bluuebunny/crossref_metadata_2025 huggingface dataset:
The evolving radio jet from the neutron star X-ray binary 4U 1820−30
Authors: Russell T D , Degenaar N , den Eijnden J van , Del Santo M , Segreto A , Altamirano D , Beri A , Díaz Trigo M , Miller-Jones J C A
Published: July 2021

The persistently bright ultracompact neutron star low-mass X-ray binary 4U 1820−30 displays an ∼170 d accretion cycle, evolving between phases of high and low X-ray modes, where the 3–10 keV X-ray flux changes by a factor of up to ≈8. The source is generally in a soft X-ray spectral state, but may transition to a harder state in the low X-ray mode. Here, we present new and archival radio observations of 4U 1820−30 during its high and low X-ray modes. For radio observations taken within a low mode, we observed a flat radio spectrum consistent with 4U 1820−30 launching a compact radio jet. However, during the high X-ray modes the compact jet was quenched and the radio spectrum was steep, consistent with optically thin synchrotron emission. The jet emission appeared to transition at an X-ray luminosity of $L_{\rm X (3-10\, keV)} \sim 3.5 \times 10^{37} (D/\rm {7.6\, kpc})^{2}$ erg s−1. We also find that the low-state radio spectrum appeared consistent regardless of X-ray hardness, implying a connection between jet quenching and mass accretion rate in 4U 1820−30, possibly related to the properties of the inner accretion disc or boundary layer.
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Surgical Risk Assessment
Authors: Harrop James S , Mohamed Basma , Bisson Erica F , Dhall Sanjay , Dimar John , Mummaneni Praveen V , Wang Marjorie C , Hoh Daniel J
Published: July 2021

BACKGROUND

Patient factors (increased body mass index [BMI], smoking, and diabetes) may impact outcomes after spine surgery. There is a lack of consensus regarding which factors should be screened for and potentially modified preoperatively to optimize outcome.

OBJECTIVE

The purpose of this evidence-based clinical practice guideline is to determine if preoperative patient factors of diabetes, smoking, and increased BMI impact surgical outcomes.

METHODS

A systematic review of the literature for studies relevant to spine surgery was performed using the National Library of Medicine PubMed database and the Cochrane Library. Clinical studies evaluating the impact of diabetes or increased BMI with reoperation and/or surgical site infection (SSI) were selected for review. In addition, the impact of preoperative smoking on patients undergoing spinal fusion was reviewed.

RESULTS

A total of 699 articles met inclusion criteria and 64 were included in the systematic review. In patients with diabetes, a preoperative hemoglobin A1c (HbA1c) >7.5 mg/dL is associated with an increased risk of reoperation or infection after spine surgery. The review noted conflicting studies regarding the relationship between increased BMI and SSI or reoperation. Preoperative smoking is associated with increased risk of reoperation (Grade B). There is insufficient evidence that cessation of smoking before spine surgery decreases the risk of reoperation.

CONCLUSION

This evidence-based guideline provides a Grade B recommendation that diabetic individuals undergoing spine surgery should have a preoperative HbA1c test before surgery and should be counseled regarding the increased risk of reoperation or infection if the level is >7.5 mg/dL. There is conflicting evidence that BMI correlates with greater SSI rate or reoperation rate (Grade I). Smoking is associated with increased risk of reoperation (Grade B) in patients undergoing spinal fusion.

The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/2-preoperative-surgical-risk-assessement
Assessment of neurological function using the National Institute of Health Stroke Scale in patients with gliomas
Authors: Zeitlberger Anna Maria , Flynn Marie-Claire , Hollenstein Monika , Hundsberger Thomas
Published: July 2021

Background

The evaluation of treatment response in patients with gliomas is performed using the Response Assessment in Neuro-Oncology (RANO) criteria. These criteria are based on cerebral magnetic resonance imaging (MRI), steroid use, and neurological function. However, a standardized tool for evaluating neurological function was lacking. We compared changes in the National Institute of Health Stroke Scale (NIHSS) to changes in the RANO categories to determine the relationship between clinical and neuroradiological findings.

Methods

We reviewed data on all adult patients with supratentorial gliomas WHO grade II-IV who were treated at the Cantonal Hospital St. Gallen from 2008 to 2015. The NIHSS was performed prospectively at baseline and at 3-month intervals simultaneously to MRI. Associations between changes in the NIHSS and RANO categories were assessed using the Stuart-Maxwell test.

Results

Our cohort consisted of 61 patients from which 471 observations were analyzed. The most common histological diagnosis was glioblastoma (49.2%). In total, 74% of RANO categories and 81% of the NIHSS scores remained stable on follow-up. Statistically, contemporaneous changes in the RANO category did not correlate with changes in the NIHSS (P < .0001).

Conclusion

The application of the NIHSS is easy and feasible in the heterogeneous population of glioma patients. In our cohort, the RANO categories did not reflect contemporaneous changes in the NIHSS. A validated clinical outcome measure with a well-defined minimal clinically important difference is warranted in neuro-oncological research and clinical practice.
Insights Into the Mini-BESTest Scoring System: Comparison of 6 Different Structural Models
Authors: Godi Marco , Arcolin Ilaria , Leavy Breiffni , Giardini Marica , Corna Stefano , Franzén Erika
Published: July 2021

Objective

The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a balance scale common to clinical practice, but different scoring has been proposed, that is, total score and/or subsections. This study aimed to investigate Mini-BESTest validity by comparing 6 structural models and to establish the best model for discriminating fallers from nonfallers, that is, those who did or did not report at least 2 falls in the 6 months before evaluation.

Methods

In this cross-sectional validation study, data from 709 individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1–3) were analyzed. Individuals were evaluated with the Mini-BESTest, and fall history was recorded. Construct, convergent, and discriminant validity and reliability of the 6 models were analyzed. The ability of the models to adequately identify individuals with or without a history of falls was tested with receiving operating characteristic curves.

Results

Confirmatory factor analysis showed that the unidimensional models and the 4-factor solutions showed the best fit indexes. Conversely, second-order models, which allowed reporting of both total and subsections, did not converge. Most models and factors showed a low convergent validity (average variance extracted values <0.5). Correlations among the anticipatory postural adjustments factor with both the sensory orientation and the dynamic gait factors of multidimensional models were high (r ≥ 0.85). Unidimensional model reliability was good, whereas low values were found in one-half of the subsections. Finally, both unidimensional models showed a large area under the receiving operating characteristic curve (0.81).

Conclusion

The original unidimensional Mini-BESTest model—with a total score of 28—showed the highest validity and reliability and was best at discriminating fallers from nonfallers. Conversely, its 4 subsections should not be reported separately, because they were highly correlated and had low reliability; therefore, they are not actually capable of measuring different aspects of balance.

Impact

This study shows that the Mini-BESTest should be used only with the original unidimensional scoring system in people with Parkinson disease.
Short- and longer-term cancer risks with biologic and targeted synthetic disease-modifying antirheumatic drugs as used against rheumatoid arthritis in clinical practice
Authors: Huss Viking , Bower Hannah , Wadström Hjalmar , Frisell Thomas , Askling Johan ,   the ARTIS group, Ahlenius Gerd-Marie , Baecklund Eva , Chatzidionysiou Katerina , Feltelius Nils , Forsblad-d’Elia Helena , Kastbom Alf , Klareskog Lars , Lindqvist Elisabet , Lindström Ulf , Turesson Carl , Sjöwall Christopher , Askling Johan
Published: July 2021

Objective

To estimate the occurrence and relative risks of first-ever-incident non-cutaneous cancer overall and for 16 sites in patients with RA treated with biologic and targeted synthetic DMARDs (b/tsDMARDs), by time since treatment start, attained age, and duration of active treatment.

Methods

This is an observational nationwide and population-based cohort study of patients with RA (n = 69 308), treated with TNF inhibitors (TNFi; adalimumab, certolizumab, etanercept, golimumab, infliximab) or other b/tsDMARDs (abatacept, rituximab, baricitinib, tofacitinib and tocilizumab) compared with RA patients not treated with b/tsDMARDs, and matched general population referents (n = 109 532), 2001–2018. The study was based on prospectively collected data from the Swedish Rheumatology Quality Register and from other registers, linked to the national Swedish Cancer Register. Incidence rates and hazard ratios were estimated via Cox regression adjusted for co-morbidities and other health characteristics.

Results

Based on 8633 incident cancers among RA patients, the overall relative risk of cancer with TNFi [hazard ratio (HR) = 1.0] was neither increased nor did it change with time since treatment start, duration of active treatment, or attained age, when compared with b/tsDMARD-naïve RA. For other b/tsDMARDs, we noted no consistent signal of increased overall risks (HRs ranged from 1.0 to 1.2), but there were statistically significant estimates above 1 for abatacept with 2–5 years of active treatment, for older age groups, and between several of the bDMARDs and urinary tract cancer.

Conclusion

TNFis, as used long term in clinical practice against RA, are not linked to increased risks for cancer overall. For other b/tsDMARDs, and for site-specific risks, our results are generally reassuring but contain signals that call for replication.
“The Squeaky Wheel Gets the Grease”: Rental Assistance Applicants’ Quests for a Rationed and Scarce Resource
Authors: Keene Danya E , Rosenberg Alana , Schlesinger Penelope , Whittaker Shannon , Niccolai Linda , Blankenship Kim M
Published: July 2021

In 2016, only one in five eligible U.S. households received rental assistance and waiting lists averaged two years nationally. The gap between available rental assistance and need requires systems to allocate this scarce resource. The way potential rental assistance recipients experience and navigate these systems is likely to shape who ultimately receives assistance. We draw on repeated qualitative interviews (N=238) with low-income New Haven residents (N=54) to examine how participants understand and navigate rental assistance applications and waiting lists. Participants encountered multiple challenges in their search for rental assistance. They described an opaque and complex application and waiting process requiring significant knowledge to navigate. They also described considerable labor associated with monitoring waiting lists, a challenge made more difficult for some by their lack of a stable address. Additionally, participants described significant labor and knowledge required to strategically navigate prioritization systems that often required them to advocate for their deservingness of scarce housing resources. Our findings suggest that the allocation of rental assistance through complex processes that depend on applicant knowledge, labor, and advocacy may create barriers to housing, particularly for more vulnerable and marginalized housing seekers.
14-Day Nose-Only Inhalation Toxicity and Haber’s Rule Study of NNK in Sprague-Dawley Rats
Authors: Hu Shu-Chieh , Min Seonggi , Kang Hyun-Ki , Yang Dong-Jin , Lewis Sherry M , Davis Kelly J , Patton Ralph E , Bryant Matthew S , Sepehr Estatira , Trbojevich Raul , Pearce Mason G , Bishop Michelle E , Heflich Robert H , Maisha MacKean P , Felton Robert , Chemerynski Susan , Yee Steven B , Coraggio Melis , Rosenfeldt Hans , Yeager R Philip , Howard Paul C , Tang Yunan
Published: July 2021

4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is one of the key tobacco-specific nitrosamines that plays an important role in human lung carcinogenesis. However, repeated inhalation toxicity data on NNK, which is more directly relevant to cigarette smoking, are currently limited. In the present study, the subacute inhalation toxicity of NNK was evaluated in Sprague Dawley rats. Both sexes (9–10 weeks age; 16 rats/sex/group) were exposed by nose-only inhalation to air, vehicle control (75% propylene glycol), or 0.8, 3.2, 12.5, or 50 mg/kg body weight (BW)/day of NNK (NNK aerosol concentrations: 0, 0, 0.03, 0.11, 0.41, or 1.65 mg/L air) for 1 h/day for 14 consecutive days. Toxicity was evaluated by assessing body and organ weights; food consumption; clinical pathology; histopathology observations; blood, urine, and tissue levels of NNK, its major metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and their glucuronides (reported as total NNK, tNNK, and total NNAL, tNNAL, respectively); O6-methylguanine DNA adduct formation; and blood and bone marrow micronucleus frequency. Whether the subacute inhalation toxicity of NNK followed Haber’s Rule was also determined using additional animals exposed 4 h/day. The results showed that NNK exposure caused multiple significant adverse effects, with the most sensitive endpoint being non-neoplastic histopathological lesions in the nose. The lowest-observed-adverse-effect level (LOAEL) was 0.8 mg/kg BW/day or 0.03 mg/L air for 1 h/day for both sexes. An assessment of Haber’s Rule indicated that 14-day inhalation exposure to the same dose at a lower concentration of NNK aerosol for a longer time (4 h daily) resulted in greater adverse effects than exposure to a higher concentration of NNK aerosol for a shorter time (1 h daily).
The Macroeconomy After Tariffs
Authors: Furceri Davide , Hannan Swarnali A , Ostry Jonathan D , Rose Andrew K
Published: July 2021

What does the macroeconomy look like in the aftermath of tariff changes? This study estimates impulse response functions from local projections using a panel of annual data that spans 151 countries from 1963 to 2014. Tariff increases are associated with persistent, economically and statistically significant declines in domestic output and productivity, as well as higher unemployment and inequality, real exchange rate appreciation, and insignificant changes to the trade balance. Output and productivity impacts are magnified when tariffs rise during expansions and when they are imposed by more advanced or smaller (as opposed to developing or larger) economies; effects are asymmetric, being larger when tariffs go up than when they fall. While firmly establishing causality is always a challenge, the results are robust to a large number of perturbations to the baseline methodology, and they hold using both macroeconomic and industry-level data.
Dual Transcriptional Profiling of Carrot and ‘Candidatus Liberibacter solanacearum’ at Different Stages of Infection Suggests Complex Host-Pathogen Interaction
Authors: Wang Jinhui , Haapalainen Minna , Nissinen Anne I. , Pirhonen Minna
Published: July 2021

The interactions between the phloem-limited pathogen ‘Candidatus Liberibacter solanacearum’ haplotype C and carrot (Daucus carota subsp. sativus) were studied at 4, 5, and 9 weeks postinoculation (wpi), by combining dual RNA-Seq results with data on bacterial colonization and observations of the plant phenotype. In the infected plants, genes involved in jasmonate biosynthesis, salicylate signaling, pathogen-associated molecular pattern- and effector-triggered immunity, and production of pathogenesis-related proteins were up-regulated. At 4 wpi, terpenoid synthesis-related genes were up-regulated, presumably as a response to the psyllid feeding, whereas at 5 and 9 wpi, genes involved in both the terpenoid and flavonoid production were down-regulated and phenylpropanoid genes were up-regulated. Chloroplast-related gene expression was down-regulated, in concordance with the observed yellowing of the infected plant leaves. Both the RNA-Seq data and electron microscopy suggested callose accumulation in the infected phloem vessels, likely to impair the transport of photosynthates, while phloem regeneration was suggested by the formation of new sieve cells and the upregulation of cell wall–related gene expression. The ‘Ca. L. solanacearum’ genes involved in replication, transcription, and translation were expressed at high levels at 4 and 5 wpi, whereas, at 9 wpi, the Flp pilus genes were highly expressed, suggesting adherence and reduced mobility of the bacteria. The ‘Ca. L. solanacearum’ genes encoding ATP and C4-dicarboxylate uptake were differentially expressed between the early and late infection stages, suggesting a change in the dependence on different host-derived energy sources. HPE1 effector and salicylate hydroxylase were expressed, presumably to suppress host cell death and salicylic acid-dependent defenses during the infection.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Multifaceted Insights on Fusarium Head Blight in Small Grains in Pennsylvania
Authors: Duffeck Maíra R. , Del Ponte Emerson M. , Esker Paul D.
Published: July 2021

Fusarium head blight (FHB) is a serious disease of small-grain cereals that causes economic losses due to both yield reduction and mycotoxin contamination worldwide. To optimize the regional management of the disease, knowledge of risk factors associated with FHB outbreaks and mycotoxin accumulation are essential steps. Therefore, a 2-year survey was conducted during the summers of 2018 and 2019, in which naturally FHB-affected spikes from different hosts were collected across the major cereal-producing regions of Pennsylvania (South, Central, and North). FHB severity (%) data were recorded from each field. Furthermore, a collection of 307 Fusarium graminearum isolates was used to investigate specific components of the pathogen biology, such as the composition of the trichothecene genotype, saprophytic and pathogenic fitness, and sensitivity to triazole-based fungicides. Our results confirm that FHB is an important disease in Pennsylvania, and the risk of disease epidemics may be impacted by both the year and the location. Overall, the regional population of F. graminearum causing FHB in Pennsylvania is the 15ADON genotype. Based on in vitro and in vivo experiments, F. graminearum populations obtained from three distinct small-grain management regions could not be differentiated for the majority of fitness traits examined. All isolates were sensitive to tebuconazole and metconazole fungicides in vitro. Overall, this new knowledge can help shed light on the relative importance of FHB epidemics in Pennsylvania and provide directions for monitoring the sustainability of the integrated strategies used to manage FHB and mycotoxin accumulation.
Reasons PAs leave their jobs
Authors: Reed Harrison , Bernard Kari , Smith Noël
Published: July 2021

Purpose:

Employee turnover is an important indicator that carries a heavy financial cost for healthcare organizations. Although previous research has highlighted some factors associated with turnover, the reasons physician assistants (PAs) leave their jobs are not fully understood. This study aimed to determine the most common reasons behind PA turnover.

Methods:

In 2019, the American Academy of PAs (AAPA) distributed a survey to all PAs with an eligible email address. The survey included a question asking respondents if they had left or changed their job in the past year. Respondents answering this question in the affirmative were asked a follow-up multiple-choice question to determine the reason behind this change.

Results:

A total of 13,088 PAs responded to the AAPA salary survey; of these, 1,261 reported leaving a job within the past year. The most common reasons provided for leaving a job were: better work/life balance (n = 209, 16.8%), moved (n = 208, 16.7%), better management/leadership/environment (reasons related to toxic/abusive environment) (n = 170, 13.6%), and better compensation/benefits (n = 148, 11.9%).

Conclusion:

Employers should focus on common reasons for turnover that can be reasonably addressed. Of the top three reasons behind PA turnover, those related to toxic/abusive work environments may be the most practical and important to address.
Can buprenorphine be used for opioid use disorder during pregnancy?
Authors: Philip Serene , Griffin Brooke
Published: July 2021

New clinical studies indicate that buprenorphine can be a promising alternative to methadone for treating opioid use disorder (OUD) in pregnant women. Various benefits for the mother have been identified with buprenorphine's unique pharmacokinetics, effect on clinical outcomes, and convenience for the patient. With the growing problem of OUD in pregnant women, clinicians must be aware of treatment options and their associated advantages and disadvantages.
Planning pregnancy during the COVID-19 pandemic
Authors: Vo Veronica Dieuhien
Published: July 2021

This literature review assesses recent research highlighting the clinical characteristics of COVID-19 in pregnant patients and children. With better understanding, clinicians can offer risk assessment for those planning pregnancies amid the pandemic while using the best practice guidelines to reassure and assist pregnant patients throughout all spectrums of perinatal care, delivery, and postpartum care.
Recurrence Rate and Risk Factors of Recurrence in Benign Paroxysmal Positional Vertigo: a Single-Center Long-Term Prospective Study With a Large Cohort
Authors: Kong Tae Hoon , Song Mee Hyun , Shim Dae Bo
Published: July 2021

Objective:

This study aimed to assess the long-term recurrence rate and correlations between recurrence and potential risk factors in patients with benign paroxysmal positional vertigo (BPPV).

Design:

A total of 548 consecutive patients who demonstrated typical posterior or horizontal BPPV between January 2010 and December 2012 were included in this prospective study. All patients were contacted by phone every 6 months for 5 years and were asked to revisit the clinic when they experienced positional vertigo to be reexamined for recurrence. Recurrence of BPPV was defined as having positional vertigo and nystagmus confirmed following a symptom-free period of at least 7 days after complete resolution. We assessed the 5-year recurrence rate of BPPV, and the time point of recurrence in all patients as well as the risk factors of BPPV recurrence, including the clinical characteristics, therapeutic results of BPPV, and various comorbidities.

Results:

Among the 548 patients, 121 (22.1 %) had at least one recurrence. Of these, 78 patients (54.5%) had only one recurrence within 5 years, while 43 (45.5%) patients experienced two or more recurrences. A recurrence occurred within 1 year in 82 patients (67.8%). The Cox proportional hazard ratio analysis found that head trauma (p = 0.015), Meniere’s disease (p = 0.016), the number of canalith repositioning procedures performed (p = 0.037), and the number of previous vertigo attacks (p = 0.038) were significant risk factors of BPPV recurrence as opposed to hypertension or hyperlipidemia.

Conclusions:

The recurrence rate of BPPV was 22.1% at 5 years after the initial treatment. About 70% of recurred patients had a recurrence within 1 year. Head trauma, ipsilateral Meniere’s disease, the number of canalith repositioning procedures performed, and the number of previous vertigo attacks were significant risk factors of BPPV recurrence.
Evaluation of Remote Check: A Clinical Tool for Asynchronous Monitoring and Triage of Cochlear Implant Recipients
Authors: Maruthurkkara Saji , Case Sasha , Rottier Riaan
Published: July 2021

Background:

A new Remote Check App permits remote self-testing of hearing function for Nucleus cochlear implant (CI) recipients and enables asynchronous review by their clinician to support patient-management decisions.

Objectives:

To evaluate the Remote Check App for: (1) ease of use; (2) overall acceptance of the test battery by CI recipient or their carer in the home setting; (3) test–retest reliability of audiological threshold and speech recognition measures via wireless streaming; and (4) to compare outcomes from patient-driven measures with conventional clinician-driven measurements of aided-hearing function.

Design:

Single-site, prospective, repeated-measures cohort study with 32 experienced CI users (28 adults and 4 children).

Methods:

Participants completed self-testing using the Remote Check app at home and in the clinic. Measures include audiological, objective and subjective tests. Self-administered speech recognition in noise, via the digit triplets test (DTT) and aided thresholds, via the aided threshold test (ATT) were reassessed in free-field and by clinicians following conventional clinical protocols. Results of ATT and DTT were compared across test conditions. Completion time and perceived ease of self-driven assessments were documented. Insights from subsequent real-world experience with Remote Check are summarized and compared to the study findings.

Results:

Remote Check was rated as easy to use by the majority (87%) of subjects. Mean group test–retest score differences for self-administered testing within the clinic versus at-home environments were nonsignificant (p > 0.05): 1.4 dB (SD = 1.97) for ATT and 1.6 dB (SD = 1.54) for DTT. Mean group test–retest score difference for patient-driven DTT in streamed versus the free-field condition was 1.8 dB (SD = 2.02). Self-administered, streamed, ATT via Remote Check, resulted in significantly lower thresholds compared to clinician-driven warble-tone thresholds in the free-field by 6.7 dB (SD = 6.8) (p < 0.001). ATT thresholds via Remote Check were not significantly different from predicted thresholds based on the Threshold Sound Pressure Level of the sound processor.

Conclusion:

Remote Check is the first CI telehealth assessment tool that uses wireless streaming to enable comprehensive, easy and reliable self-testing of hearing function by the CI recipient or their carer, in the comfort of their home. Asynchronous access to test results can assist clinicians in monitoring and triaging individuals for appropriate patient-management based on their needs. Use of remote monitoring may also help to reduce the burden of unnecessary clinic visits on clinic resources, patient travel time and associated costs. Remote Check is an important step toward addressing the current growing need for asynchronous audiological telepractice to support long-term care of CI recipients.
Diet Quality and the Risk of Impaired Speech Reception Threshold in Noise: The UK Biobank cohort
Authors: Yévenes-Briones Humberto , Caballero Francisco Félix , Struijk Ellen A. , Machado-Fragua Marcos D. , Ortolá Rosario , Rodríguez-Artalejo Fernando , Lopez-Garcia Esther
Published: July 2021

Objective:

Previous studies have examined the association between several diet quality indexes and risk of hearing loss, based on self-reported information or on audiometry test, with inconsistent results. However, the impact of healthy diets on the capacity to listening in noise, a proxy of disability due to hearing loss, is unknown. This research assessed the prospective association between five diet quality indexes and the speech reception threshold in noise in the UK Biobank study.

Design:

Prospective cohort with 105,592 participants aged ≥40 years. At baseline, adherence to the Mediterranean Diet Adherence Screener, the alternate Mediterranean Diet score, the Dietary Approaches to Stop Hypertension, the Alternate Healthy Eating Index-2010, and the healthful Plant-Based Diet Index were assessed. Functional auditory capacity was measured with a digit triplet test, and impairment was defined as a speech reception threshold in noise >−3.5 dB in any physical exam during the follow-up.

Results:

Over a median follow-up of 3.2 (SD: 2.1) years, 1704 participants showed impaired speech reception threshold in noise. After adjusting for potential confounders, the hazard ratios (95% confidence interval) of impairment per 1-SD increase in the Mediterranean Diet Adherence Screener, alternate Mediterranean Diet score, Dietary Approaches to Stop Hypertension, Alternate Healthy Eating Index-2010 and healthful Plant-Based Diet Index scores were, respectively, 0.98 (0.94 to 1.03), 1.01 (0.96 to 1.06), 1.02 (0.97 to 1.07), 1.01 (0.96 to 1.06), and 1.00 (0.96 to 1.05). Results were similar when analyses were restricted to those >60 years, with British ethnicity, without chronic disease, without tinnitus or with optimal cognitive function.

Conclusions:

Adherence to a healthy diet did not show an association with the speech reception threshold in noise. More research is needed to identify the impact of individual foods or nutrients on this outcome.
Increased Resident Diversity Precedes Increased Faculty Diversity
Authors: Amdur Robert J. , Mendenhall Nancy P. , Mendenhall William M. , Dagan Roi , Yeung Anamaria R. , Okunieff Paul G.
Published: July 2021

Objectives:

Increasing the percentage of academic faculty who are female and/or an under-represented minority (URM) is a goal in radiation oncology. When studying diversity changes in our University Radiation Oncology Department, we found that increases in resident diversity preceded changes in faculty diversity in every major category. To illustrate these findings, we plotted resident versus faculty diversity each year over the 52-year history of our program.

Materials and Methods:

Plots were generated of the percent of residents versus faculty in our program each year between 1967 and 2020 in the following categories: female, URM, and people of color.

Results:

By 1995, substantial levels of diversity were present among both residents and faculty with approximate median annual values between 1995 and 2020 of 30% female for both residents and faculty, 15% URM for both residents and faculty, and 30% persons of color for residents and 15% for faculty. In all analyses, increase in resident diversity preceded an increase in faculty diversity and, in the great majority of years, resident diversity was greater than faculty diversity.

Conclusion:

Our experience suggests that it may be easier to increase resident than faculty diversity and that increases in resident diversity may facilitate increasing faculty diversity.
Regulation of CYP3A4 and CYP3A5 by a lncRNA: a potential underlying mechanism explaining the association between CYP3A4*1G and CYP3A metabolism
Authors: Collins Joseph M , Wang Danxin
Published: July 2021

The cytochrome P450 3A4 (CYP3A4) enzyme is the most abundant drug-metabolizing enzyme in the liver, displaying large inter-person variability with unknown causes. In this study, we found that the expression of CYP3A4 is negatively correlated with AC069294.1 (ENSG00000273407, ENST00000608397.1), a lncRNA generated antisense to CYP3A4. Knockdown of AC069294.1 in Huh7 cells increased CYP3A4 mRNA ~3-fold, whereas overexpression of AC069294.1 decreased CYP3A4 mRNA by 89%. We also observed changes in CYP3A5 expression when AC069294.1 was knocked down or overexpressed, indicating dual effects of AC069294.1 on both CYP3A4 and CYP3A5 expression. Consistently, the expression level of CYP3A5 is also negatively correlated with AC069294.1. Previous studies have shown associations between an intronic single nucleotide polymorphism CYP3A4*1G (rs2242480) and CYP3A metabolism, but the results are inconsistent and the underlying mechanism is unclear. We show here that CYP3A4*1G (rs2242480) is associated with 1.26-fold increased expression of AC069294.1 (P < 0.0001), and decreased expression of CYP3A4 by 31% (P = 0.008) and CYP3A5 by 39% (P = 0.004). CYP3A4*1G is located ~2.7 kb upstream of AC069294.1 and has been previously reported to have increased transcriptional activity in reporter gene assays. Taken together, our results demonstrate the regulation of CYP3A4 and CYP3A5 by a novel lncRNA AC069294.1. Our results also indicate that the clinically observed CYP3A4*1G associations may be caused by its effect on the expression of AC069294.1, and thereby altered expression of both CYP3A4 and CYP3A5. Furthermore, because CYP3A4*1G is in high linkage disequilibrium with CYP3A5*1, increased AC069294.1 expression caused by CYP3A4*1G may decrease expression of the normal-functioning CYP3A5*1, explaining additional inter-person variability of CYP3A5.
Tips on Raising Reliable Local Perforator Flaps
Authors: Ashton Mark W.
Published: July 2021

From early on in the development of plastic surgery, it was quickly realized that utilizing locally adjacent tissue, or “matching like with like,” yielded superior aesthetic reconstructions to those in which the tissue was derived from a distant location. In many cases, the use of a local perforator flap is a simpler procedure with less patient morbidity and a quicker recovery from surgery. The difficulty with local perforator flaps has been locating the supplying perforators, ensuring that the flap has a robust and reliable blood supply, and that sufficient tissue is able to be transferred. The recent reappraisal of our understanding of the blood supply of the integument has allowed, for the first time, the capacity to accurately and inexpensively, without the need for “high tech equipment,” locate perforators, as they emerge from the deep fascia into the overlying integument, and through a better understanding of the interconnecting anastomotic vessels between perforators reliably predict how much tissue can be safely raised on a single perforator, before surgery. Further, through the use of strategic “delay,” it is possible to manipulate the interconnecting vessels between the selected perforator and its surrounding neighbors to design a flap of tissue of any dimension, composed of whatever tissue we require, and safely transfer that tissue locally, or if required, distantly, as a free flap. This article will highlight these advances, explain their relevance in raising reliable local perforator flaps, and will, where possible, call attention to any pearls and pitfalls, and how to avoid complications.
Cognitive Behavioral Therapy for Sleep Disturbance and Fatigue Following Acquired Brain Injury: Predictors of Treatment Response
Authors: Ymer Lucy , McKay Adam , Wong Dana , Frencham Kate , Grima Natalie , Tran Joanna , Nguyen Sylvia , Ponsford Jennie
Published: July 2021

Objective:

To identify factors associated with treatment response to cognitive behavioral therapy for sleep disturbance and fatigue (CBT-SF) after acquired brain injury (ABI).

Setting:

Community dwelling.

Participants:

Thirty participants with a traumatic brain injury or stroke randomized to receive CBT-SF in a parent randomized controlled trial.

Design:

Participants took part in a parallel-groups, parent randomized controlled trial with blinded outcome assessment, comparing an 8-week CBT-SF program with an attentionally equivalent health education control. They were assessed at baseline, post-treatment, 2 months post-treatment, and 4 months post-treatment. The study was completed either face-to-face or via telehealth (videoconferencing). Following this trial, a secondary analysis of variables associated with treatment response to CBT-SF was conducted, including: demographic variables; injury-related variables; neuropsychological characteristics; pretreatment sleep disturbance, fatigue, depression, anxiety and pain; and mode of treatment delivery (face-to-face or telehealth).

Main Measures:

Pittsburgh Sleep Quality Index (PSQI) and Fatigue Severity Scale (FSS).

Results:

Greater treatment response to CBT-SF at 4-month follow-up was associated with higher baseline sleep and fatigue symptoms. Reductions in fatigue on the FSS were also related to injury mechanism, where those with a traumatic brain injury had a more rapid and short-lasting improvement in fatigue, compared with those with stroke, who had a delayed but longer-term reduction in fatigue. Mode of treatment delivery did not significantly impact CBT-SF outcomes.

Conclusion:

Our findings highlight potential differences between fatigue trajectories in traumatic brain injury and stroke, and also provide preliminary support for the equivalence of face-to-face and telehealth delivery of CBT-SF in individuals with ABI.
Postconcussion Exercise Volume Associations With Depression, Anxiety, and Dizziness Symptoms, and Postural Stability: Preliminary Findings
Authors: Howell David R. , Hunt Danielle L. , Oldham Jessie R. , Aaron Stacey E. , Meehan William P. , Tan Can Ozan
Published: July 2021

Objective:

To examine the association between postconcussion exercise volume and changes in depression, anxiety, dizziness, and postural stability.

Design:

Secondary analysis of a single-site prospective clinical trial.

Setting:

Cerebrovascular research laboratory.

Participants:

Participants completed questionnaires and underwent tests of gait and balance within 2 weeks of a concussion (mean = 11 ± 3 days postconcussion) and approximately 1 month later (mean = 41 ± 7 days postconcussion). Exercise volume was tracked by weekly exercise logs.

Interventions:

On the basis of a previous work classifying exercise volume following concussion, we grouped participants according to self-reported exercise volume between visits as high exercise volume (≥150 min/wk) or low exercise volume (<150 min/wk).

Main Outcome Measures:

Participants completed assessments evaluating anxiety and depression (Hospital Anxiety and Depression Scale), dizziness (Dizziness Handicap Inventory), and postural stability (tandem gait and modified Balance Error Scoring System).

Results:

Thirty-eight participants completed the study, of which 22 were in the high exercise volume group (mean = 71 ± 40 min/wk; 16.8 ± 2.1 years; 59% female) and 16 were in the low exercise volume group (mean = 379 ± 187 min/wk; 17.5 ± 2.1 years; 31% female). Although depression symptoms were not significantly different initially (mean difference = 1.5; 95% CI, −0.68 to 3.68; P = .24), the high exercise volume group had significantly lower depression symptom scores at follow-up (mean difference = 3.0; 95% CI, 1.40 to 4.47; P < .001). Anxiety symptoms (mean difference = 2.8; 95% CI, 0.3 to 5.4; P = 0.03), dizziness symptoms (mean difference = 10.9; 95% CI, 0.2 to 21.5; P = .047), single-task tandem gait (mean difference = 3.1 seconds; 95% CI, 0.2 to 6.0; P = .04), and dual-task tandem gait (mean difference = 4.2 seconds; 95% CI, 0.2 to 8.2; P = .04) were significantly better among the high exercise volume group.

Conclusion:

Greater exercise volumes were associated with lower depression, anxiety, and dizziness symptoms, and faster tandem gait performance. These preliminary findings suggest a potentially beneficial role for exercise within several different domains commonly affected by concussion.
Phlyctenular Keratoconjunctivitis in a Patient With COVID-19 Infection
Authors: Eleiwa Taher K. , Elmaghrabi Ayman , Helal Hend G. , Abdelrahman Samar N. , ElSheikh Reem H. , Elhusseiny Abdelrahman M.
Published: July 2021

The coronavirus disease 2019 global pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several ophthalmic manifestations have been reported to be associated with SARS-CoV-2 infection, including conjunctivitis, acute sixth nerve palsy, and multiple cranial neuropathies. We present a unique case of unilateral phlyctenular keratoconjunctivitis in a 5-year-old boy in the setting of SARS-CoV-2 infection.
Increased risk for central serous chorioretinopathy in nephrotic syndrome patients: A population-based cohort study
Authors: Lee Lung-Chi , Wu Tai-Jung , Huang Ke-Hao , Chen Yi-Hao , Chen Jiann-Torng , Chung Chi-Hsiang , Chien Wu-Chien , Chen Ching-Long
Published: July 2021

Background:

Nephrotic syndrome (NS) is characterized by various etiologies that damage the glomerulus. Central serous chorioretinopathy (CSCR) is a retinal disease characterized by neurosensory detachment of the retina. Several case reports have described the relationship between both. Therefore, we try to analyze the epidemiological associations between NS and CSCR using the National Health Insurance Research Database in Taiwan.

Methods:

Data spanning 14 years were extracted from the National Health Insurance Research Database and sub-grouped. The variables were analyzed using Pearson’s chi-squared test and Fisher’s exact test. The risk factors for disease development with or without comorbidities were examined using an adjusted hazard ratio (aHR). Kaplan-Meier analysis was performed to evaluate the cumulative incidence of CSCR with or without NS.

Results:

A total of 14 794 patients with NS and 14 794 matched controls without NS were enrolled in this cohort study. The incidence rate of CSCR was higher in the study cohort than in the control cohort (aHR = 3.349, p < 0.001). The overall incidence of CSCR was 44.51 per 100 000 person-years in the study cohort and 33.39 per 100 000 person-years in the control cohort. In both groups, CSCR occurred more frequently in males than in females. Patients aged 40–49, 50–59, and ≥60 years in the study cohort had a significantly higher risk of developing CSCR than those in the control cohort (aHR = 3.445, 5.421, and 4.957, all p < 0.001). NS patient with a 4-week history of steroid usage has a higher risk of developing CSCR (aHR = 2.010, p < 0.001).

Conclusion:

Our data showed that patients with NS have an increased risk of developing subsequent CSCR. Physician should routinely refer their NS patients to ophthalmologist for ophthalmic evaluation. This is the first nationwide epidemiological study reporting the association between these two diseases. Further studies are needed to clarify this relationship.
Video Consent for Colonoscopy Improves Knowledge Retention and Patient Satisfaction
Authors: Padival Ruthvik , Harris Kevin B. , Garber Ari , El-Khider Faris , Kichler Adam , Vargo John , Baggott Brian B.
Published: July 2021

Background and Aim:

Informed consent for endoscopy is variable across institutions and remains understudied in gastrointestinal endoscopy. This study aims to standardize informed consent for screening and diagnostic colonoscopies with a supplemental video tool that includes the key components of informed consent.

Methods:

A video tool was developed that incorporated the key components of informed consent for colonoscopy. In addition, a 7-question survey was developed to query patients on core aspects of informed consent and satisfaction with the informed consent process. Patients undergoing elective outpatient colonoscopy with conscious sedation were randomized to traditional consent or consent with the addition of a video tool. A pilot study determined the sample size. Traditional consent was standard of practice before the procedure. Patients in the video tool group watched the video tool in the preprocedure area followed by traditional consent. Both groups had the opportunity to address questions with the attending physician before the procedure. All patients were contacted 1 to 2 days following the colonoscopy to answer the question survey.

Results:

A total of 110 patients were eligible for participation, and 91 were included in the final data analysis. Subjects in the video tool group demonstrated significantly higher recall of key aspects of informed consent and higher satisfaction with the informed consent process versus the traditional consent group. The history of prior colonoscopy was similar between both groups. Mean endoscopy operation metrics were not negatively impacted by the inclusion of the video tool.

Conclusion:

Patients undergoing screening and diagnostic colonoscopies who received informed consent supplemented by a video tool had a higher recall of core aspects of informed consent and higher satisfaction with the process, with no impact on procedural times.
Unhealthy Eating, Psychopathology, and Nonalcoholic Fatty Liver Disease in Youth Presenting for Bariatric Surgery
Authors: Ley Sanita L. , Zeller Meg H. , Reiter‐Purtill Jennifer , Kleiner David E. , Dixon John , Xanthakos Stavra ,   Teen View Study Group and in collaboration with the Teen‐LABS Consortium
Published: July 2021

Objectives:

Little is known about the behavioral and psychosocial correlates of pediatric nonalcoholic fatty liver disease (NAFLD). Given diet contributes to the development and persistence of NAFLD, we examined (1) the prevalence of unhealthy eating behaviors (UEB), (2) whether these varied by NAFLD or nonalcoholic steatohepatitis (NASH) presence, and explored (3) the association of psychopathology with NAFLD.

Methods:

Before metabolic and bariatric surgery (MBS), adolescents (N = 159; Mage = 16.4; MBMI = 53.7 kg/m2, 73% girls, 62.3% white) self‐reported presence/absence of 10 UEB (Questionnaire on Eating and Weight Patterns‐Revised, Night Eating Questionnaire, Look AHEAD). NAFLD and NASH presence was assessed by intraoperative liver biopsy. Height/weight, blood pressure, and blood specimens were obtained. A medical comorbidity index was created (prediabetes/diabetes, dyslipidemia, elevated blood pressure). Psychopathology was assessed in a subgroup completing the Youth Self‐Report (N = 98).

Results:

Binge eating disorder symptomatology was associated with higher odds of NAFLD whereas frequent eating out was associated with lower odds of NAFLD. Among those with NAFLD frequent eating out was associated with higher odds of NASH while nocturnal eating was associated with lower odds of NASH. Separate models identified internalizing psychopathology as associated with higher odds of NAFLD after controlling for demographics, number of UEB, and medical comorbidities.

Conclusions:

Results suggest potential phenotypical differences between adolescents presenting for MBS with/without NAFLD, with implications for behavioral/psychosocial targets for screening and intervention. Replication should occur in a sample with greater gender and ethnic diversity to improve generalizability. Understanding differences in the context of surgical weight loss and comorbidity resolution is indicated.
HER2 Protein Overexpression and Gene Amplification in Tubo-Ovarian High-grade Serous Carcinomas
Authors: Ersoy Esma , Cao Qing Jackie , Otis Christopher N.
Published: July 2021

Most tubo-ovarian high-grade serous carcinomas (TO-HGSC) are diagnosed in advanced stages. Although the majority of patients achieve initial remission with cytoreductive surgery and chemotherapy, mortality rate remains high due to recurrent/progressive disease. The addition of trastuzumab to carboplatin-paclitaxel improved progression-free survival of patients with human epidermal growth factor receptor 2 (HER2)-positive uterine serous carcinoma. After this encouraging result of transtuzumab in HER2-positive uterine serous carcinoma, we aimed to determine the frequency of HER2 overexpression/amplification in TO-HGSC and reveal the utility of 2018 ASCO/CAP HER2 testing guideline in breast cancer for TO-HGSC. For 100 cases, HER2 protein expression was assessed by immunohistochemistry and scored from 0 to 3+ according to 2018 ASCO/CAP HER2 testing guideline. HER2 gene amplification was assessed by florescence in situ hybridization for all the 2+ and 3+ cases as well as 5 of the 0/1+ cases. Among 100 cases, immunohistochemistry scores were 0/1+ in 81 cases, 2+ in 18 cases and 3+ in 1 case. By florescence in situ hybridization, the only 3+ case and 1 of the 2+ cases were HER2-amplified and all 5 of the 0/1+ cases were HER2 nonamplified. Subclonal HER2 overexpression/amplification was identified in 1 of the neoadjuvant cases comprising <10% of the entire tumor. In summary, HER2 overexpression/amplification was found in 2% of TO-HGSC. The 2018 ASCO/CAP HER2 testing guideline in breast cancer can be utilized for TO-HGSC. Future studies are needed to explore HER2-targeted therapies in TO-HGSC and expand the patient population who may benefit from HER2-targeted therapies such as patients with activating mutations in HER2 gene without overexpression/amplification.