bluuebunny/crossref_metadata_2025 huggingface dataset:
Advising the Management: A Theory of Shareholder Engagement
Authors: Kakhbod Ali , Loginova Uliana , Malenko Andrey , Malenko Nadya
Published: August 2022

We study the effectiveness of shareholder engagement, that is, shareholders communicating their views to management. When shareholders and management have different beliefs, each shareholder engages more effectively when other shareholders engage as well. A limited shareholder base can thus prevent effective engagement. However, a limited shareholder base naturally arises under heterogeneous beliefs because investors who most disagree with management do not become shareholders. Passive funds, which own the firm regardless of their beliefs, can counteract these effects and improve engagement. When shareholders’ and management’s preferences are strongly misaligned, shareholders’ engagement decisions become substitutes and the role of ownership structure declines.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Diagnostic and Historical Surveys of Sweet Cherry (Prunus avium) Virus and Virus-Like Diseases in Oregon
Authors: Reinhold Lauri A. , Pscheidt Jay W.
Published: August 2022

There are over 35 known virus and virus-like diseases of sweet cherry (Prunus avium), some with potential to cause severe economic impact by reducing vegetative growth, vigor, or fruit quality. Oregon is the second-ranked state for sweet cherry production in the United States. Statewide surveys were conducted in Oregon sweet cherry orchards for virus and virus-like diversity and distribution. Orchards in key production regions with suspected virus disease symptoms were sampled. Virus-specific enzyme-linked immunosorbent assay, isothermal amplification, or quantitative real-time PCR were used to test for the presence of common or economically important sweet cherry pathogens, including cherry leaf roll virus (CLRV), little cherry virus 2 (LChV2), prune dwarf virus (PDV), prunus necrotic ringspot virus (PNRSV), tomato ringspot virus (ToRSV), and ‘Candidatus Phytoplasma pruni’. CLRV, a new virus of sweet cherry in Oregon, was found associated with enation and dieback symptoms in The Dalles. Some viruses were found in new regions, which included Hood River (PDV, PNRSV, and ToRSV) and the Umpqua Valley (PDV and PNRSV). A subsequent survey was conducted in the Mid-Columbia production region for the presence of little cherry symptoms associated with little cherry and X-Diseases. All symptomatic samples from The Dalles and Mosier, OR, or Dallesport, WA, tested positive for ‘Ca. P. pruni’ but not LChV2. These findings provide a foundation for the current understanding and management of virus and virus-like diseases of sweet cherry in Oregon and context for further studies into these pathogens and their vectors.
Gathered from the Vine: A Survey of Seven Grapevine Viruses Within New England Vineyards
Authors: Dumas Madeleine , Borges Darlan Ferreira , Priesing Stephanie , Tippett Ethan , Ambrosio Márcia Michelle de Queiroz , Luís da Silva Washington
Published: August 2022

Vineyards in the Southeastern New England American Viticultural Area were surveyed for the incidence of seven major viruses: grapevine leafroll-associated viruses (GLRaV-1, GLRaV-2, GLRaV-3, and GLRaV-4), grapevine fanleaf virus (GFLV), tomato ringspot virus (ToRSV), and tobacco ringspot virus (TRSV). Viruses were detected by DAS-ELISA and confirmed by RT-PCR and Sanger sequencing. Multiple viruses were present in 19 out of the 25 vineyards surveyed between 2018 and 2020. GLRaV-3 (27.59%) was the most prevalent virus followed by GLRaV-4 (14.90%), GLRaV-1 (13.52%), GLRaV-2 (11.03%), ToRSV (6.34%), GFLV (5.24%), and TRSV (2.62%). Furthermore, phylogenetic analyses of the viral partial genome sequences acquired in this study revealed that the grapevine viruses present in this area are diverse, indicating that they may have been introduced from different sources. Our findings stress the need for improving the sanitary status of planting materials to avoid the introduction and dissemination of viruses to vineyards in this important wine-producing region of New England.
Epidemiology and Economic Impact of Impatiens Necrotic Spot Virus: A Resurging Pathogen Affecting Lettuce in the Salinas Valley of California
Authors: Hasegawa Daniel K. , Del Pozo-Valdivia Alejandro I.
Published: August 2022

The Orthotospovirus impatiens necrotic spot virus (INSV) is a thrips-transmitted pathogen of lettuce that has rapidly emerged as a serious threat to production in the Salinas Valley of Monterey County, California. As a first step toward understanding the severity of the virus, we utilized Spatial Analysis by Distance IndicEs (SADIE) to characterize the distribution and progression of INSV outbreaks and thrips infestations in two commercial lettuce fields. In both fields, INSV incidence rapidly increased from 15.86% ± 1.77 to 80.24% ± 2.60 over the course of 7 weeks and aggregated at specific edges in both fields as early as 3 weeks after planting (Ia = 1.63, Pa = 0.0100, and Ia = 1.53, Pa = 0.0300). In one of the fields, thrips populations aggregated in areas that also experienced the most INSV (Ia = 1.2435, Pa = 0.0400, week 3; Ia = 1.4815, Pa < 0.0001, week 6; Ia = 1.5608, Pa < 0.0001, week 9), while in the second field, thrips were distributed randomly despite the aggregated effects that were observed for INSV incidence. Economic analysis estimated that the virus accounted for over $475,000 in losses for the two fields, while stakeholder surveys documented over 750 fields that experienced INSV infection during the 2021 season in Monterey County alone. These studies enhance our knowledge on the epidemiology of thrips and INSV under current lettuce production practices in the Salinas Valley, while elucidating the economic consequences and broader challenges that are associated with managing thrips-transmitted viruses.
Photomotor Responses in Zebrafish and Electrophysiology Reveal Varying Interactions of Anesthetics Targeting Distinct Sites on γ-Aminobutyric Acid Type A Receptors
Authors: Hoyt Helen , Fantasia Ryan J. , Bhave Kieran , Yang Xiaoxuan , Forman Stuart A.
Published: August 2022

Background

Etomidate, barbiturates, alfaxalone, and propofol are anesthetics that allosterically modulate γ-aminobutyric acid type A (GABAA) receptors via distinct sets of molecular binding sites. Two-state concerted coagonist models account for anesthetic effects and predict supra-additive interactions between drug pairs acting at distinct sites. Some behavioral and molecular studies support these predictions, while other findings suggest potentially complex anesthetic interactions. We therefore evaluated interactions among four anesthetics in both animals and GABAA receptors.

Methods

The authors used video assessment of photomotor responses in zebrafish larvae and isobolography to evaluate hypnotic drug pair interactions. Voltage clamp electrophysiology and allosteric shift analysis evaluated coagonist interactions in α1β3γ2L receptors activated by γ-aminobutyric acid (GABA) versus anesthetics [log(d, AN):log(d, GABA) ratio]. Anesthetic interactions at concentrations relevant to zebrafish were assessed in receptors activated with low GABA.

Results

In zebrafish larvae, etomidate interacted additively with both propofol and the barbiturate R-5-allyl-1-methyl m-trifluoromethyl mephobarbital (R-mTFD-MPAB; mean ± SD α = 1.0 ± 0.07 and 0.96 ± 0.11 respectively, where 1.0 indicates additivity), while the four other drug pairs displayed synergy (mean α range 0.76 to 0.89). Electrophysiologic allosteric shifts revealed that both propofol and R-mTFD-MPAB modulated etomidate-activated receptors much less than GABA-activated receptors [log(d, AN):log(d, GABA) ratios = 0.09 ± 0.021 and 0.38 ± 0.024, respectively], while alfaxalone comparably modulated receptors activated by GABA or etomidate [log(d) ratio = 0.87 ± 0.056]. With low GABA activation, etomidate combined with alfaxalone was supra-additive (n = 6; P = 0.023 by paired t test), but etomidate plus R-mTFD-MPAB or propofol was not.

Conclusions

In both zebrafish and GABAA receptors, anesthetic drug pairs interacted variably, ranging from additivity to synergy. Pairs including etomidate displayed corresponding interactions in animals and receptors. Some of these results challenge simple two-state coagonist models and support alternatives where different anesthetics may stabilize distinct receptor conformations, altering the effects of other drugs.

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Interfacility Transfer Patients With Pelvic, Acetabular, and Lower Extremity Fractures Are at Higher Risk for Major Complications and Readmissions
Authors: Pean Christian A. , Watkins Ian T. , Harris Mitchel B. , Weaver Michael J. , Ly Thuan V.
Published: August 2022

Objective:

To compare the adverse event profile and patient comorbidity profile of lower extremity orthopaedic trauma patients admitted via interfacility transfer (IT) to direct admission (DA) patients from home.

Methods:

A total of 39,497 patients from 2012 to 2019 were identified in the American College of Surgeon National Surgical Quality Improvement Program database. DA patients were compared with IT patients for differences in preoperative comorbidities, adverse events, length of stay, and readmissions in the 30-day postoperative period. Studentttests were used to assess continuous variables. Pearson χ2test and odds ratios (ORs) were used for categorical variables.

Results:

The IT group comprised 7167 patients, and the DA group comprised 32,330 patients. IT patients were on average older (65.5 vs. 58.8 years,P< 0.01), more likely to be American Society of Anesthesiologists Status >2 (P< 0.01), and had a worse comorbidity profile for numerous preoperative risk factors. IT patients had significantly higher rates of mortality [3.3% vs. 1.4%; odds ratio (OR) 2.29; 95% confidence interval (CI), 1.96–2.77], major complications (10.2% vs. 6.1%; OR 1.74; 95% CI, 1.60–1.91), significantly higher readmission rates (5.8% vs. 4.8%,P< 0.01, OR 1.22 95% CI, 1.09–1.36), and more infectious complications (7% vs. 4.7%; OR 1.54; 95% CI, 1.38–1.71) than DA patients. Transfer remained a significant factor predicting major adverse events in regression analysis controlling for patient characteristics and fracture type (P< 0.01; B 1.197; 95% CI, 1.09–1.32).

Conclusions:

This study revealed that IT patients undergoing operative management of pelvic, acetabular, and lower extremity fractures are at a significantly increased risk of major complications, readmission, and have a higher morbidity burden than DA patients. As healthcare transitions to value-based care and bundled payments, hospitals that accept a high volume of ITs will face exposure to added risk and financial penalties without adequate policy protections.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Locked Lateral Plating Versus Retrograde Nailing for Distal Femur Fractures: A Multicenter Randomized Trial
Authors: Dunbar Robert P. , Egol Kenneth A. , Jones Clifford B. , Ertl Jan P. , Mullis Brian , Perez Edward , Collinge Cory A. , Ostrum Robert , Humphrey Catherine , Gardner Michael J. , Ricci William M. , Phieffer Laura S. , Teague David , Ertl William , Born Christopher T. , Zonno Alan , Siegel Jodi , Sagi Henry Claude , Pollak Andrew , Schmidt Andrew H. , Templeman David C. , Sems Andrew , Friess Darin M. , Pape Hans-Christoph , Krieg James C. , Tornetta Paul
Published: August 2022

Objectives:

The 2 main forms of treatment for distal femur fractures are locked lateral plating and retrograde nailing. The goal of this trial was to determine whether there are significant differences in outcomes between these forms of treatment.

Design:

Multicenter randomized controlled trial.

Setting:

Twenty academic trauma centers.

Patients/Participants:

One hundred sixty patients with distal femur fractures were enrolled. One hundred twenty-six patients were followed 12 months. Patients were randomized to plating in 62 cases and intramedullary nailing in 64 cases.

Intervention:

Lateral locked plating or retrograde intramedullary nailing.

Main Outcome Measurements:

Functional scoring including Short Musculoskeletal Functional Assessment, bother index, EQ Health, and EQ Index. Secondary measures included alignment, operative time, range of motion, union rate, walking ability, ability to manage stairs, and number and type of adverse events.

Results:

Functional testing showed no difference between the groups. Both groups were still significantly affected by their fracture 12 months after injury. There was more coronal plane valgus in the plating group, which approached statistical significance. Range of motion, walking ability, and ability to manage stairs were similar between the groups. Rate and type of adverse events were not statistically different between the groups.

Conclusions:

Both lateral locked plating and retrograde intramedullary nailing are reasonable surgical options for these fractures. Patients continue to improve over the course of the year after injury but remain impaired 1 year postoperatively.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Hypertension in Cancer Survivors: A Review of the Literature and Suggested Approach to Diagnosis and Treatment
Authors: Chuquin David , Abbate Antonio , Bottinor Wendy
Published: August 2022

Background:

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Hypertension, which is common among cancer survivors with a prevalence of greater than 70% by age 50, potentiates the risk for CVD in a more than additive fashion. For example, childhood cancer survivors who develop hypertension may have up to a 12 times higher risk for heart failure than survivors who remain normotensive. Studies have shown that mild valvular disease (28% incidence), cardiomyopathy (7.4%), arrhythmias (4.6%), and coronary artery disease (3.8%) are among the most common CVDs in childhood cancer survivors. Among adolescent and young adult cancer survivors, the most common reasons for cardiovascular-related hospital admission are venous/lymphatic disease (absolute excess risk 19%), cardiomyopathy and arrhythmia (15%), hypertension (13%), and ischemic heart disease (12%). In addition, cancer therapies can increase the risk for hypertension and CVD. Therefore, early detection and treatment of hypertension is essential to reducing cardiovascular morbidity and mortality among survivors.

Methods:

We present a literature review, which identified over 20 clinical trials, systemic reviews, and meta-analyses (13 clinical trials, 8 systemic reviews or meta-analyses) by searching PubMed, Google Scholar, and the Cochrane Library for relevant articles addressing hypertension in cancer survivors.

Results:

Although our understanding of the complex relationship between cancer therapies and CVD has grown significantly over the past 2 decades, there remain several gaps in knowledge when specifically addressing CVD in the survivor population. This review provides an up-to-date survivor-centered approach to the screening and treatment of hypertension, which considers survivor-specific cardiovascular risk, applies guideline directed therapies when appropriate, screens for survivor-specific factors that may influence antihypertensive medication selection, and finally considers the prohypertensive mechanisms of antineoplastic agents as a potential target for antihypertensive medications.

Conclusions:

Screening for and treating hypertension among survivors can promote cardiovascular health in this vulnerable population.
Trough Concentration Deficiency of Rivaroxaban in Patients With Nonvalvular Atrial Fibrillation Leading to Thromboembolism Events
Authors: Gao Hongjin , Li Yumei , Sun Hong , Huang Xiufang , Chen Hui , Lin Wei , Chen Min
Published: August 2022

This retrospective study investigated factors influencing the steady-state trough concentrations (Ctrough) of rivaroxaban in patients with nonvalvular atrial fibrillation (NVAF). We retrieved data from patients with NAVF who first started rivaroxaban anticoagulation at the Fujian Provincial Hospital from October 2017 to October 2020 through the electronic medical record system. Patients were followed for 1 year after the first dose of rivaroxaban, and the primary efficacy and safety end points were recorded. All follow-up visits were completed by October 2021. A Ctrough of <12 ng/mL was defined as Ctrough deficiency. Factors that influenced rivaroxaban Ctrough deficiency were investigated using multivariate binary logistic regression analysis. Kaplan–Meier survival curve analysis was used to determine differences between Ctrough deficiency and event-free survival. A total of 167 patients with NVAF were enrolled in the study, including 113 men and 54 women, with an average (± SD) age of 70.40 ± 12.46 years. High albumin levels were an independent protective factor against Ctrough deficiency (odds ratio, 0.932; P = 0.031). Ctrough deficiency was associated with the probability of freedom from thrombotic events (P = 0.004); however, there were no significant differences in the probability of freedom from bleeding events (P > 0.05). In conclusion, among the variables studied, a low albumin level was the main contributor to Ctrough deficiency. Rivaroxaban Ctrough deficiency also increased thrombotic events, but this was not associated with hemorrhagic events in Chinese patients with NVAF.
Salidroside Regulates Mitochondrial Homeostasis After Polarization of RAW264.7 Macrophages
Authors: Wang Xiu-Long , Sun Rui-Xiang , Li Dong-Xu , Chen Zhi-Gang , Li Xue-Fang , Sun Si-Yu , Lin Fei , Zhao Guo-An
Published: August 2022

Salidroside has anti-inflammatory and antiatherosclerotic effects, and mitochondrial homeostasis imbalance is closely related to cardiovascular disease. The aim of this study was to investigate the effect of salidroside on mitochondrial homeostasis after macrophage polarization and elucidate its possible mechanism against atherosclerosis. RAW264.7 cells were stimulated with 1 μg·mL−1 Lipopolysaccharide and 50 ng·mL−1 IFN-γ establish M1 polarization and were also pretreated with 400 μM salidroside. The relative expression of proinflammatory genes was detected by RT-PCR whereas that of mitochondrial homeostasis–related proteins and nuclear factor kappa-B (NF-κB) was detected by WB. Levels of intracellular reactive oxygen species (ROS), mitochondrial membrane potential, and mass were measured by chemifluorescence whereas that of NF-κB nuclear translocation was detected by immunofluorescence. Compared with the Mφ group, the M1 group demonstrated increased mRNA expression of interleukin-1β , inductible nitric oxide synthase (iNOS), and tumor necrosis factor-α ; increased protein expression of iNOS, NOD-like receptor protein 3, putative kinase 1 , and NF-κB p65 but decreased protein expression of MFN2, Tom20, and PGC-1α; decreased mitochondrial membrane potential and mass; and increased ROS levels and NF-κB p65 nuclear translocation. Salidroside intervention decreased mRNA expression of interleukin-1β and tumor necrosis factor-α compared with the M1 group but did not affect that of iNOS. Furthermore, salidroside intervention prevented the changes in protein expression, mitochondrial membrane potential and mass, ROS levels, and NF-κB p65 nuclear translocation observed in the M1 group. In summary, salidroside ultimately inhibits M1 macrophage polarization and maintains mitochondrial homeostasis after macrophage polarization by increasing mitochondrial membrane potential, decreasing ROS levels, inhibiting NF-κB activation, and in turn regulating the expression of proinflammatory factors and mitochondrial homeostasis–associated proteins.
The Practices and Attitudes of Saudi Plastic Surgeons in Managing Contaminated Autologous Grafts
Authors: Aljindan Fahad , Alhumaid Fahad , Allababidi Noor H. , Mortada Hatan , Alzaidi Salman
Published: August 2022

Background:

The use of autologous grafts is a standard reconstructive option in plastic surgery. The absence of a well-established protocol for decontamination after accidental contamination increases the risk of postoperative infection. We aimed to explore the current practice and decontamination methods among Saudi plastic surgeons. This would help develop a well-established, unified method of decontamination intraoperatively.

Methods:

A validated self-administered questionnaire cross-sectional study was conducted in February 2022. The questionnaire was distributed through social media to all board-certified plastic surgeons in Saudi Arabia. The questionnaire was designed to obtain data on incidents, treatment preferences, and management of autograft contamination.

Results:

A total sample size of 61 participants was included, with an overall response rate of 64.58%. Out of the 61 respondents, 73.8% (n = 45) had previously experienced graft contamination. Regarding the methods of graft contamination, the most common way was accidentally dropping the graft on the floor (39.7%, n = 25). The majority of the surgeons answered that they decontaminated the graft using povidone-iodine (44.6%, n = 29) and then used it (45.9%, n = 28). The lower extremity area was the most common anatomical location having surgery at the time of the graft contamination, accounting for 32.5% of the cases (n = 25).

Conclusions:

Our study indicates that graft contamination is a common occurrence among our population, but we lack national guidelines on dealing with these situations. Although most responders used adequate decontamination methods, the lack of standardization could pose a risk to patients.
Public Confidence for Undergoing Elective Plastic Surgery Procedures during the COVID-19 Pandemic
Authors: Manstein Samuel M. , Elmer Nicholas , Comer Carly D. , Shiah Eric , Laikhter Elizabeth , Bustos Valeria P. , Hassell Natalie , Veeramani Anamika , Boustany Ashley N. , Lin Samuel J.
Published: August 2022

Background:

The COVID-19 vaccine rollout has since been followed by a gradual resumption of elective surgery. Many individuals remain cautious about visiting a hospital or clinic to undergo surgery. As plastic surgeons are starting to resume elective surgery at this time, it is important to understand the perspectives of potential patients and the concerns they may have.

Methods:

A survey was distributed to participants in the United States through Amazon’s Mechanical Turk (mTurk) during March of 2021. Participants were surveyed regarding their views on the severity of COVID-19, vaccination status, and how much COVID-19 has affected their interest in undergoing surgery.

Results:

Thirty-nine percent of respondents were either no longer willing or less willing to undergo elective plastic surgery. Seventy-three percent of respondents felt comfortable going to an office for a consultation. With regards to feeling comfortable visiting a hospital, 43.4% reported they would feel safe, 36% felt they would feel safe only if they could be discharged on the same day, and 30.6% reported not feeling safe. Fifty-two percent of respondents reported feeling comfortable undergoing surgery now or within the next year. Respondents who do not think COVID-19 is still a major health issue were more likely to still want plastic surgery.

Conclusion:

The results of this study highlight that the majority of patients, regardless of vaccination status, currently feel comfortable undergoing elective plastic surgery, particularly in an office setting. Plastic surgeons may expect to see a return in demand for elective procedures in the coming months.
The impact of sodium–glucose cotransporter inhibitors on blood pressure: a meta-analysis and metaregression of 111 randomized-controlled trials
Authors: Teo Yao H. , Chia Alys Z.Q. , Teo Yao N. , Chong Elliot Y. , Syn Nicholas L. , Cheong Jia Y.A. , Ong How T. , Wee Caitlin F. , Ting Adriel Z.H. , Tan Joshua T.A. , Li Tony Y.W. , Kong William K.F. , Lee Chi-Hang , Chan Mark Y.-Y. , Wong Raymond C.C. , Yeo Tiong-Cheng , Chai Ping , Sia Ching-Hui
Published: August 2022

Objective:

Multiple trials on sodium–glucose cotransporter (SGLT) inhibitors have been performed recently demonstrating blood pressure (BP) reduction benefits in both diabetic and nondiabetic patients. Hence, we conducted a systematic review and meta-analysis to determine the effect of different SGLT inhibitors on BP in both patients with and without diabetes mellitus.

Methods:

Four electronic databases (PubMed, Embase, Cochrane, and SCOPUS) were searched on 4 November 2021 for articles published from 1 January 2000 up to 21 November 2021, for studies evaluating the BP effects of SGLT inhibitors. Pair-wise meta-analysis and random effects metaregression models were utilized.

Results:

In total, 111 studies examining SBP (108 studies, 104 304 patients) and/or DBP (82 studies, 74 719 patients) were included. In patients with diabetes, the random effects model demonstrated SGLT inhibitor produced a mean reduction in SBPs of −3.46 mmHg (95% confidence interval: −3.83, −3.09) compared with placebo. There were no statistically significant changes in BP among patients without diabetes. Drug response relationship was not observed in SGLT inhibitors and BP, except for Canagliflozin and DBP.

Conclusion:

Sodium–glucose cotransporter 2 inhibitors and combined sodium–glucose cotransporter 1/2 inhibitors produced small reductions in BP in patients with diabetes.
Clonal Hematopoiesis and Epigenetic Age Acceleration in Elderly Danish Twins
Authors: Soerensen Mette , Tulstrup Morten , Hansen Jakob Werner , Weischenfeldt Joachim , Grønbæk Kirsten , Christensen Kaare
Published: August 2022

Clonal hematopoiesis of indeterminate potential (CHIP) is common in the elderly and has been reported to associate with accelerated epigenetic age (AgeAccel), especially intrinsic (ie, cell-type independent) AgeAccel and to a lesser degree extrinsic AgeAccel, which reflects the immune-cell composition of the peripheral blood. We investigated the association between CHIP occurrence and AgeAccel in 154 Danish twin pairs aged 73–90 years (mean 79), using both individual-level and intrapair analyses, the latter to control for shared genetic and environmental factors. Of 308 individuals, 116 carried a CHIP mutation. CHIP carriers had non-significantly increased AgeAccel compared with non-carriers; the strongest association was for the Intrinsic Epigenetic Age Acceleration (IEAA) estimator (CHIP carriers 1.4 years older, P = 0.052). In intrapair analyses, the extrinsic Hannum age estimator showed the strongest association (1.6 years older, P = 0.027). In mutation-specific analyses, TET2 mutations were associated with the extrinsic Hannum age estimator in both individual-level (3.0 years older, P = 0.003) and intrapair analyses (2.8 years older, P = 0.05). DNMT3A mutations were associated with IEAA in individual-level (1.9 years older, P = 0.034) but not intrapair analysis (0.9 years, P = 0.41). Analyses of logit-transformed variant allele frequency were generally consistent with these results. Together, these observations indicate that different factors may be driving the expansion of DNMT3A and TET2 clones, respectively. Finally, CHIP carriers accelerated in both the Hannum and the GrimAge age estimators did not have an increased mortality risk in our cohort followed for 22 years (HR = 1.02, P = 0.93), hence not replicating the stratification model proposed by Nachun et al.
Multimodal imaging of Unilateral Idiopathic Macular Telangiectasia Type 2 – A five-year study
Authors: Manayath George J , Verghese Shishir , Narendran Venkatapathy
Published: August 2022

Purpose:

To report a rare presentation of unilateral macular telangiectasia type 2 (Mac-Tel 2) followed up over 5 years

Methods:

Case report

Results:

A 58-year-old gentleman presented to us with complaints of painless progressive reduction of vision in the right eye for the past two years. He had no systemic illnesses. On examination his best corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. Fundus examination in the right eye revealed loss of foveal reflex along with mild temporal greying of the fovea and the left eye was within normal limits. Both eyes showed the presence of peripapillary myelinated nerve fibres. Multimodal imaging findings included spectral domain optical coherence tomography (SD-OCT), optical coherence tomography angiography (OCTA), fundus autofluorescence and fundus fluorescein angiogram which revealed findings suggestive of exudative preproliferative variant of macular telangiectasia type 2 (Mac-Tel 2) in the right eye whereas the left eye was within normal limits. After a follow up of five years SD-OCT and OCTA revealed no striking differences in both eyes, with no evidence of the disease in his left eye.

Conclusion:

This reports highlights a rare advanced unilateral presentation of Mac-Tel 2 with no evidence of even early signs of the disease in the fellow eye, over a long term follow-up.
Effect of simulated lenticular debris on corneal endothelial cells: experimental study in rabbit eyes
Authors: Wilkinson Samuel W. , Park Sally S.E. , Ungricht Emilie L. , Trapnell Michael , Nydegger Jacob , Cardenas Ivan A. , Brintz Ben J. , Mamalis Nick , Olson Randall J. , Werner Liliana
Published: August 2022

Purpose:

To evaluate mechanical damage of simulated lenticular debris on corneal endothelial cells during phacoemulsification.

Setting:

University setting, Salt Lake City, Utah.

Design:

Experimental study.

Methods:

12 New Zealand rabbits underwent bilateral surgery. After incision, 10 1.0 mm beads were injected into the anterior chamber of test eyes to simulate lenticular debris. A balanced salt solution was injected into the contralateral eyes with the same injector. The Intrepid Balanced Tip of the Centurion Ozil handpiece was inserted into the anterior chamber, and 60% torsional ultrasound was applied for 20 seconds with 50 mL/min flow, 70 mm Hg intraocular pressure, and 600 mm Hg vacuum. Cumulative dissipated energy (CDE) was noted. After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed in a standardized manner (×400 photographs from 5 specific areas and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss in the photographs.

Results:

CDE was 4.64 ± 0.19 for test eyes with beads and 4.66 ± 0.17 for control eyes without beads (P = .58). The percentage of intact cells was statistically higher in the control group (P = .0005), whereas the percentages of damaged and lost cells were statistically higher in the test group (P = .0010 and .0005, respectively). This was observed in the analysis of the ×400 photographs and overview photographs.

Conclusions:

This study suggests that lenticular debris swirling around the anterior chamber may cause significant damage to the corneal endothelium, providing further insight on mechanisms of damage during phacoemulsification.
Comparison of keratometry using SS-OCT and dual Scheimpflug-Placido imaging in postmyopic corneal refractive surgery eyes
Authors: Khimani Karima , Ordonez Adriana , Pandit Rahul T.
Published: August 2022

Purpose:

To compare simulated (SimK) and total (True-K) keratometry and corneal astigmatism values between the IOLMaster 700 (IOLM) and Galilei G4 (G4) devices in postmyopic laser refractive surgery eyes.

Setting:

Methodist Eye Associates, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas.

Design:

Retrospective cohort study.

Methods:

A chart review was conducted on patients with prior myopic laser–assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK), undergoing phacoemulsification at a single institution from May 2019 through January 2022, who underwent imaging with both the IOLM and G4. Exclusion criteria were prior radial keratotomy, keratoectatic diseases, and inability to obtain a reliable image. Mean, flat, and steep SimK and True-K (TK from the IOLM and TCPIOL from the G4) values and astigmatism magnitude were compared.

Results:

50 eyes of 50 patients were included. The mean difference in SimK and True-K between devices (IOLM − G4) was −0.04 (95% CI −0.13 to 0.06; P > .05) diopters (D) and 1.14 (95% CI 1.02 to 1.25; P < .05) D, respectively. The IOLM measured steeper True-K values than the G4. There were no statistically significant differences between devices for all other SimK values, whereas for True-K there were significant differences in flat K and steep K (P < .05), but not astigmatism magnitude.

Conclusions:

Despite an overall good correlation in postmyopic laser refractive surgery eyes in keratometry and astigmatism measurements, there is a significant difference in True-K, with the IOLM measuring steeper values by about 1.0 D compared with the G4, similar to prior studies on nonrefractive surgery eyes.
Effectiveness of Elastic Band Exercises on the Functional Fitness of Older Adults in Long-Term Care Facilities
Authors: SU Yi-Lin , CHEN Hsiao-Lien , HAN Shao-Li , LIN Yueh-Kuei , LIN Su-Yun , LIU Chieh-Hsing
Published: August 2022

Background

Population aging has caused a rise in the institutionalization, disability, and mortality rates of older adults worldwide. Older adults are able to engage in muscle training. Elastic band exercises can safely and effectively improve the upper and lower muscle strength and balance of older adults.

Purpose

This study was developed to examine the effects of a 3-month elastic band exercise program on the activities of daily living (ADLs), hand muscle strength, balance, and lower limb muscle strength of older adults living in institutional settings.

Methods

This was a randomized controlled trial. Sixty-one participants were randomly sampled from two long-term care facilities (LTCFs) in northern Taiwan (31 participants in the experimental group and 30 participants in the control group). Both groups underwent pretesting concurrently. The experimental group participated in 3 months of elastic band exercises, whereas the control group participated in the routine exercise program in their LTCFs. All of the participants were tested 1 and 3 months after the intervention.

Results

The average ADL, hand muscle strength, balance, and lower limb muscle strength scores of participants in the experimental group had improved significantly more than those of the control group at posttest (all ps < .05).

Conclusions/Implications for Practice

Elastic band exercises positively affect ADLs, hand muscle strength, balance, and lower limb muscle strength in older adults living in LTCFs. Moreover, the high benefit-to-cost ratio of these exercises helps lower the threshold of health promotion. We recommend including elastic band exercises in routine activities and designing different elastic band exercises for older adults at different proficiency levels. Furthermore, an elastic band exercise network should be established to improve the policy and implementation aspects of elastic band activities, raise awareness among community-dwelling and institutionalized older adults, and promote elastic band exercises to LTCFs nationwide.
Factors Associated With Depression Among Family Caregivers of Patients With Stroke in Indonesia: A Cross-Sectional Study
Authors: FAUZIAH Wahyuni , KATO Mayumi , SHOGENJI Miho , TSUJIGUCHI Hiromasa , TANIGUCHI Yoshimi
Published: August 2022

Background

Strokes may lead to increased dependency, which may impact the daily lives of patients with stroke and their family caregivers. Caring for a poststroke family member in Indonesia may differ from other countries in terms of extending beyond the provision of hands-on care. Contradictions and gaps in the factors affecting caregiver depression have been highlighted in a review of the relevant literature. Few studies have examined comprehensively the contradictory factors, uncovered factors, and cultural and spiritual values affecting this phenomenon.

Purpose

This study was designed to identify the factors associated with depression in family caregivers of patients with stroke in Indonesia. We examined the following factors related to caregiver depression: demographic characteristics of the caregiver and care recipient, functional ability of the patient, caregiver self-efficacy, knowledge regarding stroke care, and spiritual values.

Methods

In this cross-sectional study, 157 primary caregivers completed questionnaires involving depression factors during face-to-face interviews. The data were analyzed using multiple logistic regression.

Results

The prevalence of depression among the participants was 56.7%. The overall mean ages of the participants and their care recipients were 43.6 and 57.1 years, respectively. In this study, 65.6% of the participants were female, and 70.1% lacked knowledge regarding stroke care. In the early caregiving phase, caregiver depression was more likely to occur in female caregivers with back pain and long care hours. Self-efficacy in achieving respite time was found to be associated with a lower risk of depression.

Conclusions/Implications for Practice

Caregivers' gender, presence of back pain, sufficient respite time, and time since stroke occurrence should be considered when providing knowledge, skills, and coping strategies to caregivers to help them adapt to their caregiving role, maintain their quality of life, and prevent the onset of depression. Understanding the factors influencing caregiver depression may help nursing professionals identify individuals at a higher risk of depression early on and provide critical follow-up and early access to supportive counseling.
The value of the lymph node ratio and total number of lymph nodes examined for resected pancreatic signet ring cell carcinoma: a retrospective cohort study
Authors: Ren Chao , Xue Feng , Wu Yinying , Wang Zheng
Published: August 2022

Background:

Pancreatic signet ring cell carcinoma (SRCC) is an exceedingly rare histological subtype of pancreatic cancer. Previous studies have focused on the trends of incidence and independent predictors of pancreatic SRCC. Our objectives of the study were to analyze the prognostic value of the lymph node ratio (LNR) and to explore the minimal number of lymph nodes examined to accurately evaluate the N stage in resected pancreatic SRCC.

Method:

We analyzed 120 patients diagnosed from January 1, 1990, to December 31, 2016, constituted the study cohort from the Surveillance, Epidemiology, and End Results (SEER) registry. We calculated the overall survival (OS) of these patients by using a Kaplan–Meier analysis. The Kaplan–Meier analysis was used to analyze the influence of various factors on the prognosis of patients in the univariate analysis. The multivariate Cox analysis were applied to find independent prognostic factors of patients with pancreatic SRCC. Receiver-operating characteristic curve (ROC) analysis to investigate the discriminatory ability of the total number of lymph nodes examined (TNLE) relative to whether lymph node metastasis was present.

Results:

The median number of lymph nodes examined among 120 patients with resected pancreatic SRCC was 14 (interquartile range: 6.25–20.0). According to the univariate analysis of OS, age, grade, chemotherapy, LNR, and TNLE were significantly different (P < .05). We demonstrated the prognostic benefit of chemotherapy in resected pancreatic SRCC, whereas radiotherapy was not associated with improved survival. The multivariate survival analysis showed that LNR and grade were independent prognostic indicators after pancreatic SRCC resection for OS. TNLE ≥ 8 showed the highest discriminatory power for evaluating lymph node metastasis (Area under curve (AUC): 0.656, 95% confidence interval: 0.564–0.741, Youden index:0.2533, sensitivity: 78.67%, specificity: 46.67%, P = .003).

Conclusion:

Our study indicated that the LNR was a valuable independent prognostic factor for resected pancreatic SRCC. Regional lymphadenectomy of at least 8 lymph nodes was necessary to accurately stage patients. An adequate number of lymph nodes examined are necessary for clinicians to accurately predict the significance of the LNR in resected pancreatic SRCC.
Endocervical Margins Status in Excision for Preventing Cervical Cancer According to the Transformation Zone Type
Authors: Gertrudes Larissa Nascimento , Yoneda Juliana Yoko , Mirandez Camila Castelhano , Carvalho Carla Fabrine , Derchain Sophie , Teixeira Julio Cesar , Vale Diama Bhadra
Published: August 2022

Objective

The aim of this study is to assess the outcomes of 610 excision types I and II in a referral facility as a function of transformation zone (TZ) types.

Methods

This is a retrospective cohort study of women with cervical precursor lesions who underwent loop electrocautery excision procedure from 2017 to 2019 at the University of Campinas. The primary outcome was endocervical margin status, negative or positive. Other variables were excision type (I/II), TZ (1/2/3), age, menopausal status, hormonal contraceptives, smoking, and sexual debut. Tests used were chi-square or Fisher exact, Mann-Whitney, and simple and multiple logistic regression.

Results

The most frequent was TZ 1 (62.5%). Excision II was the most frequent: 54.1% in TZ 1, 67.2% in TZ 2, and 82.1% in TZ 3. A negative margin was observed in TZ 1, 76.0% when excision I and 86.4% when excision II (p = .009); TZ 2, 86.4% when excision I and 88.9% when excision II (p = .672); and TZ 3, 76.5% when excision I and 78.9% when excision II (p = .672). Multivariate analysis revealed in TZ 1 a 2.12 (1.23–3.65) higher risk of obtaining a negative margin in excision type II. In TZ 2 and 3, none of the variables predicted the chance of a negative margin.

Conclusions

The endocervical margin was negative in 3 in every 4 women who underwent loop electrocautery excision procedure, regardless of excision type. Age, menopausal status, smoking, and hormonal contraception did not predict margin status.
Improving Colposcopy Education Through Images: A Preliminary Assessment of an Image-Based Mobile App for Colposcopic Education
Authors: Folsom Susan M. , Cejtin Helen , Milad Magdy P. , Armstrong Kevin , Armstrong Weronika
Published: August 2022

Objectives

Colposcopy is an indispensable part of cervical cancer screening. However, in most training programs, there is little by way of a formalized curriculum. We created an image-based teaching tool and hypothesized that this tool, in a mobile app format, would increase resident comfort with colposcopic practice and quantitatively increase their ability to correlate colposcopic images with impressions.

Materials and Methods

This was a pilot study conducted among ObGyn residents during March 2021. Thirty-eight residents participated and were randomized to either an app user or an independent study control group. Both groups were surveyed before and after their assigned training and completed a postintervention standardized cognitive examination. The primary end points were subjective improvements in comfort with colposcopy. The secondary end point was performance on a standardized image quiz.

Results

Of the 46 targeted residents, 38 participated and 26 completed all elements of the study. On the image examination, app users performed slightly better when compared with the independent study group (mean score, 14.9/25 [SD = 2.15] vs 14.0/25 [SD = 3.27], p = .39). App users also were more likely to be confident in providing an overall colposcopic impression (73% vs 30%, p = .111). One hundred percent of the participants in the app user group said that they would recommend the tool to other residents and residency programs.

Conclusions

Image-based teaching tools, such as the ICE-TI app, are valued by learners and can be a useful adjunct to standardized colposcopy curricula. In addition, making use of a mobile platform facilitated convenience learning.
Benign Paroxysmal Vertigo of Childhood. Video Recordings of Episodes
Authors: Bertholon Pierre , Mazzola Laure , Gavid Marie , Karkas Alexandre , Peyron Roland , Convers Philippe
Published: August 2022

Objectives

The main objective was to describe the nystagmus observed during benign paroxysmal vertigo (BPV) of childhood, which is one of the criteria included in the three versions of the International Classification of Headache Disorders that has never been specified. The secondary objectives were to emphasize the usefulness of a mobile phone to record nystagmus and discuss the physiopathology of this nystagmus.

Patient

A 6-year-old boy complained of approximately 30 to 50 vertigo attacks, most of them lasting around 1 minute, during a 6-month period.

Intervention

Otoneurologic history and examination, audiovestibular exploration, and brain imaging were performed between the attacks. Video recording by the parents' mobile phone and video electroencephalography recording during a 1-day hospitalization were performed during the episodes.

Main Outcome Measure

Analysis of seven video recordings performed by the parents and four during a 1-day hospitalization, as well as follow-up.

Results

The assessment between the attacks confirmed the diagnosis of BPV according to International Classification of Headache Disorders criteria. Video recordings constantly demonstrated a strong left horizontal nystagmus present at fixation in all direction of gaze, enhanced in left gaze. This nystagmus was associated with a rightward body deviation.

Conclusion

The clinical presentation was more consistent with a peripheral vestibular deficit than with a central disorder. We encourage video recording of their child by the parents because it will help both to define the ictal nystagmus and to understand the underlying pathophysiology. The latter is discussed and is probably more complex than initially thought in BPV.
A Prospective Study on the Vestibular Toxicity of Gentamicin in a Clinical Setting
Authors: Chatterton Sophie , Wang Chao , Satyan Hans , Kotsiou George , Todd Christopher J. , Migliaccio Americo A. , Cremer Phillip D.
Published: August 2022

Objective

Gentamicin is a widely used aminoglycoside with ototoxicity as a known adverse effect. Because of the difficulty in clinical recognition, the prevalence of gentamicin ototoxicity in practice is thought to be higher than reported. This study aimed to prospectively assess the effect of gentamicin on vestibular function and whether ototoxicity is underrecognized.

Study Design

Single-center, prospective, nonblinded trial.

Setting

Inpatient tertiary hospital setting followed by vestibular outpatient clinic review.

Patients

Forty-eight patients undergoing a urologic procedure were recruited, with 24 and 17 patients having one or two follow-up tests, respectively, after initial gentamicin administration.

Intervention(s)

Single dose of gentamicin during a urologic procedure.

Main Outcome Measure(s)

Gains for the vestibuloocular reflex (VOR) were measured using the video head impulse test before receiving gentamicin and at two other timepoints after gentamicin. The gains in VOR were then compared with previous testing sessions to determine if there was a deterioration after gentamicin use.

Results

Before receiving gentamicin, the gains for horizontal VOR were measured for 48 patients. The gains were measured a second time for 24 patients at varying durations postgentamicin (1–56 d) and a third time for 17 patients (14–152 d) postgentamicin. The mean VOR gain for Timepoints 1, 2, and 3 were 0.72 ± 0.13, 0.75 ± 0.16, and 0.79 ± 0.18, respectively. Linear-mixed model with repeated-measure analysis revealed no significant difference in VOR gain between Timepoints 1 and 2 (p = 0.19).

Conclusion

There was no significant effect observed on mean VOR gain decrement after a single dose of gentamicin.