bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative Physical Fitness Measures Inversely Associated With Myopia Severity in Military Males: The CHIEF Study
Authors: Lu Shao-Chi , Liu Fang-Yu , Hsieh Chia-Jung , Su Fang-Ying , Wong Tien Yin , Tai Ming-Cheng , Chen Jiann-Torng , Lin Gen-Min
Published: October 2019

Myopia has been linked to body weight and sedentary status, but the association with quantitatively measured physical fitness in adults has not been examined. Cross-sectional analyses were performed to investigate the association between physical fitness and myopia in 3,669 military men (aged 29.4 years) in Taiwan. The severity of myopia obtained from the left eye was classified as mild (−0.5 to −3.0 diopters; n = 544), moderate −3.1 to −6.0 diopters; n = 563), and high (<−6.0 diopters; n =150); others were defined as nonmyopia ( n = 2,412). Aerobic fitness was evaluated by time for a 3000-meter run test, and muscular endurance was evaluated by numbers of 2-min sit-ups and 2-min push-ups. A value of p < .0125 was considered significant. A multiple linear regression analysis was used to determine the relationship. Individuals who were less physically fit had higher risk of myopia. The associations were dose-dependently significant with mild, moderate, and high myopia for 3000-meter running time (β = 9.64; 95% confidence intervals [3.22, 16.05], β = 12.41; 95% CI [6.05, 18.76], and β = 20.87; 95% CI [9.22, 32.51], respectively) after controlling for the potential covariates. There tended to be an inverse association with moderate and high myopia for numbers of 2-min push-ups (β = −1.38; 95% CI [−2.43, −0.34] and β = −2.10; 95% CI [− 3.97, −0.22], respectively) and 2-min sit-ups (β = −0.83; 95% CI [−1.54, −0.12] and β = −1.29; 95% CI [−2.56, −0.02], respectively), respectively. This study suggested that physical fitness, particularly aerobic fitness of the military males who received regular training, is inversely associated with myopia severity, independent of service specialty, body mass index, and educational level.
Contrast-induced nephropathy: A dilemma between loss of neurons or nephrons in the setting of endovascular treatment of acute ischemic stroke
Authors: Delgado Acosta Fernando , Jiménez Gómez Elvira , Bravo Rey Isabel , Valverde Moyano Roberto , de Asís Bravo-Rodriguez Francisco , Oteros Fernández Rafael
Published: October 2019

Purpose

The aim is to report the incidence and risk factors of contrast-induced nephropathy after the use of iodine-based contrast for the endovascular treatment of acute ischemic stroke.

Methods

Data from patients who underwent neuroendovascular procedures in a center over a period of 22 months were analysed retrospectively. Contrast-induced nephropathy was determined by an increase in serum creatinine level of >25% of baseline or an absolute increase in serum creatinine level of at least 44 µmol/L (0.50 mg/dL) occurring after intravascular administration of contrast media without alternative explanation. The primary outcome measure of this study was the presence of contrast-induced nephropathy in these treated patients. Continuous data were presented as mean ± standard deviation, and categorical data as frequencies or percentages. The comparison was made using Student's t-test or Fisher's test. Logistic regression was performed to find independent contrast-induced nephropathy predictors. All statistical analyses were performed using Microsoft Excel. A p value of less than 0.05 was considered statistically significant.

Results

One hundred and eighty-nine patients undergoing endovascular treatment for acute ischemic stroke. Twenty cases of the total cohort (n = 189) presented contrast-induced nephropathy (10.58%). Only diabetes and creatinine levels between 1.3 and 2.5 mg/dL were associated with contrast-induced nephropathy. No patient was treated with dialysis.

Conclusion

Contrast-induced nephropathy is a relatively common complication after endovascular treatment of acute ischemic stroke and is associated with worse outcome in patients with this condition. However, there is no increase in the frequency of hemodialysis after the use of iodinated contrast medium.
The Utilization and Adaption of Photovoice With Rural Women Aged 85 and Older
Authors: Bryanton Olive , Weeks Lori , Townsend Elizabeth , Montelpare William , Lees Jessie , Moffatt Lyndsay
Published: October 2019

Photovoice is a qualitative research method that can have very positive outcomes, including making marginalized populations visible. Yet we found that traditional Photovoice methods were not fully effective and needed to be adapted with women aged 85 and older in rural Prince Edward Island, Canada. Concerns that required adaptation were time constraints for the researcher and participants, taking appropriate photographs, balancing power between researcher and participants, and ensuring that the women’s voices were heard and presented clearly for them and their communities. Our purpose in this article is to enrich conversations on applying and adapting Photovoice as a research method with older, rural women. With Photovoice, the women in our study learned to use digital cameras to take photographs and told stories about how and why they made choices for their photographs and how they depicted how they were supported or limited to fulfill their vision of aging in place. We address the key features of the data collection process that contributed to the effective use of Photovoice with this population, including photography training and ethical instructions, guiding them in a process for identifying their most important photographs, working out methods for engaging them in codifying the photographs, and involving them in knowledge mobilization with policy makers directly. In addition, we present key benefits they reported from participation in the Photovoice process and the value of Photovoice for them in influencing policies on aging.
How using assistive technology for cognitive impairments improves the participation and self-determination of young adults with intellectual developmental disabilities
Authors: Söderström Sylvia , Østby May , Bakken Hege , Ellingsen Karl Elling
Published: October 2019

In Norway, where all citizens are entitled to live in their own homes in their local communities, people with intellectual disabilities receive community-based home care services that aim to promote their ability to live on their own. In our study, we investigated how using an assistive device for cognitive impairment – namely, a memo planner (MP) – in community-based home care services affected the everyday lives of people with intellectual developmental disabilities (IDD). Our sample consisted of seven young adults with IDD and their support staff. Data were collected during field observations and group interviews and analysed via systematic text condensation. The findings illuminate how using an MP can structure the daily lives of young adults with IDD and afford them opportunities to participate in everyday activities. In this article, we discuss how using an MP shapes interactions between people with IDD and their support staff.
Dynamic multi-objective optimization for mixed traffic flow based on partial least squares prediction model
Authors: Chen Juan , Xue Zhengxuan , Han Dongxiao
Published: October 2019

A dynamic multi-objective genetic algorithm based on partial least squares prediction model (DNSGA-II-PLS) is presented in this paper to solve the mix traffic flow multi-objective timing optimization problem with time-varying traffic demand. Take motor vehicle delay, non-motor vehicle delay, and pedestrian delay as objectives to solve the problem. Make comparison with three improved dynamic multi-objective genetic algorithms based on prediction strategy: dynamic multi-objective evolutionary algorithm based on simple prediction (DNSGA-II-PREM), autonomous regression dynamic multi-objective evolutionary algorithm (DNSGA-II-AR), and mutation-based dynamic multi-objective evolutionary algorithm (DNSGA-II-MUT) under four kinds of test functions. The results show that compared with the other three algorithms, the DNSGA-II-PLS algorithm proposed in this paper shows better performance in convergence and distribution, and this algorithm has less complexity. Finally, taking the intersections of Taiping North Road and Zhujiang Road in Nanjing as the research object, the performance of the algorithm is tested under the simulation environment. The results show that compared with the DNSGA-II–AR, which has best performance among three compared algorithms, the proposed DNSGA-II-PLS algorithm can effectively reduce the delay of motor vehicles by 6.7%, non-motor vehicles by –2.8%, and pedestrian waiting time by 20.5%.
Neighborhood preserving sparse representation based on Nyström method for image set classification on symmetric positive definite matrices
Authors: Li Chu , Wu Xiao-Jun
Published: October 2019

In the field of pattern recognition, using the symmetric positive-definite matrices to represent image set has been widely studied, and sparse representation-based classification algorithm on the symmetric positive-definite matrix manifold has attracted great attention in recent years. However, the existing kernel representation-based classification methods usually use kernel trick with implicit kernel to rewrite the optimization function and will have some problems. To address the problem, a neighborhood preserving explicit kernel representation-based classification-based Nyström method is proposed on symmetric positive-definite manifold by embedding the symmetric positive-definite matrices into a Reproducing Kernel Hilbert Space with an explicit kernel based on Nyström method. Thus, we can take full advantage of kernel space characteristics. Through the experimental results, we demonstrate the better performance of our method in the task of image set classification.
Feasibility Study to Determine if Microfracture Surgery Using Water Jet Drilling Is Potentially Safe for Talar Chondral Defects in a Caprine Model
Authors: Kok Aimee C. , den Dunnen Steven , Lambers Kaj T.A. , Kerkhoffs Gino M.M.J. , Tuijthof Gabrielle J.M.
Published: October 2019

Objective

Surgical microfracture is considered a first-line treatment for talar osteochondral defects. However, current rigid awls and drills limit access to all locations in human joints and increase risk of heat necrosis of bone. Using a flexible water jet instrument to drill holes can improve the reachability of the defect without inducing thermal damage. The aim of this feasibility study is to determine whether water jet drilling is potentially safe compared with conventional microfracture awls by studying side effects and perioperative complications, as well as the quality of cartilage repair tissue.

Design

Talar chondral defects with 6-mm diameter were created bilaterally in 6 goats (12 samples). One defect in each goat was treated with microfracture created with conventional awls, the contralateral defect was treated with holes created with 5-second water jet bursts at a pressure of 50 MPa. Postoperative complications were recorded and after 24 weeks analyses were performed using the ICRS (International Cartilage Repair Society) macroscopic score and modified O’Driscoll histological score.

Results

Several practical issues using the water jet in the operating theatre were noted. Water jet drilling resulted in fibrocartilage repair tissue similar to the repair tissue from conventional awls.

Conclusions

These results suggest that water jet drilling gives adequate fibrocartilage repair tissue. Furthermore, the results highlight essential prerequisites for safe application of surgical water jet drilling: stable water pressure, water jet beam coherence, stable positioning of the nozzle head when jetting, and minimizing excessive fluid extravasation.
Dissecting Dispositionality: Distance Increases Stability of Attribution
Authors: Körner Anita , Moritz Sophie , Deutsch Roland
Published: October 2019

Causes of behavior are often classified as either dispositional (e.g., personality) or situational (e.g., circumstances). However, the disposition–situation dichotomy confounds locus (internal vs. external) and stability (unstable vs. stable) of attribution, rendering it unclear whether locus or stability drives changes in dispositionality. In the present research, we examine the dispositional shift—that is, psychologically distant (vs. near) events are attributed to dispositional (vs. situational) causes. Using construal level theory, we hypothesize that the dispositional shift is caused by a change in stability (but not necessarily locus) of attribution. Two experiments support this hypothesis. In Experiment 1, distant (vs. near) future events were attributed to more stable causes. In Experiment 2, actions by a socially distant person (vs. oneself) were also attributed to more stable (but also more internal) causes. Thus, important psychological manipulations, here psychological distance, can influence causal dimensions selectively, supporting the independence of stability and locus of attribution.
Stromal cell-derived factor-1 as a potential therapeutic target for osteoarthritis and rheumatoid arthritis
Authors: Bragg Robert , Gilbert William , Elmansi Ahmed M. , Isales Carlos M. , Hamrick Mark W. , Hill William D. , Fulzele Sadanand
Published: October 2019

With age, joints become subject to chronic inflammatory processes that lead to degeneration of articular cartilage. Although multifactorial, cytokines have been shown to play a role in the pathogenesis of these chronic disease states. Stromal cell-derived factor 1 (SDF-1) is a chemokine that has been shown to be active in homeostatic mechanisms and developmental processes throughout the body, such as endochondral bone formation. SDF-1 plays a role in the transition from cartilage to bone. Although it has been shown to be a factor in normal development, it has also been shown to involve in the pathogenesis of rheumatoid arthritis (RA) and osteoarthritis (OA). In RA, SDF-1 has been shown to stimulate the recruitment of proinflammatory cells, as well as osteoclasts to the synovium, aiding in the facilitation of synovial degradation. Similarly, in OA, SDF-1 has been shown to regulate key proteins involved in the degradation of the cartilage of the joint. Because of its role in degenerative joint disease, SDF-1 has been investigated as a potential therapeutic target. Animal studies have been employing SDF-1 inhibitors, such as AMD3100 and T140, to study their effects on attenuating degenerative joint disease. These studies have shown promising results in slowing the progression of cartilage degradation and could potentially be used as therapeutic target for humans OA and RA.
Symptoms and exacerbations in asthma: an apparent paradox?
Authors: Morjaria Jaymin B. , Rigby Alan S. , Morice Alyn H.
Published: October 2019

Background:

There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an uncontrolled asthma cohort. We also examined the effect of maintenance and reliever therapy (MART) on these symptoms and its effect on exacerbation rate.

Methods:

Adults with uncontrolled asthma electronically recorded their asthma symptom severity scores twice-daily over a period of 48 weeks following randomisation to beclometasone/formoterol twice daily plus pro re nata (prn) salbutamol or MART. Subjects with symptom scores of ⩾2 (ranging from 0 to 3 for each symptom) were considered more symptomatic, whereas those below a score of 2 were considered less severe. The influence treatment on exacerbation frequency and symptom profiles were then correlated.

Results:

Of the 1701 subjects in the analyses, 1403 were symptomatic with ⩾100 symptom episodes for one symptom. The remaining 298 subjects were classified as pauci-symptomatic. There was poor association between the frequency and symptom severity score for each symptom. Surprisingly, wheeze was the least reported symptom. Females were more likely to be polysymptomatic. MART compared with prn salbutamol markedly attenuated severe asthma exacerbations. This effect was most notable in subjects with fewer symptoms.

Conclusions:

In uncontrolled asthma, there is a poor correlation between reported symptoms and exacerbation frequency. This post hoc analysis suggests that MART should not be reserved for symptomatic subjects but achieves the greatest benefit in pauci-symptomatic patients with asthma.

Trial registration:

ClinicalTrials.gov identifier: NCT00861926
Prevalence and patterns of cognitive impairment in acute coronary syndrome patients: A systematic review
Authors: Zhao Emma , Lowres Nicole , Woolaston Anna , Naismith Sharon L , Gallagher Robyn
Published: October 2019

Background

Minimising risk factors through secondary prevention behaviour is challenging for patients following an acute coronary syndrome. Cognitive impairment can potentially make these changes more difficult. However, cognitive impairment prevalence in acute coronary syndrome patients is poorly understood.

Design

This study was based on a systematic review.

Methods

A systematic review was conducted of PubMed, Medline, PsycINFO and Cochrane databases up to March 2019, to identify studies reporting the prevalence of cognitive impairment in acute coronary syndrome patients. Predefined inclusion criteria were specified, including use of a validated cognitive impairment screening tool. Studies were excluded if patients had diagnosed dementia or coronary artery bypass graft surgery. Strengthening The Reporting of Observational Studies in Epidemiology and Cochrane Risk of Bias tools were used to assess quality.

Results

From 747 potential studies, nine were included. The total sample size was 6457 (range 53–2174), mean age range was 51.3–77.4 years, and range of proportions of males was 57–100%. Reported cognitive impairment prevalence rates varied substantially (9–85%) with no clear pattern over time. From the two studies which examined domains, verbal fluency, memory and language were affected the most. Meta-analysis could not be undertaken due to diverse screening tools ( n = 9), cut-off scores and screening timepoints.

Conclusions

Cognitive impairment in acute coronary syndrome patients is currently poorly described, and likely affects a substantial number of acute coronary syndrome patients who remain undetected and have the potential to develop to dementia in the future. As domains are most affected, this could impact understanding and retention of health education. Research is needed to accurately determine the prevalence of cognitive impairment in acute coronary syndrome patients and create suitable standardised measures and thresholds.
HEART score improves efficiency of coronary computed tomography angiography in patients suspected of acute coronary syndrome in the emergency department
Authors: Arslan Murat , Schaap Jeroen , Rood Pleunie PM , Nieman Koen , Budde Ricardo PJ , Attrach Mohamed , Dubois Eric A , Dedic Admir
Published: October 2019

Aims:

Coronary computed tomography angiography is increasingly employed in the emergency department for suspected acute coronary syndrome patients. The HEART score has been proposed for initial risk stratification in these patients. The aim of this study was to investigate the diagnostic value and efficiency of the HEART score before coronary computed tomography angiography.

Methods and results:

We included patients suspected of acute coronary syndrome who underwent coronary computed tomography angiography in the emergency department. Based on the HEART score, patients were stratified as low-risk (HEART≤3), intermediate-risk (HEART4–6) and high-risk (HEART≥7). We assessed coronary computed tomography angiography for the presence of significant coronary artery disease (>50% stenosis). The primary outcome, the level of major adverse cardiac events, was a composite endpoint of all-cause mortality, acute coronary syndrome or coronary revascularisation within 30 days. The study population consisted of 340 patients (mean age: 55.6±10.1 years, 44.7% women), major adverse cardiac events occurred in 45 (13.2%) patients. The incidence of major adverse cardiac events in patients stratified as low-risk (35.0%), intermediate-risk (56.8%) and high-risk (8.2%) was 3.4%, 12.4% and 60.7%, respectively. All four low-risk patients with major adverse cardiac events had a HEART score of three. An algorithm where coronary computed tomography angiography is reserved for patients with HEART 3–6 resulted in a sensitivity of 97.8%, specificity of 84.1%, negative predictive value of 99.6% and positive predictive value of 48.4%, while reducing the need for coronary computed tomography angiography by 22% ( n=75).

Conclusion:

The predictive value of coronary computed tomography angiography for 30-day major adverse cardiac events in suspected acute coronary syndrome patients is good, and reserving coronary computed tomography angiography for HEART score 3–6 patients reduces the number of needed coronary computed tomography angiograms without affecting diagnostic accuracy.
Long-Term Impact of Bariatric Surgery on Renal Outcomes at a Community-Based Publicly Funded Bariatric Program: The Regina Bariatric Study
Authors: McIsaac Mark , Kaban Gordon , Clay Adam , Berry Warren , Prasad Bhanu
Published: October 2019

Background:

Obesity is recognized as an independent risk factor for chronic kidney disease through multiple direct and indirect biological pathways. Bariatric surgery is a proven, effective method for sustained weight loss. However, there is a relative paucity of data on the impact of bariatric surgery on renal outcomes.

Objective:

The primary objective was to evaluate the change in urine albumin/creatinine ratio (ACR) in patients undergoing bariatric surgery, at 12 months after the procedure. Secondary objectives were to determine the changes in ACR at (6 and 24 months), estimated glomerular filtration rate (eGFR; 6, 12, and 24 months), and hemoglobin A1c (HbA1c); 12 and 24 months) after the procedure.

Design:

This observational retrospective cohort study included consecutive obese patients who underwent bariatric surgery.

Setting:

Provincial Bariatric Surgery Clinic at the Regina General Hospital, Saskatchewan.

Patients:

This study includes 471 consecutive obese adult patients who underwent bariatric surgery between 2008 and 2015.

Measurements:

We studied the impact of bariatric surgery on body mass index (BMI), renal outcomes (urine ACR and eGFR) and metabolic outcomes (fasting glucose, total cholesterol, low-density lipoprotein, triglycerides, and HbA1c) in 471 patients.

Methods:

Patients were followed for 2 years postsurgery in the bariatric clinic. Mixed linear models that accounted for the repeated nature of the data were used to access changes in outcomes over time.

Results:

Patients were predominantly female (81%) with a mean age (±SD) of 46 ± 10 years. Most patients (87%) had a BMI > 40 kg/m2 and 81% of the patients underwent Roux-en-Y gastric bypass. The mean BMI decreased from 47.7 ± 7.8 kg/m2 at baseline to 37.1 ± 7.9 kg/m2 at 6 months and 34.8 ± 8.8 kg/m2 at 12 months. In a subcohort of patients with microalbuminuria, ACR showed an improvement from a median [interquartile] value of 5.1 [3.7-7.5] mg/mmol at baseline to 2.3 [1.2-3.6] mg/mmol at 6 months ( P = .007), to 1.4 [0.9-3.7] mg/mmol at 2-year follow-up ( P < .001). Similarly, eGFR increased in patients with microalbuminuria from 109 ± 10 mL/min/1.73 m2 at baseline to 120 ± 36 mL/min/1.73 m2 at 2-year follow-up ( P = .013). There were statistically significant reductions in triglycerides, fasting glucose, and HbA1c.

Limitations:

This was a retrospective chart review, with the lack of a control group. Patients with eGFR less than 60 mL/min/1.73 m2 were not considered for surgery, and we had to measure renal outcomes predominantly on the presence of proteinuria.

Conclusions:

Our results suggest bariatric surgery significantly decreased weight and consequently improved renal and metabolic outcomes (eGFR, ACR, fasting glucose, cholesterol, and triglycerides) in patients with elevated BMI.
Medical Cannabis for the Primary Care Physician
Authors: Slawek Deepika , Meenrajan Senthil Raj , Alois Marika Rose , Comstock Barker Paige , Estores Irene Mison , Cook Robert
Published: October 2019

Medical cannabis use is common in the United States and increasingly more socially acceptable. As more patients seek out and acquire medical cannabis, primary care physicians will be faced with a growing number of patients seeking information on the indications, efficacy, and safety of medical cannabis. We present a case of a patient with several chronic health conditions who asks her primary care provider whether she should try medical cannabis. We provide a review of the pharmacology of medical cannabis, the state of evidence regarding the efficacy of medical cannabis, variations in the types of medical cannabis, and safety monitoring considerations for the primary care physician.
Entrepreneurial Orientation, Interaction Orientation, and Innovation Performance: A Model of Moderated Mediation
Authors: Song Wenhao , Ma Xifang , Yu Hongyan
Published: October 2019

This research explored the relationships between entrepreneurial orientation (EO), interaction orientation (IO), and innovation performance based on resource-based theory. We used two market approaches (market-driving and market-driven) to test our research model. We collected data from the responses of 209 corporations in China. Our findings indicated that both EO and IO positively affected knowledge combination capability (KCC), which contributed to innovation performance. The results indicated that organizational collectivism moderated the link between EO and KCC. It also moderated the mediation effect of EO on firm’s innovation performance by KCC. Interestingly, we found that organizational collectivism moderated the link between IO and KCC and also moderated the mediation of IO on innovation performance by KCC. Our research contributes to the field of strategic orientation and suggests that managers should pay attention to the two market approaches and organizational culture, which can improve innovation performance. Furthermore, this research offers theoretical and practical implications to firm’s innovation capability.
Indigenous Knowledge Systems and the Teaching of Climate Change in Zimbabwean Secondary Schools
Authors: Tanyanyiwa Vincent Itai
Published: October 2019

Indigenous African education grew out of the immediate environment, real or imaginary, where people had knowledge of the environment. Indigenous education inculcated a religious attitude that imbued courtesy, generosity, and honesty. At colonization, Africans were thought of as primitive although they had their own systems, contents, and methods of education. Colonialism signified the decline in the importance of indigenous knowledge systems (IKS). By shifting focus in the core curriculum from teaching/learning based on Western science to teaching/learning through IKS as a foundation for all education, it is anticipated that all forms of knowledge, ways of knowing, and world views be acknowledged as equally valid, adaptable, and complementary to one another in equally valuable ways. The uniqueness of indigenous people and their knowledge is inextricably connected to their lands, which are situated primarily at the social-ecological margins of human habitation such as tropical forests and desert margins. It is at these margins that the consequences of climate change manifest themselves in the following sectors: agriculture, pastoralism, fishing, hunting and gathering, and other subsistence activities, including access to water. Government policies in Zimbabwe often limit options and thus undermine indigenous peoples’ efforts to adapt. IKS is very important for community-based adaptation and mitigation actions in the agricultural sector for maintenance of resilience of social-ecological systems at a local level. This article, through interviews, document analysis, and personal observations, proposes that it is best for Zimbabwe to develop her own climate change curricula and modes of delivery that incorporates IKS.
Dating With Social Anxiety: An Empirical Examination of Momentary Anxiety and Desire for Future Interaction
Authors: Asher Maya , Aderka Idan M.
Published: October 2019

Individuals with social anxiety disorder (SAD) have substantial difficulties in romantic relationships. The aim of the present study was to examine initial, opposite-sex interactions of individuals with SAD and their interaction partners. Specifically, we investigated gender and social context (small talk vs. closeness-generating conversations) and their effects on momentary social anxiety during the interaction, as well as on participants’ desire for future interaction. Participants in this study ( N = 160) formed 42 experimental dyads, each comprising one individual with SAD and another non–socially anxious (NSA) individual, and 38 control dyads of two NSA individuals. We found that men with SAD benefitted significantly from closeness-generating interactions such that levels of momentary social anxiety were greatly reduced and both members of the dyad reported increased desire for future interaction. This effect was not found in small-talk conversations and not found for women with SAD. Implications for psychopathology and treatment are discussed.
Effective Connectivity Between Broca’s Area and Amygdala as a Mechanism of Top-Down Control in Worry
Authors: Guha Anika , Spielberg Jeffrey M. , Lake Jessica , Popov Tzvetan , Heller Wendy , Yee Cindy M. , Miller Gregory A.
Published: October 2019

Individuals higher in trait worry exhibit increased activation in Broca’s area during inhibitory processing tasks. To identify whether such activity represents an adaptive mechanism supporting top-down control, we investigated functional and effective connectivity of Broca’s area during a task of inhibitory control. Functional MRI data obtained from 106 participants performing an emotion-word Stroop task were examined using psychophysiological interaction and Granger causality (GC) analyses. Findings revealed greater directed connectivity from Broca’s area to amygdala in the presence of emotional distraction. Furthermore, a predictive relationship was observed between worry and the asymmetry in effective connectivity; worriers exhibited greater directed connectivity from Broca’s area to amygdala. When performing the task, worriers with greater GC directional asymmetry were more accurate than worriers with less asymmetry. Present findings indicate that individuals with elevated trait worry use a mechanism of top-down control in which communication from Broca’s area to amygdala fosters successful compensation for interference effects.
Development of AOSpine BOnE (Bone Osteobiologics and Evidence) Classification
Authors: Wang Jeffrey C. , Yoon S. Tim , Brodke Darrel S. , Park Jong-Beom , Hsieh Patrick , Meisel Hans-Joerg , Buser Zorica
Published: October 2019

Study Design:

Classification development.

Objectives:

The aim of our study was to develop a 3-tier classification for the levels of evidence for osteobiologics and provide a description of the principles by which osteobiologics can be evaluated. BOnE (Bone Osteobiologics and Evidence) classification evaluates each osteobiologic based on the available evidence, and if the published evidence is based on clinical, in vivo or in vitro studies.

Methods:

The process of establishing the BOnE classification included 5 face-to-face meetings and 2 web calls among members of the AOSpine Knowledge Forum Degenerative.

Results:

The 3 levels of evidence were determined based on the type of data on osteobiologics: level A for human studies, level B for animal studies, and level C for in vitro studies, with level A being the highest level of evidence. Each level was organized into 4 subgroups (eg, A1, A2, A3, and A4).

Conclusions:

The use and the variety of osteobiologics for spine fusion has dramatically increased over the past few decades; however, literature on their effectiveness is inconclusive. Several prior systematic reviews developed by AOSpine Knowledge Forum Degenerative reported low level of evidence primarily due to the high risk of bias, small sample size, lack of control groups, and limited patient-reported outcomes. BOnE classification will provide a universal platform for research studies and journal publications to classify a new or an existing product and will allow for creating decision-making algorithms for surgical planning.
Closed-Wedge Osteotomy of the Distal Humerus for Treating Osteochondritis Dissecans of the Capitellum in Young Patients
Authors: Ueki Masato , Moriya Koji , Yoshizu Takae , Tsubokawa Naoto , Kouda Hisao , Endo Naoto
Published: October 2019

Background:

Even in patients with an open capitellar physis, nonsurgical treatment for advanced-stage osteochondritis dissecans (OCD) of the capitellum often yields poor outcomes. However, surgical methods for such patients are controversial. At our institution, we have consistently performed closed-wedge osteotomy of the distal humerus to treat advanced-stage OCD of the capitellum, regardless of the OCD grade or condition of the capitellar physis.

Purpose:

To clarify the clinical and radiological results and determine the influence of the capitellar physis on closed-wedge osteotomy for advanced-stage OCD of the capitellum in young patients.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 32 patients with OCD of the humeral capitellum were treated surgically with closed-wedge osteotomy. Of these, 17 patients with more than 2-year follow-up were available for an evaluation. The mean patient age was 11.8 years (range, 11-12 years), and the mean follow-up period was 70.1 months (range, 25-184 months). The clinical assessment included range of motion, elbow pain, and the Japanese Orthopaedic Association (JOA) and Timmerman-Andrews scores. The radiological assessment at the final examination included cross-bridging of the physis, size and fishtail deformity of the distal part of the humerus, size of the radial head, healing of the OCD lesion, and osteoarthritis.

Results:

The mean range of motion and JOA and Timmerman-Andrews scores improved significantly after surgery; 13 patients were completely pain free. In 11 patients with an open capitellar physis, metaphyseal-epiphyseal, cross-bridging was observed in 1 patient. A fishtail deformity of the distal part of the humerus was not observed. Healing of the OCD lesion was defined as excellent in 9 patients, good in 3, fair in 3, and poor in 2. In 3 of the 5 patients in whom healing was described as fair or poor, there was a lesion of the lateral widespread type with osteoarthritis before surgery. Moderate osteoarthritic changes were evident in 2 patients.

Conclusion:

Closed-wedge osteotomy for the treatment of advanced-stage OCD of the capitellum in young patients can provide satisfactory clinical and radiological results. However, fair and poor outcomes were found in lateral widespread–type cases with osteoarthritis before surgery. We believe that patients in whom osteoarthritic changes have not yet appeared are eligible for closed-wedge osteotomy.
Toward a Framework for Classifying Teachers’ Use of Assessment Data
Authors: Farley-Ripple Elizabeth N. , Jennings Austin S. , Buttram Joan
Published: October 2019

Research consistently has found teachers’ use of assessment data for instructional purposes challenging and inconsistent. To support teachers’ use of data, we need to develop shared knowledge about how data are and can be used to advance teaching and learning. However, the literature on the specific actions teachers take is inconsistent, creating challenges for both research and practice. As part of a larger project examining data use in instructional decision making, we developed a framework to classify teachers’ instructional responses to data. Then, we used quantitative and qualitative data from educators across 5 districts and 20 schools to evaluate the utility of the framework. This article documents the process and outcomes of our multistage, mixed-methods approach to these tasks. We conclude with the potential uses of this framework for research and practice.
Point Shear Wave Elastography of the Spleen in Predicting the Presence of Esophageal Varices in Cirrhosis: Liver Stiffness vs. Spleen Stiffness
Authors: Sindhu Nadella , Koteshwar Prakashini , Shetty Shiran
Published: October 2019

Objective:

To determine the diagnostic ability of the spleen and liver stiffness in predicting the presence of esophageal varices (EVs).

Methods:

A sample of cirrhotic patients, diagnosed with sonography, was recruited. The cohorts’ liver stiffness (LS) and spleen stiffness (SS) were measured with the Philips’ Elast PQ technique. Platelet count and spleen size were also documented. The endoscopic report was used as the diagnostic gold standard. Singular and combined parameters were assessed to determine the presence of EV using an independent variable t test, area under the receiver operating characteristic curve, and multilogistic regression analysis statistical tests.

Results:

In predicting the presence of EV, there was a statistically significant difference in means of SS (2.13 ± 0.69 m/s vs. 3.23 ± 1.32 m/s) and LS (2.33 ± 1.20 m/s vs. 3.05 ± 1.4 m/s), as well as discriminating between groups of patients, with and without EV. The ability to diagnostically classify EV with SS and LS was fair while the remaining parameters were deemed poor, using a SS cutoff value of 1.99 m/s.

Conclusion:

Despite the difference in means, none of the assessed parameters demonstrated a better classification ability than endoscopy. LS and SS were equal in the prediction of EV in these patients. The LS estimate of fibrosis would have grossly predicted the presence of varices. However, the addition of SS, for the estimation of varices, provided no significant benefit.
Defective interaction of mutant calreticulin and SOCE in megakaryocytes from patients with myeloproliferative neoplasms
Authors: Di Buduo Christian A. , Abbonante Vittorio , Marty Caroline , Moccia Francesco , Rumi Elisa , Pietra Daniela , Soprano Paolo M. , Lim Dmitry , Cattaneo Daniele , Iurlo Alessandra , Gianelli Umberto , Barosi Giovanni , Rosti Vittorio , Plo Isabelle , Cazzola Mario , Balduini Alessandra
Published: October 2019

Approximately one-fourth of patients with essential thrombocythemia or primary myelofibrosis carry a somatic mutation of the calreticulin gene (CALR), the gene encoding for calreticulin. A 52-bp deletion (type I mutation) and a 5-bp insertion (type II mutation) are the most frequent genetic lesions. The mechanism(s) by which a CALR mutation leads to a myeloproliferative phenotype has been clarified only in part. We studied the interaction between calreticulin and store-operated calcium (Ca2+) entry (SOCE) machinery in megakaryocytes (Mks) from healthy individuals and from patients with CALR-mutated myeloproliferative neoplasms (MPNs). In Mks from healthy subjects, binding of recombinant human thrombopoietin to c-Mpl induced the activation of signal transducer and activator of transcription 5, AKT, and extracellular signal-regulated kinase 1/2, determining inositol triphosphate–dependent Ca2+ release from the endoplasmic reticulum (ER). This resulted in the dissociation of the ER protein 57 (ERp57)-mediated complex between calreticulin and stromal interaction molecule 1 (STIM1), a protein of the SOCE machinery that leads to Ca2+ mobilization. In Mks from patients with CALR-mutated MPNs, defective interactions between mutant calreticulin, ERp57, and STIM1 activated SOCE and generated spontaneous cytosolic Ca2+ flows. In turn, this resulted in abnormal Mk proliferation that was reverted using a specific SOCE inhibitor. In summary, the abnormal SOCE regulation of Ca2+ flows in Mks contributes to the pathophysiology of CALR-mutated MPNs. In perspective, SOCE may represent a new therapeutic target to counteract Mk proliferation and its clinical consequences in MPNs.
Clonal hematopoiesis in elderly twins: concordance, discordance, and mortality
Authors: Hansen Jakob Werner , Pedersen Dorthe Almind , Larsen Lisbeth Aagaard , Husby Simon , Clemmensen Signe Bedsted , Hjelmborg Jacob , Favero Francesco , Weischenfeldt Joachim , Christensen Kaare , Grønbæk Kirsten
Published: October 2019

Clonal hematopoiesis (CH) of indeterminate potential (CHIP) is defined by mutations in myeloid cancer–associated genes with a variant allele frequency of at least 2%. Recent studies have suggested a possible genetic predisposition to CH. To further explore this phenomenon, we conducted a population-based study of 594 twins from 299 pairs aged 73 to 94 years, all with >20 years’ follow-up. We sequenced DNA from peripheral blood with a customized 21-gene panel at a median coverage of 6179X. The casewise concordance rates for mutations were calculated to assess genetic predisposition. Mutations were identified in 214 (36%) of the twins. Whereas 20 twin pairs had mutations within the same genes, the exact same mutation was only observed in 2 twin pairs. No significant difference in casewise concordance between monozygotic and dizygotic twins was found for any specific gene, subgroup, or CHIP mutations overall, and no significant heritability could be detected. In pairs discordant for CHIP mutations, we tested if the affected twin died before the unaffected twin, as a direct measurement of the association of having CH when controlling for familial factors. A total of 127 twin pairs were discordant for carrying a mutation, and in 61 (48%) cases, the affected twin died first (P = .72). Overall, we did not find a genetic predisposition to CHIP mutations in this twin study. The previously described negative association of CHIP mutations on survival could not be confirmed in a direct comparison among twin pairs that were discordant for CHIP mutations.
The innervation of the male copulatory organ of spiders (Araneae) – a comparative analysis
Authors: Dederichs Tim M. , Müller Carsten H. G. , Sentenská Lenka , Lipke Elisabeth , Uhl Gabriele , Michalik Peter
Published: October 2019

Background

Nervous tissue is an inherent component of the many specialized genital structures for transferring sperm directly into the female’s body. However, the male copulatory organ of spiders was considered a puzzling exception. Based on the recent discovery of nervous tissue in the pedipalps of two distantly related spider species, we investigated representatives of all major groups across the spider tree of life for the presence of palpal nerves. We used a correlative approach that combined histology, micro-computed tomography and electron microscopy.

Results

We show that the copulatory organ is innervated in all species investigated. There is a sensory organ at the base of the sperm transferring sclerite in several taxa and nervous tissue occurs close to the glandular tissue of the spermophor, where sperm are stored before transfer.

Conclusions

The innervation of the copulatory organ by the bulb nerve and associated efferent fibers is part of the ground pattern of spiders. Our findings pave the way for unraveling the sensory interaction of genitalia during mating and for the still enigmatic mode of uptake and release of sperm from the male copulatory organ.
Nivolumab-related severe thrombocytopenia in a patient with relapsed lung adenocarcinoma: a case report and review of the literature
Authors: Hasegawa Takeo , Ozaki Yuki , Inoue Takuya , Watanabe Yuzuru , Fukuhara Mitsuro , Yamaura Takumi , Muto Satoshi , Okabe Naoyuki , Higuchi Mitsunori , Shio Yutaka , Suzuki Hiroyuki
Published: October 2019

Background

Immune checkpoint inhibitor therapy has changed the standard drug therapy for relapsed or advanced non-small cell lung cancer; its efficacy is well-recognized by pulmonary physicians, oncologists, and thoracic surgeons. Nivolumab, one of the anti-programmed cell death 1 antibodies, was the first immune checkpoint inhibitor to be approved and is used as a standard second-line regimen for patients with non-small cell lung cancer irrespective of the expression of programmed cell death ligand 1. Programmed cell death 1 antibodies have been generally confirmed to be less toxic than conventional cytotoxic chemotherapy, although unusual immune-related adverse events such as type I diabetes mellitus, adrenal failure, and myasthenia gravis may occur with a very low incidence. A case of severe grade V immune-related thrombocytopenia after two courses of nivolumab as second-line therapy for relapsed non-small cell lung cancer is reported.

Case presentation

An 82-year-old Japanese woman with relapsed lung adenocarcinoma was treated with nivolumab as second-line systemic therapy at our institute. Her laboratory data indicated thrombocytopenia suspected to be an immune-related adverse event following two courses of nivolumab. Subsequently, she developed a massive pulmonary hemorrhage and left cerebral infarction despite intensive treatment including systemic steroid therapy. Although there have been a few reports of thrombocytopenia caused by nivolumab, this is the first report of grade V thrombocytopenia following administration of nivolumab for relapsed non-small cell lung cancer.

Conclusion

A very difficult case of grade V immune-related thrombocytopenia after the administration of nivolumab as second-line therapy for relapsed lung adenocarcinoma was described. Immune-related thrombocytopenia is a rare adverse event, but it must be considered a possible complication because it may become critical once it has occurred.
Basket Designs: Statistical Considerations for Oncology Trials
Authors: Kaizer Alexander M. , Koopmeiners Joseph S. , Kane Michael J. , Roychoudhury Satrajit , Hong David S. , Hobbs Brian P.
Published: October 2019

Progress in the areas of genomics, disease pathways, and drug discovery has advanced into clinical and translational cancer research. The latest innovations in clinical trials have followed with master protocols, which are defined by inclusive eligibility criteria and devised to interrogate multiple therapies for a given tumor histology and/or multiple histologies for a given therapy under one protocol. The use of master protocols for oncology has become more common with the desire to improve the efficiency of clinical research and accelerate overall drug development. Basket trials have been devised to ascertain the extent to which a treatment strategy offers benefit to various patient subpopulations defined by a common molecular target. Conventionally conducted within the phase II setting, basket designs have become popular as drug developers seek to effectively evaluate and identify preliminary efficacy signals among clinical indications identified as promising in preclinical study. This article reviews basket trial designs in oncology settings and discusses several issues that arise with their design and analysis.