bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomy of Corporate Borrowing Constraints*
Authors: Lian Chen , Ma Yueran
Published: September 2020

Macro-finance analyses commonly link firms’ borrowing constraints to the liquidation value of physical assets. For U.S. nonfinancial firms, we show that 20% of debt by value is based on such assets (asset-based lending in creditor parlance), whereas 80% is based predominantly on cash flows from firms’ operations (cash flow–based lending). A standard borrowing constraint restricts total debt as a function of cash flows measured using operating earnings (earnings-based borrowing constraints). These features shape firm outcomes on the margin: first, cash flows in the form of operating earnings can directly relax borrowing constraints; second, firms are less vulnerable to collateral damage from asset price declines, and fire sale amplification may be mitigated. Taken together, our findings point to new venues for modeling firms’ borrowing constraints in macro-finance studies.
Lymphadenopathy in IgG4-related disease: a phenotype of severe activity and poor prognosis, with eotaxin-3 as a new biomarker
Authors: Takanashi Satoshi , Kikuchi Jun , Sasaki Takanori , Akiyama Mitsuhiro , Yasuoka Hidekata , Yoshimoto Keiko , Seki Noriyasu , Sugahara Kunio , Chiba Kenji , Kaneko Yuko , Takeuchi Tsutomu
Published: September 2020

Objective

To clarify relevant proteins and clinical characteristics of a phenotype of IgG4-related disease (IgG4-RD) with lymphadenopathy.

Methods

We enrolled patients newly diagnosed with IgG4-RD in our department between January 2000 and June 2018 and performed proteomic analysis to measure serum concentrations of 1305 proteins. We extracted proteins overexpressed in patients with IgG4-RD with lymphadenopathy by comparing between those with lymphadenopathy, those without lymphadenopathy and healthy controls. We further reviewed all the patients with IgG4-RD in our institution and investigated the characteristics and prognosis of the patients with IgG4-RD with lymphadenopathy.

Results

Eighty-five patients with IgG4-RD were enrolled, of which, 55% had lymphadenopathy. Proteomic analysis in 31 patients with IgG4-RD and 6 healthy controls revealed that eotaxin-3 was a potential serum biomarker in the patients with lymphadenopathy versus those without lymphadenopathy and healthy controls. A cohort of 85 patients with IgG4-RD demonstrated that patients with lymphadenopathy showed a significantly higher serum IgG4, IgG4:IgG ratio, IgG4-RD responder index and eosinophilia (P < 0.001 for all), irrelevant of the extent to which organ involvement developed. Patients with lymphadenopathy treated with glucocorticoid alone relapsed with significantly higher rates than those without lymphadenopathy (P = 0.03).

Conclusion

Lymphadenopathy in IgG4-RD represents a phenotype associated with high disease activities, eosinophilia and relapsing disease. Eotaxin-3 is a novel biomarker related to IgG4-RD with lymphadenopathy.
Ten-Year Long-term Results of Modified Cervical Double-door Laminoplasty With C3 Laminectomy Preserving the Semispinalis Cervicis Inserted Into the Axis Compared With Those of Conventional Cervical Laminoplasty
Authors: Kudo Hitoshi , Takeuchi Kazunari , Wada Kanichiro , Kumagai Gentaro , Tanaka Sunao , Asari Toru , Araki Ryo , Yokoyama Toru , Ishibashi Yasuyuki
Published: September 2020

Study Design:

A retrospective study.

Objective:

To compare long-term clinical and radiologic outcomes between conventional double-door laminoplasty (LP) (group A) and cervical LP with C3 laminectomy (group B).

Summary of Background Data:

Cervical LP with C3 laminectomy preserving the semispinalis cervicis inserted into the axis decreased the patients’ postoperative axial pain and muscle atrophy, prevented interlaminar bony fusion, decreased limitations of daily living activity, including reduced postoperative neck mobility, and maintained the cervical range of motion (ROM) more effectively than conventional cervical LP reattaching the semispinalis cervicis in the short-term.

Materials and Methods:

Group A included 14 patients with an average age of 56.6 years at the time of surgery (follow-up rate 58.1%), and group B included 21 patients with an average age of 56.3 years at the time of surgery (follow-up rate 29.1%). We evaluated the clinical results, which included the Japanese Orthopaedic Association (JOA) score, JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiologic results, including C2–C7 ROM, number of interlaminar bony fusions and presence of new spondylolisthesis at C3.

Results:

There were no significant differences in preoperative and postoperative JOA scores, recovery rate of JOA score, and JOACMEQ. Significantly fewer patients in group B experienced interlaminar bony fusion at C2–C3 compared with those in group A. There was no significant difference in the presence of new spondylolisthesis at C3. In patients with cervical spondylotic myelopathy, the rate of decrease of C2–C7 ROM was significantly less in group B than in group A. In patients with ossification of the posterior longitudinal ligament, there was no significant difference in the rate of decrease of C2–C7 ROM between the groups.

Conclusions:

C3 laminectomy prevented interlaminar bony fusion at C2–C3. C3 laminectomy maintained cervical ROM in patients with cervical spondylotic myelopathy. There were no adverse events due to C3 laminectomy at 10 years postsurgery.
Race and smoking status associated with paclitaxel drug response in patient-derived lymphoblastoid cell lines
Authors: Akhtari Farida S. , Havener Tammy M. , Hertz Daniel L. , Ash Jeremy , Larson Alexandra , Carey Lisa A. , McLeod Howard L. , Motsinger-Reif Alison A.
Published: September 2020

The use of ex-vivo model systems to provide a level of forecasting for in-vivo characteristics remains an important need for cancer therapeutics. The use of lymphoblastoid cell lines (LCLs) is an attractive approach for pharmacogenomics and toxicogenomics, due to their scalability, efficiency, and cost-effectiveness. There is little data on the impact of demographic or clinical covariates on LCL response to chemotherapy. Paclitaxel sensitivity was determined in LCLs from 93 breast cancer patients from the University of North Carolina Lineberger Comprehensive Cancer Center Breast Cancer Database to test for potential associations and/or confounders in paclitaxel dose-response assays. Measures of paclitaxel cell viability were associated with patient data included treatment regimens, cancer status, demographic and environmental variables, and clinical outcomes. We used multivariate analysis of variance to identify the in-vivo variables associated with ex-vivo dose-response. In this unique dataset that includes both in-vivo and ex-vivo data from breast cancer patients, race (P = 0.0049) and smoking status (P = 0.0050) were found to be significantly associated with ex-vivo dose-response in LCLs. Racial differences in clinical dose-response have been previously described, but the smoking association has not been reported. Our results indicate that in-vivo smoking status can influence ex-vivo dose-response in LCLs, and more precise measures of covariates may allow for more precise forecasting of clinical effect. In addition, understanding the mechanism by which exposure to smoking in-vivo effects ex-vivo dose-response in LCLs may open up new avenues in the quest for better therapeutic prediction.
Utility of platelet indices in alcoholic hepatitis: a retrospective study
Authors: Vijayakumar Saravanakumari , Viswanathan Stalin , Jain Dheeraj
Published: September 2020

Background:

The commonly available platelet indices are platelet distribution width (PDW), plateletcrit (PCT), and mean platelet volume (MPV). They have been used in diagnosis and prognosis of various abdominal disorders. They have never been used to predict severity of alcoholic hepatitis.

Methods:

A retrospective analysis of chronic alcohol consumers presenting with jaundice and deranged liver function tests was performed. Maddrey discriminant function (MDF) and modified end-stage liver disease (MELD) scores were calculated and patients compared between severe and nonsevere alcoholic hepatitis (MDF ≥32 vs MDF <32 and MELD >20 vs MELD ≤20). Logistic regression analysis was performed to find significant predictors. Receiver operating characteristic was used to find the area under the curve. Spearman correlation was performed to discover association between platelet indices and severity scores.

Results:

There were 119 patients in the study. Coexisting illnesses included pancreatitis, cirrhosis, infections, and alcohol withdrawal syndrome. The mean age (years), duration of alcohol consumption (years), and ethanol (g/day) were 45.13 ± 11.53, 18.84 ± 11.40, and 65.61 ± 45.42, respectively. The average MELD and Maddrey scores were 14.13 ± 5.17 and 36.45 ± 29.63, respectively. The mean platelet counts, PDW, MPV, and PCT were 194.01 ± 178.82 × 109/L, 17.10 ± 1.21, 5.99 ± 0.96, and 0.14 ± 0.04, respectively. PDW >18 and MPV had a significant positive correlation with MELD scores. Only bilirubin and prothrombin prolongation were significant predictors of severe alcoholic hepatitis. The area under the curve was highest for PCT at 0.622 (P = .07; confidence interval = 0.500–0.743).

Conclusions:

Platelet indices appear to be significantly altered in alcoholic hepatitis, but they do not predict severe disease. Whether this inability to predict severe alcoholic hepatitis is due to coexisting illnesses such as pancreatitis, cirrhosis, and infection needs to be studied further.
The Utility of the King-Devick Test in Evaluating Professional Ice Hockey Players With Suspected Concussion
Authors: Echemendia Ruben J. , Thelen Joanie , Meeuwisse Willem , Comper Paul , Hutchison Michael G. , Rizos John , Bruce Jared M.
Published: September 2020

Objective:

The purpose of this study was to (1) examine the diagnostic utility of the King-Devick (KD) in professional ice hockey players and (2) determine whether the KD provides unique variance in predicting a diagnosis of concussion when given in combination with the SCAT-5.

Study Design:

Cohort Study.

Setting:

Primary care.

Patients/Participants:

Professional ice hockey players.

Independent Variables:

Diagnosis versus no diagnosis of concussion.

Main Outcome Measures:

King-Devick and SCAT-5 component scores.

Methods:

In part 1, players suspected of having a concussion were evaluated at baseline and acutely with the KD and either the SCAT-3 or the SCAT-5. Players evaluated and not diagnosed with concussion served as active controls. In part 2, a separate group of players suspected of having a concussion was evaluated acutely with both the KD and SCAT-5.

Results:

In part 1 of this study, 53 concussed players declined in performance on the KD from baseline to acute evaluation, whereas the performance of 76 active controls improved significantly. In part 2 of the study, 75 players were diagnosed with concussion and compared with 80 active controls who were evaluated and not diagnosed with concussion. Concussed players revealed a decline in KD performance from baseline to acute evaluation when compared with controls. However, the KD did not account for significant unique variance in predicting a diagnosis of concussion after accounting for SCAT-5 data.

Conclusions:

The KD is useful in differentiating concussed and not concussed athletes acutely, but the KD does not seem to add additional diagnostic value over and above the SCAT-5.
Pelvic Region Avulsion Fractures in Adolescent Athletes: A Series of 242 Cases
Authors: Moeller James L. , Galasso Lisa
Published: September 2020

Objective:

The objective of this descriptive study was to evaluate pelvic region avulsion fractures in adolescents, including age of injury, location of injury, activity and mechanism at time of injury, treatments used, duration of treatment, and outcomes.

Design:

This was a retrospective chart review of patients who presented with pelvic region avulsion fracture over a 19-year period.

Setting:

Private practice, primary care sports medicine clinic.

Patients:

All patients younger than 20 years of age diagnosed with an acute pelvic region avulsion fracture.

Interventions:

There was no set intervention protocol. A variety of interventions and combination of interventions were used and determined by the treating physician on a case-by-case basis.

Main Outcome Measures:

Clearance for return toward sport activities.

Results:

Of the 242 cases, 162 were male. Soccer was the most common sport at the time of injury, and running/sprinting was the most common mechanism. Males were generally older at presentation and were more likely than females to have anterior inferior iliac spine injuries, whereas females were more likely to have iliac crest avulsions. Conservative treatment was effective in all cases. Males were treated for a shorter duration than females, but this difference was not statistically significant.

Conclusions:

Pelvic avulsion fractures are a rare injury in adolescent athletes. Males are twice as likely to experience these injuries and are older at presentation compared to females. Conservative management leads to successful outcomes in most cases.
Pain management in patients with chronic kidney disease and end-stage kidney disease
Authors: Roy Payel J. , Weltman Melanie , Dember Laura M. , Liebschutz Jane , Jhamb Manisha
Published: September 2020

Purpose of review

This review evaluates current recommendations for pain management in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) with a specific focus on evidence for opioid analgesia, including the partial agonist, buprenorphine.

Recent findings

Recent evidence supports the use of physical activity and other nonpharmacologic therapies, either alone or with pharmacological therapies, for pain management. Nonopioid analgesics, including acetaminophen, topical analgesics, gabapentinoids, serotonin–norepinephrine reuptake inhibitors, and TCA may be considered based on pain cause and type, with careful dose considerations in kidney disease. NSAIDs may be used in CKD and ESKD for short durations with careful monitoring. Opioid use should be minimized and reserved for patients who have failed other therapies. Opioids have been associated with increased adverse events in this population, and thus should be used cautiously after risk/benefit discussion with the patient. Opioids that are safer to use in kidney disease include oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Buprenorphine appears to be a promising and safer option due to its partial agonism at the mu opioid receptor.

Pain is poorly managed in patients with kidney disease. Nonpharmacological and nonopioid analgesics should be first-line approaches for pain management. Opioid use should be minimized with careful monitoring and dose adjustment.
Waiting times in renal transplant candidates with a history of malignancy: time for a change?
Authors: Bojic Marija , Watschinger Clara , Reiter Thomas , Watschinger Bruno
Published: September 2020

Purpose of review

With the aging population of kidney transplant candidates, a history of malignancy is an increasingly prevalent finding. Tumors can constitute a contraindication for transplantation or can lead to a delay of acceptance to the waiting-list. Current waiting time guidelines mainly refer to early data collected nearly 30 years ago, when the knowledge on tumors was, by current standards, still limited.

Recent findings

Today, cancers can usually be divided into many different biological subtypes, according to histological and molecular subclassification and the availability of genetic testing. A more precise stratification and targeted antitumor therapies have led to better therapy outcomes or even cures from certain malignancies and to a better appreciation of tumor risks for the patient.

Even though transplant patients do have an increased risk for malignancies, it is often overlooked that patients, while on dialysis, are equally prone to develop a tumor. Competing risks (e.g. cardiovascular, mortality risks) through prolonged time on dialysis have to be equally considered, when the decision for acceptance of a patient to the waiting-list is made. Current waiting time suggestions should be critically reconsidered for every patient after a thorough discussion with an oncologist, including new diagnostic and therapeutic strategies, as well as novel risk stratifications.
Evaluating Age-related Disparity of Outcomes in Ewing Sarcoma Patients Treated at a Pediatric Academic Medical Center
Authors: Perisa Michael P. , Stanek Joseph , Setty Bhuvana A. , Nicol Kathleen , Yeager Nicholas
Published: September 2020

Adolescent and young adult (AYA) patients with Ewing sarcoma have inferior survival compared with pediatric patients even when treated with similar regimens. Investigation into specific explanations is lacking. A retrospective chart review of Ewing sarcoma patients at a single institution was performed, and 104 patients were identified, 45 were 15 to 39 years of age (AYA cohort) and 59 younger than 15 years (pediatric cohort). AYA patients demonstrated more metastatic disease (50% vs. 24%, P=0.009), peripheral tumor location (64% vs. 41%, P=0.025), percentage of male patients (76% vs. 51%; P=0.010), and tumor size ≥5 cm (93% vs. 70%, P=0.016) than pediatric patients. Five-year overall survival was 77.7% and 53.0% and event-free survival was 68.7% and 40.6% for pediatric versus AYA, respectively. Similar rates of toxicity and chemotherapeutic dose adjustments were demonstrated. In this cohort, increased AYA patient mortality appears to be related to disease characteristics rather than treatment-related differences.
Clinical and Genetic Features of Patients With Fanconi Anemia in Lebanon and Report on Novel Mutations in the FANCA and FANCG Genes
Authors: Farah Roula A. , Nair Pratibha , Koueik Jack , Yammine Tony , Khalifeh Hassan , Korban Rima , Collet Agnes , Khayat Claudia , Dubois-Denghien Catherine , Chouery Eliane , Blanluet Maud , El-Hayek Stephany , Stoppa-Lyonnet Dominique , Megarbane Andre
Published: September 2020

Fanconi anemia (FA) is the most common inherited bone marrow failure syndrome and presents with cytopenias, characteristic physical features, increased chromosomal breaks, and a higher risk of malignancy. Genetic features of this disease vary among different ethnic groups. We aimed to identify the incidence, outcome, overall condition, and genetic features of patients affected with FA in Lebanon to optimize management, identify the most common genes, describe new mutations, and offer prenatal diagnosis and counseling to the affected families. Over a period of 17 years, 40 patients with FA were identified in 2 major diagnostic laboratories in Lebanon. Information was obtained on their clinical course and outcome from their primary physician. DNA was available in 20 patients and was studied for underlying mutations. FANCA seemed to be the most frequent genetic alteration and 2 novel mutations, one each in FANCA and FANCG, were identified. Nine patients developed various malignancies and died. This is the first study looking at clinical and genetic features of FA in Lebanon, and points to the need for establishing a national and regional registry for this condition.
Evaluation of Inflammatory Biomarkers in Pediatric Hematology-Oncology Patients With Bloodstream Infection
Authors: Chen Senmin , Liu Sixi , Yuan Xiuli , Wang Huihui , Wen Feiqiu
Published: September 2020

Bloodstream infection (BSI) is a serious complication in pediatric hematology-oncology patients. To evaluate the clinical significance of C-reactive protein (CRP), procalcitonin (PCT), albumin, fibrinogen, and D-dimer as potential biomarkers to differentiate among various subtypes of BSIs in pediatric patients with hematologic and oncologic diseases, we retrieved and analyzed the medical records of pediatric hematology-oncology patients diagnosed with BSI at our hospital between January 2016 and December 2017. The demographic (sex and age) and clinical (primary diseases) characteristics, and laboratory test results (white blood cell and absolute neutrophil counts, and serum CRP, PCT, albumin, fibrinogen, and D-dimer levels) were compared between nosocomial and non-nosocomial; neutropenic and non-neutropenic; and Gram-positive and Gram-negative BSI episodes. A total of 125 BSI episodes were included, including 69 (55.2%) nosocomial cases, 94 (75.2%) neutropenic cases, and 49 (39.2%) Gram-positive episodes. Of the 5 potential biomarkers evaluated (CRP, PCT, albumin, fibrinogen, and D-dimer), PCT levels were significantly lower in neutropenic episodes and Gram-positive BSIs (P=0.008 and P=0.001, respectively). At a cutoff value of 0.67 ng/mL, the diagnostic sensitivity, specificity, and positive/negative predictive values of PCT for the differentiation of Gram-positive and Gram-negative bacterial sepsis were 74.2%, 64.6%, 70.8%, and 65.2%, respectively. We concluded that PCT might potentially serve as a biomarker to differentiate between Gram-positive and Gram-negative BSIs in pediatric hematology-oncology patients.
Comparison of Corneal Higher-order Aberrations between Miniscleral and Hybrid Lenses in Keratoconus
Authors: Assadpour Mehrdad , Nabovati Payam , Hashemi Hassan , Rafati Shokoofeh , Yekta Abbasali , Jafarzadehpur Ebrahim , Khabazkhoob Mehdi
Published: September 2020

SIGNIFICANCE

Fitting specialty contact lenses (hybrid and miniscleral) can be a useful option in keratoconus patients to decrease higher-order aberrations (HOAs) and increase the quality of vision.

PURPOSE

The aim of the present study was to compare corneal HOAs between miniscleral and hybrid lenses in keratoconus patients.

METHODS

The target population of this study was 37 patients with bilateral keratoconus aged 20 to 35 years who were referred to a specialized contact lens clinic by a corneal specialist. Pre-fitting examinations included objective and subjective refraction, measurement of uncorrected and best spectacle-corrected visual acuity, and measurement of corneal HOAs. Lens fitting was performed in the next step. Finally, post-fitting measurements including contact lens–corrected visual acuity and corneal HOAs were performed.

RESULTS

The root mean square of the total HOAs significantly decreased after fitting both miniscleral and hybrid lens designs. There was a significant change in the third-order vertical coma and spherical aberration after fitting the miniscleral lens. In the hybrid lens group, a significant change was found only in vertical coma after fitting. There was no significant difference in the post-fitting HOA change between the two groups.

CONCLUSIONS

The results of this study showed the effectiveness of both miniscleral and hybrid lenses in decreasing HOAs in keratoconus patients. No significant difference was observed between these two lenses in this regard.
Comparison of Pneumatonometry and Transpalpebral Tonometry Measurements of Intraocular Pressure during Scleral Lens Wear
Authors: Fogt Jennifer Swingle , Nau Cherie B. , Schornack Muriel , Shorter Ellen , Nau Amy , Harthan Jennifer S.
Published: September 2020

SIGNIFICANCE

As scleral lens wear becomes more common, understanding the impact of these lenses upon ocular physiology is critically important. Studies on the effect of scleral lens wear upon intraocular pressure (IOP) have used different instruments and have reported conflicting results.

PURPOSE

The purpose of this study was to compare assessment of IOP during scleral lens wear using pneumatonometry and transpalpebral tonometry.

METHODS

Twenty healthy subjects wore a small-diameter (15.2 mm) and a large-diameter (18.0 mm) scleral lens on the right eye, each for 1 hour in randomized order. IOP was assessed with pneumatonometry and transpalpebral tonometry on both eyes before lens application, immediately after lens application, after 1 hour of lens wear, and immediately after lens removal. Pairedttest compared mean IOP in the study eye to the control eye. Repeated-measures ANOVA was performed to take instrumentation, lens diameter, and their interaction into account in an analysis of the change in IOP in the study eye.

RESULTS

Mean peripheral IOP measured with pneumatonometry was not significantly different from baseline at any subsequent measurement. Measurements with transpalpebral tonometry, however, were significantly different during scleral lens wear immediately after application and after 1 hour of wear with both diameter lenses (P< .005), but were not significantly different after either sized lens was removed. Repeated-measures ANOVA revealed that the instrument used to measure IOP was a significant factor in IOP changes found during lens wear (P≤ .001).

CONCLUSIONS

Assessment of IOP during scleral lens wear varies based upon the instrument that is used. Although further studies are clearly needed to further elucidate this issue, clinicians should continue to monitor optic nerve structure and function in scleral lens wearers, as they do in all patients.
The Critical Role of the Oncology Nurse as a Partner in the Management of Patients With Advanced Kidney Cancer
Authors: Moldawer Nancy P. , Wood Laura S.
Published: September 2020

The treatment of advanced renal cell carcinoma has changed dramatically since 2005 with the approval of 12 regimens including oral, intravenous, and combination strategies. These approvals have changed the treatment paradigm for these patients and developed new challenges and a critical role for oncology nurses to ensure that the treatment plan and adverse events are managed effectively. The majority of these regimens include an oral anticancer drug, which requires patients and their caregivers to understand the medication, the potential adverse events, the importance of medicine adherence, and the importance of early and ongoing education with the oncology team to maximize clinical outcomes. The evolution of the role of the nurse in meeting this need and its critical contribution to the comprehensive care of the kidney cancer patient will be reviewed.
Epigenetic Dysregulation in Advanced Kidney Cancer
Authors: Goldsamt Austin , Damayanti Nur P. , De Nigris Filomena , Pili Roberto
Published: September 2020

Understanding the complex epigenome of advanced renal cell carcinoma may lead to novel epigenomic-based pharmaceutical strategies and identify new targets for therapeutic interventions. Epigenetic changes, such as DNA methylation and histone acetylation, modulate the activity of significant oncogenic signaling pathways by regulating gene expression. Such pathways include the WNT–β-catenin pathway, the von Hippel-Lindau–hypoxia-inducible factor pathway, and epithelial-mesenchymal transition pathway. Common genetic alterations in histone modifier genes in renal cell carcinoma may not only be responsible for the pathogenesis of this disease but also represent potential biomarkers of response to immunotherapies. Rational combinations strategies with histone deacetylase inhibitors are being tested in clinic trials. Renal cell carcinoma represents an ideal setting to dissect the epigenetic-driven changes in the tumor microenvironment that modulate the response to targeted therapies.
Underrepresentation of Racial Minorities in Breast Surgery Literature
Authors: Cho Daniel Y. , Kneib Cameron J. , Shakir Afaaf , Burns Jacob R. , Lane Megan , Massie Jonathan P. , Crowe Christopher S. , Sobol Danielle L. , Morrison Shane D. , Sousa Janelle D. , Sabin Janice
Published: September 2020

Objective:

In this study, the extent of racial diversity in images of breast-related plastic surgery published literature was investigated to better understand disparities that exist in breast surgery.

Background:

The lack of racial diversity in images of skin color in surgery literature can perpetuate implicit bias and stereotypes. Implicit bias can affect the way patients are evaluated, diagnosed, and treated. The visual aspects of plastic surgery make a lack of diversity in imagery especially impactful on patient care and outcomes.

Methods:

Published medical images and graphics depicting human skin were analyzed across 4 major plastic surgery journals. Up to 4 years were chosen a priori to evaluate from each journal and represented the initial year of color image publication, the year of study initiation (2016), and representative years for a given decade (2000 and 2010). Images and graphics were tabulated, rated by Fitzpatrick scale and categorized into “White” or “non-White.” Data were evaluated with pair-wise and linear regression statistics.

Results:

Of the 2774 images and 353 graphics that met inclusion criteria, only 184 (8.18%) images and 9 graphics (6.34%) depicted non-White skin. Temporal analysis showed that there is an increased diversity of images published since 2010 with 0% of images being non-White before and 7.3% to 10.3% after 2010. International and multi-national authors tended to publish more non-White images.

Conclusions:

There is insufficient racial diversity visually represented in the breast-related plastic surgery literature with a small degree of progress made towards more equitable imagery over time. Increasing awareness of image content, and the need for equitable visual representation may allow for improved racial diversity in surgical literature.
Robot-assisted Nipple-sparing Mastectomy With Immediate Breast Reconstruction
Authors: Ryu Jai Min , Kim Jee Ye , Choi Hee Jun , Ko BeomSeok , Kim Jisun , Cho Jihyoung , Lee Moo Hyun , Choi Jung Eun , Kim Joo Heung , Lee Jeea , Jung Sung Mi , Shin Hyuk Jai , Lee Jeeyeon , Park Hyung Seok
Published: September 2020

Objective:

The aim of this study was to present the results of early experience of robot-assisted nipple sparing mastectomy (RANSM).

Background:

RANSM improves cosmetic outcomes over conventional nipple-sparing mastectomy. However, data on the feasibility and safety of the RANSM are limited.

Methods:

Patients who underwent RANSM with immediate breast reconstruction as part of the Korea Robot-endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG) from November 2016 to January 2020 were enrolled. clinicopathologic characteristics, perioperative complications, and operation time were collected.

Results:

Overall, 73 women underwent 82 RANSM procedures conducted by 11 breast surgeons at 8 institutions. The median patient age was 45.5 years old (20–66 years), and 52 (63.4%) patients were premenopausal. Invasive breast cancer was noted in 55 cases (40 cases were stage i, 11 cases were stage ii, and 4 cases were stage iii, respectively) and ductal carcinoma in-situ was recorded in 20 cases. Of those, 3 patients with BRCA1/2 mutation carriers underwent contralateral risk-reducing RANSM. The median length of hospitalization was 12.0 days (5.0–24.0 days). The incision location was the mid-axillary line and the median incision length was 50.0 mm (30.0–60.0 mm). Median total operation time, median total mastectomy time, and median reconstruction time was 307.0 minutes (163.0–796.0 minutes), 189.5 minutes (97.5–325.0 minutes), and 119.5 minutes (45.0–689.0 minutes). Only 2 cases (2.5%) required reoperation. Nipple ischemia was found in 9 cases (10.9%) but only 1 case (1.2%) required nipple excision given that 8 cases (9.7%) resolved spontaneously. Skin ischemia was observed in 5 cases (6.1%) and only 2 (2.4%) cases needed skin excision whereas 3 cases (3.6%) resolved spontaneously. There was no conversion to open surgery orcases of mortality. The mean time for mastectomy among surgeons who performed more than 10 cases was 182.3 minutes (± 53.7, minutes) and 195.4 minutes (± 50.4, minutes).

Conclusion:

This was the first report of RANSM conducted in the KoREa-BSG. RANSM is technically feasible and acceptable with a short learning curve. Further prospective research to evaluate surgical and oncologic outcomes is needed.
Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: Bugaev Nikolay , Como John J. , Golani Guy , Freeman Jennifer J. , Sawhney Jaswin S. , Vatsaas Cory J. , Yorkgitis Brian K. , Kreiner Laura A. , Garcia Nicole M. , Aziz Hiba Abdel , Pappas Peter A. , Mahoney Eric J. , Brown Zachary W. , Kasotakis George
Published: September 2020

BACKGROUND

Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management guideline was to evaluate the role of the viscoelasticity tests, which are thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical, and critically ill patients.

METHODS

Systematic review and meta-analyses of manuscripts comparing TEG/ROTEM with non–TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was applied to assess the level of evidence and create recommendations for TEG/ROTEM-guided blood product transfusions in adult trauma, surgical, and critically ill patients.

RESULTS

Using TEG/ROTEM-guided blood transfusions in acutely bleeding trauma, surgical, and critically ill patients was associated with a tendency to fewer blood product transfusions in all populations. Thromboelastography/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. Thromboelastography/ROTEM-guided transfusions were associated with a reduction in mortality in trauma patients.

CONCLUSION

In patients with ongoing hemorrhage and concern for coagulopathy, we conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and adult patients with critical illness.

LEVEL OF EVIDENCE

Systematic Review/Meta-Analysis, level III.
Genetic association study detected misalignment in previous whole exome sequence: association study of ZNF806 and SART3 in tardive dystonia
Authors: Kanahara Nobuhisa , Nakata Yusuke , Iyo Masaomi
Published: September 2020

Tardive dystonia is one of the most serious types of extrapyramidal symptoms that antipsychotics can cause. There is no established treatment to relieve this symptom, and its etiology is unclear. Recently, we identified very rare single-nucleotide polymorphisms (SNPs) on ZNF806 and SART3 by exome sequencing in three patients with profoundly severe tardive dystonia. Here, we conducted an association study (case, N = 16 vs. control, N = 96) on the rarest SNP selected from each gene. The results showed that rs2287546 on SART3 was not related to tardive dystonia and that rs4953961 on ZNF806 was a heterozygote in all the subjects, implying the absence of a rare SNP in this locus. We found three other genomic regions with high similarity to the relevant region on ZNF806 by BLAT searches. This strongly suggested a misalignment error in this region in our previous exome sequence. In conclusion, ZNF806 and SART3 are unlikely to be related to tardive dystonia.
Impact of COVID-19 on China's agricultural trade
Authors: Cao Lijuan , Li Tianxiang , Wang Rongbo , Zhu Jing
Published: September 2020

Purpose

The outbreak of the novel COVID-19 virus has spread throughout the world, causing unprecedented disruption to not only China's agricultural trade but also the world's agricultural trade at large. This paper attempts to provide a preliminary analysis of the impact of the COVID-19 pandemic on China's agricultural importing and exporting from both short- and long-term perspectives.

Design/methodology/approach

This study seeks to analyze how the outbreak of COVID-19 could potentially impact China's agricultural trade. With respect to exports, the authors have pinpointed major disruptive factors arising from the pandemic which have affected China's agricultural exports in both the short and long term; in doing so, we employ scenario analysis which simulates potential long-term effects. With regard to imports, possible impacts of the pandemic regarding the prospects of food availability in the world market are investigated. Using scenario analysis, the authors estimate the potential change in China's food market—especially meat import growth—in light of the implementation of the newly signed Sino-US Economic and Trade Agreement (SUETA).

Findings

The results show that China's agricultural exports have been negatively impacted in the short-term, mostly due to the disruption of the supply chain. In the long term, dampened external demand and potential imposition of non-tariff trade barriers (NTBs) will exert more profound and lasting negative effects on China's agricultural export trade. On the other hand, despite panic buying and embargoing policies from some exporting and importing countries, the world food availability and China's food import demand are still optimistic. The simulation results indicate that China's import of pork products, in light of COVID-19 and the implementation of SUETA, would most likely see a sizable climb in quantity, but a lesser climb in terms of value.

Originality/value

Agricultural trade in China has been a focal-point of attention in recent years, with new challenges slowing exports and increasing dependence on imports for food security. The outbreak of the COVID-19 pandemic adds significant uncertainty to agricultural trade, giving rise to serious concerns regarding its potential impact. By exploring the impact of the unprecedented pandemic on China's agricultural trade, this study should contribute to a better understanding of the still-evolving pandemic and shed light on pertinent policy implications.
Entrepreneurial career choice intentions among secondary students in Colombia: the role of entrepreneurial exposure
Authors: Osorio Tinoco Fabian , Bayon Manoj Chandra , Murillo Vargas Guillermo
Published: September 2020

Purpose

Based on a theoretical framework grounded in the social-cognitive theory and its derivative the social-cognitive career theory, the main purpose of this paper is to examine the role of entrepreneurial exposure in moderating the relationship between self-efficacy and entrepreneurial intention in the presence of different levels of outcome expectations.

Design/methodology/approach

Using a sample of 643 secondary students from Colombia, the authors tested the validity and reliability of scales used to measure the main constructs of the socio-cognitive career theory and used the construct of entrepreneurial exposure to examine contingent hypotheses using a four-step linear regression analysis.

Findings

The study results suggest that although the main social-cognitive career variables (self-efficacy and outcome expectation) and entrepreneurial exposure directly influence the formation of entrepreneurial intention and thus support previous findings, the authors also discover a new configuration of (interacting) antecedents. While on the one hand, even a low level of entrepreneurial exposure leads to a significant increase in the entrepreneurial intention of secondary students with high outcome expectation and high self-efficacy; on the other hand, high entrepreneurial exposure leads to a decrease in entrepreneurial intention among students with high entrepreneurial expectation and high self-efficacy.

Research limitations/implications

The main implication of the study findings is although entrepreneurial exposure is beneficial for fostering entrepreneurial intention among secondary students, a high level of entrepreneurial exposure can have a detrimental effect especially among those with high self-efficacy and outcome expectations.

Practical implications

The paper suggests implications and suggestions for educators to foster the development of entrepreneurial intentions among students.

Originality/value

This study provides empirical evidence on the formation of entrepreneurial intention in a new setting. In addition, it improves one’s understanding of the main tenets of social-cognitive career theory by taking into account an important environment factor that can have a contrasting impact on the formation on entrepreneurial intention among adolescents.
Self-esteem among college students: the intersectionality of psychological distress, discrimination and gender
Authors: Becerra Monideepa B. , Arias Devin , Cha Leah , Becerra Benjamin J.
Published: September 2020

Purpose

The purpose of this study was to assess the prevalence of low self-esteem among college students and how exogenous and endogenous factors, such as experiences of discrimination and psychological distress, respectively, impact such an outcome.

Design/methodology/approach

General education courses were used to conduct a quantitative cross-sectional study among undergraduate college students. The primary outcome variable of interest in this study was self-esteem, which was measured using the Rosenburg’s self-esteem scale. Primary independent variable was psychological distress (measured using Kessler 6 scale). Discrimination experiences were measured using the Everyday Discrimination Scale (EDS). Descriptive, bivariate and multiple linear regressions were conducted to find associations among such variables.

Findings

Among 308 young adults in this study, psychological distress was significantly related to low self-esteem (ß = −6.50, p < 0.001). In addition, increasing EDS score (ß = −0.37, p = 0.019) and women gender (ß = −1.29, p = 0.038) were also associated with low self-esteem.

Research limitations/implications

The study was cross-sectional and thus cannot provide causal relationship. The self-reported data is susceptible to recall bias. College students continue to face negative social experiences that impact their self-esteem, and discrimination plays a substantial role.

Practical implications

Gender-specific self-esteem coaching is needed among college students with psychological distress and among those with experiences of discrimination.

Social implications

The results of the current study provide information for understanding the role of discrimination and psychological well-being on self-esteem of college students, and thus further address the importance of social determinants of health and well-being.

Originality/value

This study provides a unique insight into the disparities faced by college students. Understanding self-esteem at the individualistic and collectivistic levels will allow for the planning and implementation of comprehensive interventions that address gender differences and psychological distress that will increase the positive health outcomes and decrease the negative health outcomes.
Applying the Anna Karenina principle for wild animal gut microbiota: Temporal stability of the bank vole gut microbiota in a disturbed environment
Authors: Lavrinienko Anton , Tukalenko Eugene , Kesäniemi Jenni , Kivisaari Kati , Masiuk Sergii , Boratyński Zbyszek , Mousseau Timothy A. , Milinevsky Gennadi , Mappes Tapio , Watts Phillip C.
Published: September 2020

Gut microbiota play an important role in host health. Yet, the drivers and patterns of microbiota imbalance (dysbiosis) in wild animals remain largely unexplored.

One hypothesised outcome of stress on animal microbiomes is a destabilised microbial community that is characterised by an increase in inter‐individual differences compared with microbiomes of healthy animals, which are expected to be (a) temporally stable and (b) relatively similar among individuals. This set of predictions for response of microbiomes to stressors is known as the Anna Karenina principle (AKP) for animal microbiomes.

We examine the AKP in a wild mammal inhabiting disturbed environments by conducting a capture–mark–recapture survey of bank voles Myodes glareolus in areas that contrast in levels of radionuclide contamination (Chernobyl, Ukraine).

Counter to key predictions of the AKP, bank voles that are not exposed to radionuclides harbour variable (increased inter‐individual differences) and temporally dynamic gut microbiota communities, presumably tracking the natural spatio‐temporal variation in resources. Conversely, bank voles exposed to radionuclides host more similar gut microbiota communities that are temporally stable, potentially due to a dysbiosis or selection (on host or bacteria) imposed by chronic radiation exposure.

The implication of these data is that environmental stress (radiation exposure) can constrain the natural spatial and temporal variation of wild animal gut microbiota.
Chronic disease management in emergency department patients presenting with dyspnoea
Authors: Jones Peter , Kelly Anne‐Maree , Keijzers Gerben , Klim Sharon , Holdgate Anna , Graham Colin A , Craig Simon , Kuan Win Sen , Laribi Said ,   AANZDEM Study Group
Published: September 2020

Objectives

Guideline recommended treatments for chronic conditions are thought to reduce ED presentations.

Method

We used data from 1958 ED patients with dyspnoea to describe medication use in patients with chronic conditions.

Results

A total of 1233 (63.5%) patients had one or more of: chronic obstructive pulmonary disease 547 (28%), asthma 454 (23%), atrial fibrillation 368 (19%) or heart failure 401 (21%). Approximately, 70% were prescribed appropriate preventative medication for their chronic condition when they presented to ED with dyspnoea.

Conclusion

Prescription of guideline recommended therapies for chronic conditions in patients presenting to the ED in Australasia with acute dyspnoea is similar or higher than reported previously.
Impact of aging on the overall liking and sensory characteristics of sourdough breads and comparison of two methods to determine their sensory shelf life
Authors: Gauchez Hélène , Loiseau Anne‐Laure , Schlich Pascal , Martin Christophe
Published: September 2020

The objectives of the present work were to study the evolution of the sensory properties and overall liking of four sourdough breads over their lifespans and to determine their sensory shelf life (SSL). We also intended to identify the main sensory characteristics leading to a decrease in overall liking and the end of the consumption of the breads. Seventy‐eight consumers evaluated different 1 kg sourdough breads at home. Two methods were used to describe the evolution of the sensory properties and overall liking: one based on ratings of descriptors’ intensities and the other based on the magnitude of the changes observed since the previous consumption. As expected, the results showed that sensory properties and liking scores evolved over time. While the aroma and taste properties changed little, the texture deteriorated significantly. The overall liking scores decreased steadily over time, while the percentage of subjects who stopped eating bread increased. “Easiness to cut with the teeth,” “easiness to chew,” “crispness,” and “softness” were the main characteristics positively correlated with the overall liking scores and negatively correlated with the percentage of rejection. In contrast, “dryness of the crumb” was negatively correlated with the liking scores and positively correlated with the percentage of rejection. A survival analysis determined that the SSL (50% rejection) of the breads was approximately 2.5 days. Interestingly, we highlighted that the average liking score corresponding to the SSL was just below the middle of the overall liking scale.

Practical Application

The results of this work could be of interest to bread‐making professionals who will be able to use the main conclusions to advise their clients and possibly adapt the bread format to their sensory shelf life. This work was also an opportunity to highlight sourdough bread, which offers more flexibility than French baguette in managing the consumption of the bread purchased. The alternative approach tested to measure the evolution of sensory characteristics and overall liking could interest the professionals of sensory analysis.