Problematic internet use (PIU) is increasingly recognized as a mental health concern, particularly among adolescents. The resting-state functional connectivity (rsFC) of the triple-network model has been described inconsistently in PIU. Using resting-state fMRI (rsFMRI) and hypothesizing a lower rsFC between default mode (DMN) and central executive networks (CEN) but a higher rsFC within the salience network (SN), this study scrutinized the neural substrates of PIU adolescents. A total of 30 adolescents with PIU and 30 control subjects underwent rsFMRI. The severity of PIU was evaluated by the Internet Addiction Test. Additionally, personality traits as well as emotional and behavioral problems were evaluated by the Temperament and Character Inventory (TCI) and the Strength and Difficulties Questionnaire (SDQ), respectively. Focusing on the DMN, SN, and CEN, we compared rsFC values between PIU and the control. Subsequently, within the combined group of subjects, TCI and SDQ correlation and mediation effects were investigated. Higher rsFC values of the left lateral prefrontal cortex (LPFC(L)) with the left anterior insula (aIns(L)) were observed for PIU than for the control, while rsFCs of the LPFC(L) with the medial PFC (MPFC), LPFC(L), as well as with the right lateral parietal cortex (LP(R)) were lower for PIU. Among these significant group differences, the rsFC between the LPFC(L) and MPFC was mediated by emotional symptoms (standardized β = −0.12, 95% CI −0.29, −0.0052). The dysfunctional attention switching and incentive salience regulated by the SN were implicated as being a neural correlate of PIU, and this relationship would in part be explained by the emotional dysregulation associated with PIU in adolescents.

Introduction. The COVID-19 pandemic has entered a new phase with the roll-out of several vaccines worldwide at an accelerated phase. The occurrence of a more severe presentation of COVID-19 after vaccination may affect policymakers decision-making and vaccine uptake by the public. Vaccine-associated disease enhancement (VADE) is the modified presentation of infections in individuals after having received a prior vaccination. Currently, little is known about the potential of vaccine-associated disease enhancement (VADE) following COVID-19 immunization. Case Illustration. We herewith report two patients admitted with confirmed COVID-19 pneumonia with a history of CoronaVac vaccination. The first patient with a relatively milder course of the disease had received two doses of CoronaVac, whereas the second patient with a more progressive course of the disease received only one dose before developing symptoms and being admitted to the hospital. Our observations suggest that vaccination could act in boosting the inflammatory process and reveal the previously asymptomatic COVID-19 illness. Theoretically, vaccines could induce VADE, where only suboptimal, nonprotective titers of neutralizing antibodies were produced or proinflammatory T-helper type 2 response was induced. Secondly, enhanced respiratory disease (ERD) could manifest, where pulmonary symptoms are more severe due to peribronchial monocytic and eosinophilic infiltration. Understanding VADE is important for the decision-making by the public, clinicians, and policymakers and is warranted for successful vaccination uptake. Conclusion. We report two cases of patients developing COVID-19 shortly after CoronaVac vaccination in which VADE is likely. We recommend that current vaccination strategies consider the measurement of neutralizing antibody titer as a guide in ensuring the safest strategy for mass immunization. Studies are needed to investigate the true incidence of VADE on vaccinated individuals as well as on how to differentiate between VADE and severe manifestations of COVID-19 that are unrelated to vaccination.

Background: Knee osteoarthritis (OA) significantly affects quality of life and imposes economic burdens due to its prevalence and the disability it causes. The efficacy of current treatments is limited to alleviating the symptoms, and they cannot be used for regenerative purposes. This study aims to evaluate the efficacy and safety of combining hyaluronic acid (HA), human umbilical cord-derived mesenchymal stem cells (hUC-MSCs), and synthetic human growth hormone (somatotropin) in the treatment of knee OA, assessing pain relief, functional improvement, and cartilage regeneration. Methods: A four-arm, double-blind randomized trial was conducted with 51 knees from 28 subjects aged ≥50 with primary knee OA. The treatments involved were HA alone, HA with hUC-MSCs, HA with somatotropin, and a combination of all three. Efficacy was measured through the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog score (VAS), and MRI T2 mapping of cartilage was conducted on pre-implantation at the 6th and 12th month. Results: All treatment arms showed improvements in the VAS and WOMAC scores over 12 months, suggesting some pain relief and functional improvement. However, MRI T2 mapping showed no significant cartilage regeneration across the groups. Conclusions: While the combined use of HA, hUC-MSCs, and somatotropin improved symptoms of knee OA, it did not enhance cartilage regeneration significantly. This study highlights the potential of these combinations for symptom management but underscores the need for further research to optimize these therapies for regenerative outcomes.

The umbilical cord-mesenchymal stem cells (UC-MSC) has been shown to improve the viability of degenerated chondrocytes in knee osteoarthritis (KOA) in cellular level. Additional somatotropin injection also shown clinical improvement in patients. The present trial is conducted to assess the efficacy of umbilical cord mesenchymal stem cells (UC-MSC) in comparison to somatotropin and hyaluronic acid (HA) injection to treat and slow the progression of knee osteoarthritis. Methods: This study was conducted from January 2016 to April 2018 in Cipto Mangunkusumo General Hospital. A total of 28 knees from 15 patients with early KOA Kellgren Lawrence I-II were randomized into three groups. Group A was treated with 1x106 units of intra-articular UC-MSCs + 2 ml HA followed with 2 consecutive weeks of HA injection; group B was treated with the same dose of HA with additional 8 IU of Somatotropin; group C was treated as control. The International Knee Documentation Committee (IKDC) score, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue score (VAS), were assessed on the 1st and 3rd month, then every 3rd month until 12 months. Cartilage evaluation using MRI cartigram were performed at pre-implantation, and after the 6th and 12th month after implantation Results: General improvement were observed in all groups after 6 and 12 months. The IKDC score improved significantly among groups after 12 months (69.43 [48.3-89.66], 79.31 [51.72-90.08], and 75.9 [67.82-97.7] in group A, B, and C, respectively, p =0.005). We did not find a significant difference between groups in VAS and WOMAC results. However, we observed a medial T2 improvement in group A (39.55 [32.65-67.85] initially and 45.64 [38.12-70.65] 12 months after implantation). Conclusion: Injection of UC-MSC could improve knee function and cartilage profile in early KOA. However, further multicenter studies with larger samples are required to investigate the efficacy of such treatment for treating knee osteoarthritis.

Osteoarthritis is a chronic joint disease that occurs when the protective cartilage that cushions the ends of bones wears down over time and fails to be repaired. The common form of the disease is knee osteoarthritis while it can affect all body parts with joints, such as hands, ankles, hips, and spine. The major cause of knee osteoarthritis is the continuous depletion of its cartilage. During the diagnosis, machine learning is used because early prevention is necessary for proper treatment. This study, therefore, considers classification methods of Support Vector Machine (SVM) and clustering methods using fuzzy clusterings such as Fuzzy C-Means (FCM), Fuzzy Possibilistic C-Means (FPCM), and Fuzzy Possibilistic C-Means based on kernel (FPCMK) to analyze of knee osteoarthritis. SVM is a machine learning technique that works based on the principle of structural risk minimization (SRM) to obtain the best hyperplane to separate two or more classes in input space. Otherwise, the fuzzy clustering is to determine the value of a distance and to know and measure the similarity of each object to be observed. FPCMK uses the kernel Radial Base Function (RBF) in the fuzzy clustering method. The kernel function is applicable for handling non-separable data problems. This method will be compared to the level of the measured parameter; their accuracy, recall, precision, and f1 score. The greatest level of accuracy is generated from SVM with an accuracy value of 86.7%, then followed by FPCMK with an accuracy value of 85.5%.

This is a cross-sectional study. This study aims to describe the characteristics of sacrum vertebrae and spinopelvic parameters among the Indonesian population and compare them with studies from other populations. This study also intends to determine the sexual dimorphism of sacrum vertebrae and find the correlations between spinopelvic parameters. Morphometry of the sacrum is necessary for designing sacral prosthesis and instrumentations. Knowledge of spinopelvic parameters further supports the prosthesis installation procedure to restore the physiological spinal alignment of the patients. However, previous studies showed varied results among different populations. This is the first study to be conducted among the Indonesian population. Morphometric dimensions of sacrum vertebrae and the spinopelvic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis) were analyzed using thin-cut (1 mm) computed tomography images in 150 males and 150 females, aged 25 to 50 years without any spinal pathology. Generally, the size of the sacrum vertebrae was greater in males (P < .05). The sacral index, curvature index, and corporo-basal index were statistically different between genders (P < .001). Lumbar lordosis was the only spinopelvic parameter found significantly greater in females (P < .001). Significant positive correlations between all spinopelvic parameters, except for lumbar lordosis and pelvic tilt, were found in the present study (P < .001). The study serves as the first large series database of sacrum morphometric characteristics and spinopelvic parameters of the Indonesian population. There was significant gender-associated differences in various dimensions of sacrum vertebrae. The sacral index was found to be the most useful parameter for sex determination. There were strong significant positive correlations between various spinopelvic parameters. A comparison of populations revealed morphometric characteristic differences, which is proved to be critical in surgical implications.