bluuebunny/crossref_metadata_2025 huggingface dataset:
Optical and near-UV spectroscopic properties of low-redshift jetted quasars in the main sequence context
Authors: Mengistue Shimeles Terefe , Del Olmo Ascensión , Marziani Paola , Pović Mirjana , Martínez-Carballo María Angeles , Perea Jaime , Márquez Isabel
Published: August 2023

This paper presents new optical and near-UV spectra of 11 extremely powerful jetted quasars, with radio to optical flux density ratio >103, which concomitantly cover the low-ionization emission of Mg iiλ2800 and hβ as well as the Fe ii blends in the redshift range 0.35 ≲ z ≲ 1. We aim to quantify broad emission line differences between radio-loud (RL) and radio-quiet (RQ) quasars by using the 4D eigenvector 1 parameter space and its main sequence (MS) and to check the effect of powerful radio ejection on the low-ionization broad emission lines. The hβ and Mg iiλ2800 emission lines were measured by using non-linear multicomponent fittings as well as by analysing their full profile. We found that broad emission lines show large redward asymmetry both in hβ and Mg iiλ2800. The location of our RL sources in a UV plane looks similar to the optical one, with weak Fe iiUV emission and broad Mg iiλ2800. We supplement the 11 sources with large samples from previous work to gain some general inferences. We found that, compared to RQ, our extreme RL quasars show larger median hβ full width at half maximum (FWHM), weaker Fe ii emission, larger MBH, lower Lbol/LEdd, and a restricted bf space occupation in the optical and UV MS planes. The differences are more elusive when the comparison is carried out by restricting the RQ population to the region of the MS occupied by RL sources, albeit an unbiased comparison matching MBH and Lbol/LEdd suggests that the most powerful RL quasars show the highest redward asymmetries in hβ.
Searching for magnetic fields in pulsating A-type stars: the discovery of a strong field in the probable δ Sct star HD 340577 and a null result for the γ Dor star HR 8799
Authors: Hubrig S , Järvinen S P , Alvarado-Gómez J D , Ilyin I , Schöller M
Published: August 2023

Numerous δ Sct and γ Dor pulsators are identified in the region of the Hertzsprung–Russell diagram that is occupied by chemically peculiar magnetic Ap stars. The connection between δ Sct and γ Dor pulsations and the magnetic field in Ap stars is however not clear: theory suggests for magnetic Ap stars some critical field strengths for pulsation mode suppression by computing the magnetic damping effect for selected p and g modes. To test these theoretical considerations, we obtained PEPSI spectropolarimetric snapshots of the typical Ap star HD 340577, for which δ Sct-like pulsations were recently detected in Transiting Exoplanet Survey Satellite data, and the γ Dor pulsator HR 8799, which is a remarkable system with multiple planets and two debris discs. Our measurements reveal the presence of a magnetic field with a strength of several hundred Gauss in HD 340577. The measured mean longitudinal field would be the strongest field measured so far in a δ Sct star if the pulsational character of HD 340577 is confirmed spectroscopically. No magnetic field is detected in HR 8799.
Factors Associated With Long-Term Quadriceps Muscle Function After Surgical Fixation of Lower Extremity Fractures
Authors: Brightwell Benjamin D , Van Wyngaarden Joshua J , Samaan Michael A , Matuszewski Paul E , Jacobs Cale A , Noehren Brian
Published: August 2023

Objective

The long-term performance of the quadriceps femoris muscle and physical function following surgical repair of a lower extremity fracture remains largely undefined. The purpose of this study was to investigate between-limb differences in quadriceps performance 12 months after surgical fixation of a lower extremity fracture. It was hypothesized that the injured limb would be significantly weaker, have a lower rate of torque development (RTD), and that there would be a reduced step-down performance compared to the uninjured limb 12 months after surgery. Additionally, this study sought to identify demographic, surgical, and psychological factors associated with poor quadriceps function 12 months after surgery.

Methods

Quadriceps performance was measured bilaterally in 95 participants (49 female), aged 42 (SD = 14.5) years, 12 months after surgical fixation of a lower extremity fracture. Isometric quadriceps strength and RTD were quantified using isometric dynamometry, and a timed step-down test was used to evaluate quadriceps performance. Independent predictor variables from the time of surgery were extracted from participants’ medical records. Kinesiophobia was screened at the time of testing. Wilcoxon signed-rank tests and linear regression analyses were used to assess between-limb differences in quadriceps performance and to determine factors associated with quadriceps performance 12 months after surgery.

Results

Significant between-limb differences in each measure of quadriceps performance were identified (peak torque involved: 1.37 [0.71] Nm × kg−1; uninvolved: 1.87 [0.74] Nm × kg−1; RTD involved: 4.16 [2.75] Nm × kg−1 × s−1; uninvolved: 6.10 [3.02] Nm × kg−1 × × −1; and single-leg step-downs involved: 12.6 [5.0]; uninvolved: 21.7 [14.8]). Female biological sex, external fixation, and kinesiophobia at 12 months were associated with reduced after-surgery quadriceps performance outcomes.

Conclusion

Quadriceps performance is impaired 12 months after surgical repair of a lower extremity fracture, particularly in female participants, in cases requiring external fixation, and in those with higher kinesiophobia 12 months after surgery.

Impact

Because long-term quadriceps weakness negatively impacts functional mobility, targeted strengthening should be emphasized after surgical repair of lower extremity fracture.
Human Retinal Ganglion Cells Respond to Evolutionarily Conserved Chemotropic Cues for Intra Retinal Guidance and Regeneration
Authors: Subramani Murali , Van Hook Matthew J , Qiu Fang , Ahmad Iqbal
Published: August 2023

Retinal ganglion cells (RGCs) connect the retina with the higher centers in the brain for visual perception. Their degeneration leads to irreversible vision loss in patients with glaucoma. The mechanism underlying human RGCs (hRGCs) axon growth and guidance remains poorly understood because hRGCs are born during development and connections with the central targets are established before birth. Here, using RGCs directly generated from human embryonic stem cells, we demonstrate that hRGCs express a battery of guidance receptors. These receptors allow hRGCs to read the spatially arrayed chemotropic cues in the developing rat retina for the centripetal orientation of axons toward the optic disc, suggesting that the mechanism of intraretinal guidance is conserved in hRGCs. The centripetal orientation of hRGCs axons is not only in response to chemorepulsion but also involves chemoattraction, mediated by Netrin-1/DCC interaction. The spatially arrayed chemotropic cues differentially influence hRGCs physiological responses, suggesting that neural activity of hRGCs and axon growth may be coupled during inter-retinal guidance. In addition, we demonstrate that Netrin-1/DCC interaction, besides promoting axon growth, facilitates hRGCs axon regeneration by recruiting the mTOR signaling pathway. The diverse influence of Netrin-1/DCC interaction ranging from axon growth to regeneration may involve recruitment of multiple intracellular signaling pathways as revealed by transcriptome analysis of hRGCs. From the perspective of ex vivo stem cell approach to glaucomatous degeneration, our findings posit that ex vivo generated hRGCs can read the intraretinal cues for guidance toward the optic disc, the first step required for connecting with the central target to restore vision.
PaLectinL7 enhances salt tolerance of sweet cherry by regulating lignin deposition in connection with PaCAD1
Authors: Wu Fanlin , Qu Dehui , Zhang Xu , Sun Yao , Wang Jingtao , Zhu Dongzi , Yang Lina , Liu Xiao , Tian Wei , Wang Lei , Liu Qingzhong , Su Hongyan
Published: August 2023

Lectin receptor-like kinases (LecRLKs), a large family of plant receptor-like kinases, play an important role in plant response to abiotic stresses. However, little information is available about the roles of LecRLKs in the salt stress response of sweet cherry (Prunus avium). Here, an L-type LecRLK gene (PaLectinL7) was characterized from sweet cherry. Subcellular localization analysis revealed that PaLectinL7 is a plasma membrane protein. The expression of PaLectinL7 was up-regulated by salt, drought and exogenously gibberellin treatments. Overexpression of PaLectinL7 in the roots of Gisela 6 enhanced its tolerance to salt stress. Additionally, transcriptome analysis showed that lignin metabolic-related genes were regulated by PaLectinL7 overexpression. Meanwhile, the lignin contents and associated enzymes (CAD and COMT) rose concurrently with PaLectinL7 overexpression under salt stress. We also found that PaCAD1, a key enzyme involved in lignin metabolism, interacted with PaLectinL7 and could be phosphorylated by PaLectinL7 in vitro, suggesting that PaLectinL7 may regulate the enzyme activity of PaCAD1. Therefore, these results indicated that PaLectinL7, as a membrane-bound regulator, promoted lignin deposition by regulating the activities of enzymes related to lignin metabolism, thus enhancing salt tolerance.
Multisite Field Evaluation of Bacteriophages for Fire Blight Management: Incorporation of Ultraviolet Radiation Protectants and Impact on the Apple Flower Microbiome
Authors: Gdanetz Kristi , Dobbins Madison R. , Villani Sara M. , Outwater Cory A. , Slack Suzanne M. , Nesbitt Darlene , Svircev Antonet M. , Lauwers Erin M. , Zeng Quan , Cox Kerik D. , Sundin George W.
Published: August 2023

Fire blight, a disease of pome fruits caused by the bacterium Erwinia amylovora, has become increasingly difficult to manage after the emergence of streptomycin-resistant strains. Alternative antibiotics and copper are available; however, these chemicals have use restrictions in some countries and also can carry risks of phytotoxicity. Therefore, there is growing interest in biological-based management options, with bacteriophage (phages) showing promise, as these naturally occurring pathogens of bacteria are easy to isolate and grow. However, there are several technical challenges regarding the implementation of phage biocontrol in the field, as the viral molecules suffer from ultraviolet radiation (UVR) degradation and can die off rapidly in the absence of the host bacterium. In this work, we assessed the efficacy of Erwinia phages and a commercial phage product for blossom blight control in the field across multiple locations in the eastern United States. In these tests, disease control ranged from 0.0 to 82.7%, and addition of a UVR protectant only resulted in significantly increased disease control in 2 of 12 tests. We also analyzed microbial community population changes in response to phage application. Changes in bacterial community diversity metrics over time were not detected; however, relative abundances of target taxa were temporarily reduced after phage applications, indicating that these phage applications did not have deleterious effects on the flower microbiome. We have demonstrated that biological control of fire blight with phages is achievable, but a better understanding of phage−pathogen dynamics is required to optimize disease control efficacy.
Raynaud phenomenon and microvasculopathy in systemic sclerosis: multi-modality imaging for diagnosis and evaluation
Authors: Markousis-Mavrogenis George , Bournia Vasiliki-Kalliopi , Sfikakis Petros P. , Mavrogeni Sophie I.
Published: August 2023

Purpose of review

To describe the clinical significance of and the diagnostic approach to Raynaud phenomenon (RP) in the peripheral extremities and the heart.

Recent findings

Nailfold capillaroscopy has recently been standardized in an expert consensus paper. Abnormal capillaroscopy in combination with specific autoantibody profiles and clinical signs are highly predictive of progression of RP to systemic sclerosis (SSc). Magnetic resonance imaging (MRI) can also perform tissue characterization of both the extremities and the heart. Microvascular wall abnormalities detected using nailfold capillaroscopy in patients with SSc may lead to deposition of erythrocyte-derived iron, due to microhemorrhages, which may predispose to fibrosis. MRI can assess the presence of iron using T2∗ measurements.

RP is a hallmark of the microvasculopathy in SSc and can affect both the peripheral extremities and the heart. Nailfold capillaroscopy is the current gold standard for the evaluation of the peripheral microvasculature. Other imaging modalities include thermography, laser Doppler-derived methods, 99mTc-pertechnetate hand perfusion scintigraphy, power Doppler ultrasonography, dynamic optical coherence tomography, MRI, and photoacoustic imaging, but these are currently not widely used. Cardiac RP can be investigated with positron emission tomography or cardiovascular magnetic resonance, with the latter offering the additional possibility of tissue characterization and iron content quantification secondary to microhemorrhages.
Effect of SARS-COV-2 on Eye Banking in an Urban Region
Authors: Wiley Zachary C. , Garcia Angelica I. , Colborn Samantha L. , Khandelwal Sumitra S.
Published: August 2023

Purpose:

SARS-CoV-2 caused disruption for institutions throughout the world. This descriptive analysis reports the effects of SARS-CoV-2 on donor recovery in a large urban area.

Methods:

This retrospective analysis draws from internal eye bank data on donor referrals and exclusions and public data on positive viral tests. Data regarding total numbers of donations accepted and excluded were analyzed for January–December of 2019 and 2020. In addition, for May through December 2020, data regarding number of donor referrals, eligible donors, recovered donors, and donors excluded because of SARS-CoV-2 positivity or suspicion were analyzed and compared against Texas Department of State Health Services data for positive SARS-CoV-2 tests.

Results:

The average corneas recovered in 2020 was 80 per month compared with an average of 87 per month in 2019. Cornea recoveries for April, May, and June were 22, 67, and 75, respectively. There was no statistical difference in overall number of cornea recovered between 2019 (87.3 ± 10.7) and 2020 (80.2± 21.2; P = 0.36). The percentage of donated tissue excluded because of SARS-CoV-2 positivity or suspicion increased from May to July 2020 because of regional surge in SARS-CoV-2 cases. For May 2020, 141 were excluded of 1113 referrals (13%), and in July 2020, 688 were excluded of 1479 referrals (46%).

Conclusions:

SARS-CoV-2 affected donor recovery patterns in 2020; however, the overall number of donor tissues was not different compared with 2019. A regional surge in SARS-CoV-2 cases resulted in higher percentage donor tissue number excluded.
Single-stage Palatal Lengthening Using Modified Buccinator Myomucosal and Buccal Fat Flaps
Authors: Termanini Kareem M. , Lentskevich Marina A. , Moradian Simon , Gosain Arun K.
Published: August 2023

Surgical treatment of velopharyngeal insufficiency (VPI) after primary palatoplasty poses a difficult challenge in cleft care management. Traditional treatment options have shown improved speech outcomes but oftentimes lead to airway obstruction by constriction of the posterior pharynx. The buccinator myomucosal flap is an alternative flap used for VPI correction that re-establishes palatal length and velar sling anatomy by recruiting tissue from the buccal mucosa and buccinator muscle. We present innovative modifications to the original buccinator myomucosal flap by performing the procedure in one stage without a mucosal bridge, incorporating full-thickness buccinator muscle during flap elevation, and placement of bilateral buccal fat flaps. These refinements facilitate wound healing by providing a tension-free closure with both a well-vascularized myomucosal flap and interposed buccal fat flap to prevent scar contracture. Furthermore, no additional surgery is necessary for pedicle division.
The Limb Salvage Approach for the Surgical Management of Necrotizing Soft Tissue Infection
Authors: Boey Johnson , Yu Longbiao , Hui Zeng , Meng Fanbin , Wan Shengxiang , Xiao Yingfeng , Zhegang Zhou
Published: August 2023

Necrotizing soft tissue infection (NSTI) is a complex infection known for its rapid progression of necrosis within the subcutaneous tissue and fascia. Time is of essence for the management of NSTI. In this report, we present a case of NSTI after infection of poorly managed diabetic foot ulcer in the ankle. The limb salvage approach involves sequential staged procedures. Multiple surgical debridements and “washout” were performed for source control. At the same time, the patient also received a systemic antibiotic regimen. In the second stage, a perforator free flap taken from the anterolateral thigh was used to repair the extensive soft tissue defect and reconstruct a functional foot to achieve maximal limb salvage. The kickstand technique of external fixation was used to reduce soft tissue compression and enhance the surgical offloading of the skin flap. At the 2-year follow-up, the skin integrity of the flap was well-preserved, and the patient returned to his premorbid quality of life.
Long-Term Outcomes of Pediatric Traumatic Brain Injury Following Inpatient Rehabilitation
Authors: Horn Timothy C. , Lundine Jennifer P. , Busch Tyler A. , Benkart Rebekah A. , Taylor H. Gerry , Koterba Christine H.
Published: August 2023

Objective:

Assess residual disability in youth with traumatic brain injury (TBI) treated in a pediatric inpatient rehabilitation unit and examine associations of disability with inpatient status and measures of concurrent functioning.

Setting:

Large, urban, quaternary care children's hospital in the Midwestern United States.

Participants:

Forty-five youth aged 6 to 18 years treated in an inpatient rehabilitation unit for mild-complicated to severe TBI at a minimum of 12 months postdischarge (mean = 3.5 years).

Design:

Retrospective chart review of clinical data collected from standard clinical care at admission and discharge combined with follow-up data examining current functioning at the time of study enrollment.

Main Outcome Measures:

Glasgow Outcome Scale—Extended, Pediatric Revision (GOS-E Peds), Neurology Quality of Life Measurement System Short Form (NeuroQOL) Social Interaction with Peers and Cognitive Short Forms, Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale, Strengths and Difficulties Questionnaire, and the Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2).

Results:

Based on parent report at follow-up, 62% of the children had residual TBI-related disabilities on the GOS-E Peds, while 38% reported “good recovery.” Children with residual disability also reported more long-term problems in overall health, social relationships, emotional regulation, behaviors, and executive functioning than those with no residual disability. Measures of functional independence and cognitive recovery at discharge were associated with these impairments.

Conclusions:

More than half of the children with TBI in this study had residual disability more than 1 year after inpatient rehabilitation. Findings highlight the associations between measures of functional independence and cognitive recovery during inpatient rehabilitation with later outcomes and underscore the need for continued services to support the needs of children with TBI following their inpatient rehabilitation stay.
TOPICAL CARBONIC ANHYDRASE INHIBITORS CLOSING BILATERAL SECONDARY MACULAR HOLES AND A REVIEW OF LITERATURE
Authors: Lee Yong Min , Bahrami Bobak , Chan Weng Onn
Published: August 2023

Purpose:

To present a rare occurrence of bilateral macular hole secondary to vitrectomy that was successfully treated with topical carbonic anhydrase inhibitors and to review the literature for this phenomenon.

Methods:

Monthly clinical examination and optical coherence tomography was conducted before and after eight weeks of topical 2% dorzolamide administered twice a day.

Results:

A 62-year-old man who had bilateral giant retinal tears which were repaired with vitrectomy subsequently presented with bilateral small macular holes of size 74 and 78 μm. The patient was trialed on 2% topical dorzolamide twice a day and reviewed monthly with optical coherence tomography scans. Macular hole closure was identified after four weeks of topical treatment.

Conclusion:

Clinical improvement with conservative measures suggests a potential first-line approach to the treatment of macular holes avoiding surgery and its risk profile. We also present a review of the literature regarding macular holes treated with topical carbonic anhydrase inhibitors and its mechanism of action in treating macular holes.
X-LINKED JUVENILE RETINOSCHISIS ASSOCIATED WITH AN RS1 IN-FRAME DELETION AND BILATERAL CENTRAL SEROUS CHORIORETINOPATHY
Authors: Wheelock-Gutierrez Lorena , Peña-Ortiz Samuel , de Dios-Cuadras Ulises , Jiménez-Sierra Juan Manuel , Zenteno Juan C. , Payro-Evia Katherinne , Dorantes-Diez Miguel A. , Enriquez-Gonzalez Ana Bety
Published: August 2023

Purpose:

To report the case of a patient with X-linked juvenile retinoschisis, caused by an in-frame deletion of the RS1 gene, who presented with visual loss because of bilateral central serous chorioretinopathy.

Methods:

Observational case report.

Results:

A 34-year-old man, with type-A personality, presented with a one-month history of decreased visual acuity and metamorphopsia in his right eye. Funduscopic examination showed a dome-like foveal elevation in both eyes as well as subtle pigmentary changes of the retinal pigment epithelium with a tapetal reflex in the fovea. Spectral-domain optical coherence tomography revealed intraretinal cystic foveal changes and serous retinal detachment in both eyes. Fundus fluorescein angiography of both eyes showed a focal area of intense hyperfluorescence with leakage in late phases. Electroretinogram revealed a markedly attenuated b-wave and a diminished a-wave in photopic and scotopic phases. Genetic testing revealed a hemizygous c.282_284delCTT deletion in the RS1 gene, predicting a p.Ser95del change at the protein level. The patient was diagnosed with X-linked juvenile retinoschisis and central serous chorioretinopathy as a coexisting condition. Patient was observed during a 3-month period but showed no improvement. Therefore, subthreshold micropulse laser was applied, achieving complete resolution of signs and symptoms of central serous chorioretinopathy.

Conclusion:

Central serous chorioretinopathy can be a cause of acute or subacute visual loss in patients with X-linked juvenile retinoschisis when other complications such as vitreous hemorrhage and retinal detachment have been excluded.
The Hatchet Flap for Eyelid and Midfacial Reconstruction: Experience From 70 Cases
Authors: Custer Philip L. , Maamari Robi N.
Published: August 2023

Purpose:

To describe surgical variations of the hatchet flap and a large series of patients in which this procedure was used for eyelid and midfacial reconstruction.

Methods:

A retrospective review was performed on patients treated with a hatchet flap between March 2016 and March 2023. Patient demographics, defect characteristics, surgical techniques, and outcomes were investigated.

Results:

The hatchet flap was used to repair 70 defects in 69 patients, aged 41.6 to 90.0 years (mean, 66.1). Defects measured 0.6 to 23.6 cm2 (mean, 4.8) and resulted from Mohs surgery (n = 62), exenteration (n = 2), benign lesion excision (n = 3), or cicatricial ectropion/fistula repair (n = 3). The flap tail was managed with 3 techniques: V-Y plasty (n = 26), transposition (n = 34), and excision (n = 10). Ancillary procedures were often used during reconstructions (skin grafts: 29; double hatchet flap: 2; additional skin flaps: 26; tarsoconjunctival flaps: 6; and other grafts: 7). Small distal eschars healed in 7 flaps without necrosis. Four patients with subcutaneous thickening improved after steroid injections. Mild hatchet flap contracture may have contributed to postoperative cicatricial ectropion in 1 patient. There were no other flap related complications.

Conclusions:

In selected patients, the hatchet flap is a versatile technique to mobilize vascularized tissue into eyelid/midfacial defects resulting from the excision of lesions or treatment of cicatricial ectropion/fistulas. Individuals without laxity in the plane perpendicular to the flap base may not be good candidates for this procedure. The hatchet flap can be modified by advancing, transposing, or excising the flap tail. Reconstruction is often combined with other flaps/grafts. Few complications were associated with the hatchet flap.
Ten-Year Follow-Up of Orbital Volume Augmentation With Calcium Hydroxyapatite Filler in Postenucleation Socket Syndrome
Authors: Di Maria Alessandra , Ferraro Vanessa , Trenti Nicoletta , Morenghi Emanuela , Gaeta Alessandro , Vinciguerra Paolo , Confalonieri Filippo
Published: August 2023

Purpose:

To describe the efficacy and persistence of injectable calcium hydroxyapatite (CAHY) to correct orbital volume deficit in postenucleation socket syndrome.

Methods:

An observational study was conducted as a clinical review of all patients in the authors' practice who received injectable CAHY placed in the extraconal and intraconal space to increase orbital volume with a 10-year follow up. The amount of CAHY to be injected was defined according to the degree of orbital volume deficit. Patients previously treated with radiotherapy or with a conjunctival fornix insufficient to accommodate the external prosthesis were excluded. All the patients with at least 10 years of follow up were included in the study.

Results:

Thirty-one postenucleation socket syndrome patients received injectable CAHY for orbital volume augmentation, with a 10-year follow up. The mean amount of preoperative relative enophthalmos measured by Hertel’s exophthalmometry was 14.16 ± 2.15. An increase in the mean orbital volume of 3.35 ± 0.91 at 6 months and 2.97 ± 1.35 at 10 years was obtained. The mean follow-up was 219 ± 18 months (range, 184–240). Patients demonstrated clinical and cosmetic improvement that was observed to continue for 10 years. The complications were peribulbar ecchymosis, 2 extrusions of the internal prosthesis, and 2 ptosis.

Conclusions:

Injectable CAHY provides safe, simple, repeatable, and cost-effective technique to treat volume deficiency in the enophthalmic orbit in the long term. The volume augmentation obtained with this semipermanent filler demonstrated a lasting effect in the orbit with negligible loss of volume at 10 years.
Transforming the Heart of Student Learning and Engagement
Authors: Stam Daniel , Jenkins Greta M. , Goettl Hannah , Martinson Jordan , Fondrick Alex , Lindahl Russell , Withrow Zach
Published: August 2023

Purpose:

Entry-level physical therapists must effectively learn cardiovascular and physiological monitoring, including electrocardiography (ECG) interpretation, to fulfill the demands of acute care hospital settings. Preliminary evidence among medical students and young physicians suggests that proficiency in basic ECG interpretation may be insufficient to meet the needs of a society with increasing levels of cardiovascular disease. In addition, as a new generation of students (Generation Z) enters health care education programs, educators may need to adapt their instructional approaches and technology. The purpose of this study was to evaluate whether a novel virtual reality (VR) learning module resulted in more accurate ECG interpretation than a conventional written learning activity for predominantly Generation Z Doctor of Physical Therapy (DPT) students. The study also assessed whether a preference existed for either of the 2 activities.

Methods:

A blocked-randomized controlled crossover trial was integrated within a second-year cardiopulmonary course for DPT students. Students were blocked into 2 groups, VR-Conventional or Conventional-VR, based on the order in which they participated in the activities. Twenty-item multiple-choice knowledge assessments and a satisfaction survey were the outcomes.

Results:

Eighteen DPT students participated. Median pretest scores for the VR-Conventional group and the Conventional-VR group were 60% (interquartile range [IQR]: 50-75) and 65% (IQR: 55-75), respectively; the distributions were not different (Mann-Whitney U test =36.00, n1 = n2 = 9, P = .688, 2-tailed). Median posttest 1 scores for the VR-Conventional group and the Conventional-VR group were 70% (IQR: 62.50-85) and 75% (IQR: 67.50-85), respectively; the distributions were not different (Mann-Whitney U test = 39.00, n1 = n2 = 9, P = .893, 2-tailed). After crossing over, the VR-Conventional group scored 70% (IQR: 62.50-80) on posttest 2 while the Conventional-VR group scored 70% (IQR: 65-77.50); the distributions were not different (Mann-Whitney U test = 38.50, n1 = n2 = 9, P = .858, 2-tailed). Fifty percent of participants preferred the VR activity, 33% preferred the conventional written activity, and 17% had no preference. All participants reported wanting to see VR used more in education.

Conclusions:

VR was well received and may aid student engagement and motivation for learning complex topics such as ECG interpretation. In this study, VR was not superior to conventional learning activities for knowledge acquisition. Educators should additionally consider an evidence-based instructional design when choosing to integrate VR technologies in the classroom.
Challenging routine: technical difficulties and solutions of endoscopic thyroidectomy via a combined transoral and breast approach, a case-series and learning curve
Authors: Zhou Shiwei , Wu Peng , Li Wu , Li Hui , Wang Zhiyuan , Zhang Lu , Li Jigang , Peng Xiaowei
Published: August 2023

Objective:

Conventional cervical lymph node dissection often leaves large surgical scars, which seriously compromises the postoperative aesthetic effect and can affect the quality of life of patients. In this study, the safety and feasibility of robotic-assisted endoscopic thyroidectomy with central neck dissection (CND) and lateral neck dissection (LND) via a combined transoral and breast approach are discussed in detail.

Methods:

A retrospective analysis was made of the data of 26 patients with stage cN1b papillary thyroid carcinoma who were admitted to the Thyroid Surgery Department of the XX Hospital from March 2021 to September 2022 and who underwent robotic-assisted endoscopic thyroidectomy with LND via a combined transoral and breast approach. The demographic data, surgical indicators, postoperative data, and the postoperative complication rate of the patients were analyzed, and the learning curve was analyzed by cumulative summation (CUSUM).

Results:

All the patients underwent endoscopic surgery without any conversion to open surgery. The mean operation time was 313.7±50.3 mins, the mean number of total positive/retrieved lymph nodes was 11.2±8.1/36.8±13.7. Two patients developed temporary laryngeal recurrent nerve palsy and three patients developed temporary hypoparathyroidism, all of whom recovered within 3-months postoperatively. No other complications or tumor recurrence occurred during follow-up that ranged from 6-24 months. The mean postoperative quality of life (QOL) score was 189.1±118.2, test results ranging from 0-1300 with a lower score indicating a higher QOL, and the aesthetic satisfaction score was 4.2±0.7, test scores ranging from 0-5 with higher scores indicate higher satisfaction. The turning point of the learning curve was in the 11th case.

Conclusion:

The robotic-assisted endoscopic thyroidectomy with CND and LND via a combined transoral and breast approach is safe and feasible, and the improved cosmetic effect is remarkable, which is conducive to improving the postoperative QOL of patients. It provides a new surgical option for patients.
Affordable Care Act Medicaid Expansion was Associated With Reductions in the Proportion of Hospitalizations That are Potentially Preventable Among Hispanic and White Adults
Authors: Hanchate Amresh D. , Abdelfattah Lindsey , Lin Meng-Yun , Lasser Karen E. , Paasche-Orlow Michael K.
Published: August 2023

Objective:

Using data on 5 years of postexpansion experience, we examined whether the coverage gains from Affordable Care Act Medicaid expansion among Black, Hispanic, and White individuals led to improvements in objective indicators of outpatient care adequacy and quality.

Research Design:

For the population of adults aged 45–64 with no insurance or Medicaid coverage, we obtained data on census population and hospitalizations for ambulatory care sensitive conditions (ACSCs) during 2010–2018 in 14 expansion and 7 nonexpansion states. Our primary outcome was the percentage share of hospitalizations due to ACSC out of all hospitalizations (“ACSC share”) among uninsured and Medicaid-covered patients. Secondary outcomes were the population rate of ACSC and all hospitalizations. We used multivariate regression models with an event-study difference-in-differences specification to estimate the change in the outcome measures associated with expansion in each of the 5 postexpansion years among Hispanic, Black, and White adults.

Principal Findings:

At baseline, ACSC share in the expansion states was 19.0%, 14.5%, and 14.3% among Black, Hispanic, and White adults. Over the 5 years after expansion, Medicaid expansion was associated with an annual reduction in ACSC share of 5.3% (95% CI, −7.4% to −3.1%) among Hispanic and 8.0% (95% CI, −11.3% to −4.5%) among White adults. Among Black adults, estimates were mixed and indicated either no change or a reduction in ACSC share.

Conclusions:

After Medicaid expansion, low-income Hispanic and White adults experienced a decrease in the proportion of potentially preventable hospitalizations out of all hospitalizations.
Reliability and validity of the T-shirt test for the assessment of unsupported sitting in manual wheelchair users with spinal cord injury
Authors: Romanini Francielle , Zambetta Rafaella M , Padula Natália , Gaspar Roberta C , Russo Thiago L , Ilha Jocemar
Published: August 2023

This study aimed to evaluate the validity and reliability of the T-shirt test (TST) in assessing sitting stability under three thigh support conditions and with timed outcomes derived in six ways among individuals with a spinal cord injury (SCI). The TST was performed five times under three thigh support conditions (85%, 55% and 25% of total thigh length) in two evaluations spaced between 7−14 days. For each thigh condition, six different outcomes were derived (average or best time from 2, 3, and 5 trial). All outcomes derivation showed excellent reliability on test day (intraclass correlation coefficient; ICC  ≥ 0.997) and excellent test-retest reliability (ICC ≥ 0.874) for each thigh support condition. The TST showed high inverse correlations with the Spinal Cord Independence Measure III (SCIM)-mobility score for all outcomes and support conditions (ρ≥−0.706), except for Best-5; moderate inverse correlations with total SCIM-total scores for most outcome derivations and support conditions (ρ≥−0.636); and a moderate inverse correlation with confidence and capacity domains of Wheelchair Skills Test-Questionnaire for most outcome derivation and support conditions (ρ≥−0.504). The TST could discriminate cervical from high and low thoracic levels of injuries under minimal thigh support condition. Overall, all the TST-derived outcomes and support conditions showed adequate validity and test-retest reliability, but Best-5 had inconsistency. Under the minimal thigh support condition, all outcome derivations except Best-3 could discriminate cervical from other injury-level groups. Although all outcome derivations and thigh support conditions provided reliable results, we recommend using the average of 3 trials under the maximal thigh support condition.
Role of radiological corroboration in a locally aggressive inverted papilloma: a case report
Authors: Mahat Asim , Yadav Gopal K. , Neupane Durga , Mishra Upama , Khadka Sujan , Lamichhane Bishesh
Published: August 2023

Introduction and importance:

Sinonasal inverted papilloma is a rare benign tumor of the nasal cavity and paranasal sinuses (PNS). Radiological evaluation is the key to management.

Case presentation:

A 46-year-old male presented with complaints of right nasal congestion and occasional bleeding for 4 months. During anterior rhinoscopy, a pinkish fleshy mass occupying the right nasal cavity was seen. X-ray and computed tomography (CT) PNS view showed opacification in the right nasal cavity and maxillary sinus. An MRI of the nose and PNS revealed a peculiar convoluted striated/cerebriform pattern. Histopathology report described the features of an inverted papilloma. The patient underwent endoscopic removal of the mass under general anesthesia. Surgical resection of the tumor was performed along with adjacent normal mucosal tissues. The patient recovered well and was followed-up for recurrence.

Clinical discussion:

Sinonasal inverted papilloma is commonly found in males in their fifth to sixth decade of life. A CT scan is the initial modality of choice to evaluate the extent of the disease. MRI is superior to CT in distinguishing tumors from other conditions as well as to evaluate soft tissue extensions. Involvement of the frontal sinus is a risk factor for recurrence. The first option for treating an inverted papilloma is complete surgical removal with the adjacent uninvolved mucosa.

Conclusion:

In a biopsy-proven case, radiological assessments like CT and MRI play a pivotal role in studying the typical morphology, delineating the extension, and detecting recurrence.
Expanded dengue syndrome in diabetic patient with history of COVID-19 infection: a case report
Authors: Nelwan Erni J. , Pramanta Pramanta , Safitri Wanda J. , Adiwinata Randy , So Amy , Nainggolan Leonard
Published: August 2023

Introduction:

Overlapping symptoms between dengue and coronavirus disease 2019 (COVID-19) may become a diagnostic challenge; moreover, social stigma and fear of being diagnosed with COVID-19 may lead the patients to delayed medical visit. Delayed medical management of dengue may lead to expanded dengue syndrome and a fatal outcome.

Case presentation:

A 35-year-old female patient with uncontrolled diabetes mellitus and a recent COVID-19 infection presented with a continuous fever for 4 days. She delayed seeking medical advice due to traumatized being infected by COVID-19, the self-isolation protocol, and the COVID-19 protocol in every hospital for every febrile patient. She developed multiorgan failure during her hospitalization and was diagnosed with expanded dengue syndrome.

Clinical discussion:

Diagnosing the etiology of acute febrile illness in the COVID-19 pandemic era is problematic. Most of healthcare facilities warranted COVID-19 evaluation in every acute febrile patient. This protocol may lead to a potential delayed diagnosis and serve as a barrier to accessing healthcare facility. False perception, fear and anxiety of being isolated, discrimination in society, and others may lead to stigmatization of COVID-19 and affect the individual decision for COVID-19 testing and seeking medical advices. Our patient had a fatal outcome due to delayed detection and treatment of dengue hemorrhagic fever.

Conclusion:

Delayed management of expanded dengue syndrome leads to a fatal outcome. Stigma may play a role as the barrier for seeking medical advice. Having a broad differential diagnosis in COVID-19 pandemic era is essential.
Health Social Networks of Black Women With Hypertension
Authors: Jones Lenette M. , Hawkins Jaclynn , Mitchell Jamie , Wright Kathy D. , Cuffee Yendelela
Published: August 2023

Background

The prevalence of hypertension is 55% among African American/Black women, who have a higher risk for poor health outcomes compared to women from other racial and ethnic groups, in part because of uncontrolled blood pressure. Previous research results suggest that peers may positively influence self-management of chronic conditions like hypertension. However, few studies have described the personal characteristics of peers in the health social networks of Black women.

Objective

This substudy aimed to examine health social networks and describe the peers’ characteristics, as reported by a convenience sample of Black women with hypertension.

Methods

In this analysis of data from a larger study, 94 Black women with hypertension attending a church conference participated in a cross-sectional, descriptive study. Their mean age was 59 years, and their mean systolic blood pressure was 143 mm Hg. All participants completed a survey to gather data about (a) the characteristics of individuals they discussed health matters with (their peers or health social network) and (b) their perceptions about hypertension status and knowledge of hypertension among the peers in their health social network.

Results

Collectively, participants from the larger study named a total of 658 peers who were part of their health social networks; the mean health social network size was six peers. The peers were mostly women, Black, family members, and, on average, 54 years old. The participants discussed hypertension with 71% of the peers, reported that 36% had hypertension, and felt that 67% were somewhat or very knowledgeable about the condition. A small, positive correlation existed between the participants’ health social network size (number of peers named) and their systolic blood pressure levels.

Discussion

The health social network peers were similar to those in the larger study, with most of the same gender, race, and age. The findings of this analysis may be used to help practitioners and scientists guide patients in building health social networks for support in self-managing hypertension and conducting future studies to examine the best strategies for developing and using health social networks to improve health outcomes and reduce health disparities.
Chronic Pain and Pain Management in Older Adults
Authors: LaRowe Lisa R. , Miaskowski Christine , Miller Angela , Mayfield Andrea , Keefe Francis J. , Smith Alexander K. , Cooper Bruce A. , Wei Lee-Jen , Ritchie Christine S.
Published: August 2023

Background

Chronic pain occurs in 30% of older adults. This prevalence rate is expected to increase, given the growth in the older adult population and the associated growth of chronic conditions contributing to pain. No population-based studies have provided detailed, longitudinal information on the experience of chronic pain in older adults; the pharmacological and nonpharmacological strategies that older adults use to manage their chronic pain; and the effect of chronic pain on patient-reported outcomes.

Objectives

This article aims to describe the protocol for a population-based, longitudinal study focused on understanding the experience of chronic pain in older adults. The objectives are to determine the prevalence and characteristics of chronic pain; identify the pharmacological and nonpharmacological pain treatments used; evaluate for longitudinal differences in biopsychosocial factors; and examine how pain types and pain trajectories affect important patient-reported outcomes. Also included are the results of a pilot study.

Methods

A population-based sample of approximately 1,888 older adults will be recruited from the National Opinion Research Center at the University of Chicago’s AmeriSpeak Panel to complete surveys at three waves: enrollment (Wave 1), 6 months (Wave 2), and 12 months (Wave 3). To determine the feasibility, a pilot test of the enrollment survey was conducted among 123 older adults.

Results

In the pilot study, older adults with chronic pain reported a range of pain conditions, with osteoarthritis being the most common. Participants reported an array of pharmacological and nonpharmacological pain strategies. Compared to participants without chronic pain, those with chronic pain reported lower physical and cognitive function and poorer quality of life. Data collection for the primary, longitudinal study is ongoing.

Discussion

This project will be the first longitudinal population-based study to examine the experience and overall effect of chronic pain in older adults. Pilot study results provide evidence of the feasibility of study methods. Ultimately, this work will inform the development of tailored interventions for older patients targeted to decrease pain and improve function and quality of life.
Prevalence of depression in women diagnosed with breast cancer in Georgia
Authors: Kakhniashvili Tamar , Okribelashvili Nino , Kiladze Ivane , Fielding Richard
Published: August 2023

Background:

Depression commonly occurs in patients with breast cancer (BC), significantly affecting their quality of life. We screened Georgian women diagnosed with BC for depressive symptoms to determine their prevalence and examine associations with various sociodemographic and clinical characteristics. This is the first study focusing on mental well-being in patients with cancer in Georgia.

Methods:

In a multicenter observational study, 177 women receiving BC treatment were examined at three tertiary oncology hospitals in Georgia. Patient Health Questionnaire 9 (PHQ-9) was used for the identification of depressive symptoms. Patients were stratified using basic information on age, marital status, educational level, social and financial support, employment status, and clinical characteristics.

Results:

The average age was 52.9 years (34–77); 117 (66%) were married; 79 (45%) were working, but only 30 (17%) reported having adequate financial status; 128 (72%) had stage I-III disease; and 64 (36%) reported some degree of pain. Using pro-rated PHQ-9 scores, 46 patients (44%; 95% CI, 37–51) reported some level of depressive symptoms while 25 women (14%; 95% CI, 9–19) met the criteria for probable depressive disorder. A higher proportion of patients reporting pain also reported depressive symptoms (37/66, 56%) compared with those reporting no pain (41/111, 34%) (P = .013); women with stage IV disease were more likely to report depressive symptoms (26/44, 57%) compared with those with stages I-III (53/133, 40%) (P = .049); and single/previously married women (42/60, 70%) were more likely to report depressive symptoms than married women (51/117, 44%) (P = .001). Depressive symptom reporting did not differ by age or reported support.

Conclusion:

One in six of this sample of Georgian patients with BC had depressive symptom levels consistent with a depressive disorder. Depressive symptoms covaried by marital status, staging, and reported pain. These results can inform practitioner oncologists in Georgia of the needs for psychological support for patients with cancer and assist in building such support services.