS). Patients and Methods: Patients were included for participation if they had an interdelivery interval (IDI) of at least 18 months from their primary CS, accepted TOLAC, and had no contraindications. Information was collected about patients' demographics, obstetric history, and factors impacting their labor process. Descriptive analyses compared patients that had a successful VBAC and those who did not. Univariate and multivariate binary logistic regression models identified factors associated with a successful VBAC. Results: Among 231 eligible patients who attempted a VBAC, 57.6% (133) achieved VBAC. Participants had a mean age of 29 (SD 6), with the majority having a prior vaginal delivery (68.8%). VBAC was positively associated with a higher Bishop score (AOR 1.12, 95% CI 1.02, 1.23) and a spontaneous labor onset (AOR 3.06, 95% CI 1.52, 6.17). VBAC was negatively associated with a macrosomic fetus (AOR 0.21, 95% CI 0.08, 0.58). Conclusion: TOLAC results in VBAC more than half the time and is associated with a spontaneous labor onset and a higher Bishop score. Women with a macrosomic fetus were more likely to have an unsuccessful VBAC, resulting in an RCS. An optimal IDI was not enough to ensure a successful VBAC. Upon patients' arrival to the hospital, practitioners should re-evaluate their eligibility to attempt a VBAC based on their Bishop score and if they had a spontaneous labor onset to decrease the health risks of an RCS.

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Previous studies have found evidence of viral interference between seasonal respiratory viruses. Using laboratory-confirmed data from a Utah-based healthcare provider, Intermountain Health Care, we analyzed the time-specific patterns of respiratory syncytial virus (RSV), influenza A, influenza B, human metapneumovirus, rhinovirus, and enterovirus circulation from 2004 to 2018, using descriptive methods and wavelet analysis (n = 89,462) on a local level. The results showed that RSV virus dynamics in Utah were the most consistent of any of the viruses studied, and that the other seasonal viruses were generally in synchrony with RSV, except for enterovirus (which mostly occurs late summer to early fall) and influenza A and B during pandemic years.

Background: In middle- and low-income countries, the inter-delivery interval is an important parameter considered in the decision of TOLAC. The objective of this study is to determine influencing factors for success of trial of labor after cesarean in women with secure inter-delivery interval after a cesarean-section at a referral hospital.Methods: A cross-sectional study was conducted at Panzi hospital on 231 cases in one year period. Women with one previous cesarean section, an inter-delivery interval space at least 18 months and no contracted pelvis were included. A successful TOLAC was defined as vaginal delivery and failed if cesarean section after trial of labor. Chi-square univariate testing and multi-variate logistic regression were used to understand the relationship between influencing factors the recorded variables and successful TOLAC, with a significance threshold of 5%.Results : 57.6% (133 cases) successfully completed TOLAC with vaginal delivery. Many obstetric factors have a significant effect on success of TOLAC. middle cervix was likely to increase success of TOLAC by 61.50 times (OR=61.50, p-value=0.000). Cervical softening was likely to increase success of TOLAC by 5.96 times (OR=5.96, p-value=0.001). Active labor was likely to increase success of TOLAC by 7.79 times (OR=7.79, p-value=0.013). Uterine height also has a significant effect such that every centimeter increase in uterine height decreased likelihood of successful TOLAC by about half (OR= 0.62, p-value=0.000). Every unit increase in Apgar score in the 1st minute after birth increased likelihood of successful TOLAC by 1.71 times (OR=1.71, p-value=0.010). For every increase in parity, the likelihood of successful TOLAC increases by 1.30 (OR=1.30, p-value=0.031). The remaining obstetric factors in the model had no significant effect on success of TOLAC. Conclusions: Our study shows that within a secure inter-delivery interval, high parity, uterine height less than 34 cm, active labor and cervical parameters such as cervical softening and middle cervix are important contributing factors to the success of TOLAC and VBAC. These factors should be considered by practitioners to influence their decision making regarding TOLAC.