bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of flight connectivity on the introduction and evolution of the COVID-19 outbreak in Canadian provinces and territories
Authors: Hincapie Roberto , Munoz Diego A , Ortega Nathalia , Isfeld-Kiely Harpa K , Shaw Souradet Y , Keynan Yoav , Rueda Zulma Vanessa
Published: August 2022

Background

The COVID-19 pandemic has challenged health services and governments in Canada and around the world. Our research aims to evaluate the effect of domestic and international air travel patterns on the COVID-19 pandemic in Canadian provinces and territories.

Methods

Air travel data were obtained through licensed access to the ‘BlueDot Intelligence Platform’, BlueDot Inc. Daily provincial and territorial COVID-19 cases for Canada and global figures, including mortality, cases recovered and population data were downloaded from public datasets. The effects of domestic and international air travel and passenger volume on the number of local and non-local infected people in each Canadian province and territory were evaluated with a semi-Markov model. Provinces and territories are grouped into large (>100 000 confirmed COVID-19 cases and >1 000 000 inhabitants) and small jurisdictions (≤100 000 confirmed COVID-19 cases and ≤1 000 000 inhabitants).

Results

Our results show a clear decline in passenger volumes from March 2020 due to public health policies, interventions and other measures taken to limit or control the spread of COVID-19. As the measures were eased, some provinces and territories saw small increases in passenger volumes, although travel remained below pre-pandemic levels. During the early phase of disease introduction, the burden of illness is determined by the connectivity of jurisdictions. In provinces with a larger population and greater connectivity, the burden of illness is driven by case importation, although local transmission rapidly replaces imported cases as the most important driver of increasing new infections. In smaller jurisdictions, a steep increase in cases is seen after importation, leading to outbreaks within the community.

Conclusions

Historical travel volumes, combined with data on an emerging infection, are useful to understand the behaviour of an infectious agent in regions of Canada with different connectivity and population size. Historical travel information is important for public health planning and pandemic resource allocation.
RELATIONSHIPS, RIGHTS, AND RESPONSIBILITIES: (RE)VIEWING THE NHS CONSTITUTION FOR THE POST-PANDEMIC ‘NEW NORMAL’
Authors: Redhead Caroline A B , Fovargue Sara , Frith Lucy , Chiumento Anna , Draper Heather , Baines Paul B
Published: August 2022

Action needs to be taken to map out the fairest way to meet the needs of all NHS stakeholders in the post-pandemic ‘new normal’. In this article, we review the NHS Constitution, looking at it from a relational perspective and suggesting that it offers a useful starting point for such a project, but that new ways of thinking are required to accommodate the significant changes the pandemic has made to the fabric of the NHS. These new ways of thinking should encompass concepts of solidarity, care, and (reciprocal) responsibility, grounded in an acceptance of the importance of relationships in society. To this end, we explore and emphasise the importance of our interconnections as NHS stakeholders and ‘re-view’ the NHS Constitution from a relational perspective, concentrating on the rights and responsibilities it describes for patients and the public as NHS stakeholders. We argue that the NHS Constitution, of which most stakeholders are probably unaware, can be used as a tool to engage us, and to catalyse conversation about how our responsibilities as NHS stakeholders should change in the post-pandemic ‘new normal’.
Numerical relativity simulations of the neutron star merger GW190425: microphysics and mass ratio effects
Authors: Camilletti Alessandro , Chiesa Leonardo , Ricigliano Giacomo , Perego Albino , Lippold Lukas Chris , Padamata Surendra , Bernuzzi Sebastiano , Radice David , Logoteta Domenico , Guercilena Federico Maria
Published: August 2022

GW190425 was the second gravitational wave (GW) signal compatible with a binary neutron star (BNS) merger detected by the Advanced LIGO and Advanced Virgo detectors. Since no electromagnetic counterpart was identified, whether the associated kilonova was too dim or the localization area too broad is still an open question. We simulate 28 BNS mergers with the chirp mass of GW190425 and mass ratio 1 ≤ q ≤ 1.67, using numerical-relativity simulations with finite-temperature, composition dependent equations of state (EOS) and neutrino radiation. The energy emitted in GWs is $\lesssim 0.083\mathrm{\, M_\odot }c^2$ with peak luminosity of 1.1–$2.4\times ~10^{58}/(1+q)^2\, {\rm {erg \, s^{-1}}}$. Dynamical ejecta and disc mass range between 5 × 10−6–10−3 and 10−5–$0.1 \mathrm{\, M_\odot }$, respectively. Asymmetric mergers, especially with stiff EOSs, unbind more matter and form heavier discs compared to equal mass binaries. The angular momentum of the disc is 8–$10\mathrm{\, M_\odot }~GM_{\rm {disc}}/c$ over three orders of magnitude in Mdisc. While the nucleosynthesis shows no peculiarity, the simulated kilonovae are relatively dim compared with GW170817. For distances compatible with GW190425, AB magnitudes are always dimmer than ∼20 mag for the B, r, and K bands, with brighter kilonovae associated to more asymmetric binaries and stiffer EOSs. We suggest that, even assuming a good coverage of GW190425’s sky location, the kilonova could hardly have been detected by present wide-field surveys and no firm constraints on the binary parameters or EOS can be argued from the lack of the detection.
Migration and heating in the galactic disc from encounters between Sagittarius and the Milky Way
Authors: Carr Christopher , Johnston Kathryn V , Laporte Chervin F P , Ness Melissa K
Published: August 2022

Stars born on near-circular orbits in spiral galaxies can subsequently migrate to different orbits due to interactions with non-axisymmetric disturbances within the disc such as bars or spiral arms. This paper extends the study of migration to examine the role of external influences using the example of the interaction of the Sagittarius dwarf galaxy (Sgr) with the Milky Way (MW). We first make impulse approximation estimates to characterize the influence of Sgr disc passages. The tidal forcing from Sgr can produce changes in both guiding radius ΔRg and orbital eccentricity, as quantified by the maximum radial excursion ΔRmax. These changes follow a quadrupole-like pattern across the face of the disc, with amplitude increasing with Galactocentric radius. We next examine a collisionless N-body simulation of a Sgr-like satellite interacting with an MW-like galaxy and find that Sgr’s influence in the outer disc dominates the secular evolution of orbits between disc passages. Finally, we use the same simulation to explore possible observable signatures of Sgr-induced migration by painting the simulation with different age stellar populations. We find that following Sgr disc passages, the migration it induces manifests within an annulus as an approximate quadrupole in azimuthal metallicity variations (δ[Fe/H]), along with systematic variations in orbital eccentricity, ΔRmax. These systematic variations can persist for several rotational periods. We conclude that this combination of signatures may be used to distinguish between the different migration mechanisms shaping the chemical abundance patterns of the MW’s thin disc.
Spectroscopic reverberation mapping of Quasar PKS 0736 + 017: broad-line region and black-hole mass
Authors: Pandey Shivangi , Rakshit Suvendu , Woo Jong-Hak , Stalin C S
Published: August 2022

To understand the mass distribution and co-evolution of supermassive black holes with their host galaxy, it is crucial to measure the black hole mass of AGN. Reverberation mapping is a unique tool to estimate the black hole masses in AGN. We performed spectroscopic reverberation study using long-term monitoring data with more than 100 spectra of a radio-loud quasar PKS 0736 + 017 to estimate the size of the broad-line region (BLR) and black hole mass. The optical spectrum shows strong H β and H γ emission lines. We generated the light curves of 5100 Å continuum flux (f5100), H β, and H γ. All the light curves are found to be strongly variable with fractional variability of 69 per cent, 21 per cent, 30 per cent for V-band, H β, and H γ light curves, respectively. Along with the thermal contribution, non-thermal emission contributes to the estimated continuum luminosity at 5100 Å. Using different methods, e.g. CCF, JAVELIN, von-neumann, we estimated the size of the BLR, which is found to be 66.4$^{+6.0}_{-4.2}$ light days in the rest frame. The BLR size combined with the line width of H β provides a black hole mass of 7.32$^{+0.89}_{-0.91} \times 10^{7}M_{\odot }$. The source closely follows the BLR size–luminosity relation of AGN.
Age-related muscle anabolic resistance: inevitable or preventable?
Authors: Aragon Alan A , Tipton Kevin D , Schoenfeld Brad J
Published: August 2022

Age-related loss of muscle mass, strength, and performance, commonly referred to as sarcopenia, has wide-ranging detrimental effects on human health, the ramifications of which can have serious implications for both morbidity and mortality. Various interventional strategies have been proposed to counteract sarcopenia, with a particular emphasis on those employing a combination of exercise and nutrition. However, the efficacy of these interventions can be confounded by an age-related blunting of the muscle protein synthesis response to a given dose of protein/amino acids, which has been termed “anabolic resistance.” While the pathophysiology of sarcopenia is undoubtedly complex, anabolic resistance is implicated in the progression of age-related muscle loss and its underlying complications. Several mechanisms have been proposed as underlying age-related impairments in the anabolic response to protein consumption. These include decreased anabolic molecular signaling activity, reduced insulin-mediated capillary recruitment (thus, reduced amino acid delivery), and increased splanchnic retention of amino acids (thus, reduced availability for muscular uptake). Obesity and sedentarism can exacerbate, or at least facilitate, anabolic resistance, mediated in part by insulin resistance and systemic inflammation. This narrative review addresses the key factors and contextual elements involved in reduction of the acute muscle protein synthesis response associated with aging and its varied consequences. Practical interventions focused on dietary protein manipulation are proposed to prevent the onset of anabolic resistance and mitigate its progression.
Music and the Politics of Culture in the Middle East
Authors: LeVine Mark
Published: August 2022

This chapter explores the evolution of extreme youth music (EYM) across the countries of the MENA during the last 40 years. After discussing the main historical roots of the genres associated with EYM—primarily more extreme forms of heavy metal, hip-hop, and hardcore—the chapter investigates the role of artists, fans, and scenes more broadly in the evolution of the youth subcultures in the first decade of the 21st century which, seemingly out of nowhere, morphed into powerful countercultural and even revolutionary forces beginning with the Tunisian revolution in late 2010, demonstrating the ways in which EYM offers a unique lens through which to understand these processes. I conclude by offering three areas where the study of EYM points to several felicitous new ways to study political contestation in the MENA and beyond: a spatialized analysis of the “aura” of the work of art, a decolonial and Indigenously grounded approach to research, and collaborative authorship with the artists and activists.
Burning questions for a warming and changing world: 15 unknowns in plant abiotic stress
Authors: Verslues Paul E , Bailey-Serres Julia , Brodersen Craig , Buckley Thomas N , Conti Lucio , Christmann Alexander , Dinneny José R , Grill Erwin , Hayes Scott , Heckman Robert W , Hsu Po-Kai , Juenger Thomas E , Mas Paloma , Munnik Teun , Nelissen Hilde , Sack Lawren , Schroeder Julian I , Testerink Christa , Tyerman Stephen D , Umezawa Taishi , Wigge Philip A
Published: August 2022

We present unresolved questions in plant abiotic stress biology as posed by 15 research groups with expertise spanning eco-physiology to cell and molecular biology. Common themes of these questions include the need to better understand how plants detect water availability, temperature, salinity, and rising carbon dioxide (CO2) levels; how environmental signals interface with endogenous signaling and development (e.g. circadian clock and flowering time); and how this integrated signaling controls downstream responses (e.g. stomatal regulation, proline metabolism, and growth versus defense balance). The plasma membrane comes up frequently as a site of key signaling and transport events (e.g. mechanosensing and lipid-derived signaling, aquaporins). Adaptation to water extremes and rising CO2 affects hydraulic architecture and transpiration, as well as root and shoot growth and morphology, in ways not fully understood. Environmental adaptation involves tradeoffs that limit ecological distribution and crop resilience in the face of changing and increasingly unpredictable environments. Exploration of plant diversity within and among species can help us know which of these tradeoffs represent fundamental limits and which ones can be circumvented by bringing new trait combinations together. Better defining what constitutes beneficial stress resistance in different contexts and making connections between genes and phenotypes, and between laboratory and field observations, are overarching challenges.
Dry Needling for Subacromial Pain Syndrome: A Systematic Review with Meta-Analysis
Authors: Griswold David , Learman Ken , Ickert Edmund , Tapp Annie , Ross Omar
Published: August 2022

Objective

The authors of this systematic review with meta-analysis evaluated the evidence for the effectiveness of various applications of dry needling (DN) combined with other conservative treatments for subacromial pain syndrome (SAPS).

Methods

Six databases (PubMED, CINAHL, Biosis, Web of Science, SPORTDiscus, and Cochrane Central Register of Controlled Trials) were searched after the study had been registered in PROSPERO. The authors included randomized clinical trials investigating the clinical effects of DN in combination with other conservative interventions for SAPS. Outcomes included pain and disability.

Results

Eight studies were selected. All eight studies involving 10 comparisons were included in the analyses (N = 538). A random-effects model was used to analyze between-group effects. Dry needling performed in combination with other conservative interventions produced favorable outcomes at all time points for pain and disability. Standard mean differences ranged from –0.57 (moderate) to –1.29 (large) for pain and –0.69 (moderate) to –1.07 (large) for disability, favoring groups receiving DN in addition to conservative treatment. Four of the eight studies were rated as having unclear or high risk of bias.

Conclusion

The meta-analysis suggests that various applications of DN performed with other conservative interventions are more effective than conservative treatment alone for reducing pain and disability in patients with SAPS. Direct-comparison studies are needed to determine whether one application of DN is superior to another.
Potential mechanisms for lung fibrosis associated with COVID-19 infection
Authors: Parimon T , Espindola M , Marchevsky A , Rampolla R , Chen P , Hogaboam C M
Published: August 2022

Pulmonary fibrosis is a sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection that currently lacks effective preventative or therapeutic measures. Post-viral lung fibrosis due to SARS-CoV-2 has been shown to be progressive on selected patients using imaging studies. Persistent infiltration of macrophages and monocytes, a main feature of SARS-CoV-2 pulmonary fibrosis, and long-lived circulating inflammatory monocytes might be driving factors promoting the profibrotic milieu in the lung. The upstream signal(s) that regulates the presence of these immune cells (despite complete viral clearance) remains to be explored. Current data indicate that much of the stimulating signals are localized in the lungs. However, an ongoing low-grade systemic inflammation in long Coronavirus Disease 2019 (COVID-19) symptoms suggests that certain non-pulmonary regulators such as epigenetic changes in hematopoietic stem cells might be critical to the chronic inflammatory response. Since nearly one-third of the world population have been infected, a timely understanding of the underlying pathogenesis leading to tissue remodeling is required. Herein, we review the potential pathogenic mechanisms driving lung fibrosis following SARS-CoV-2 infection based upon available studies and our preliminary findings (Graphical abstract).
Wide moments ofL-functions II: dirichletL-functions
Authors: Nordentoft AsbjØrn Christian
Published: August 2022

We study wide moments of Dirichlet L-functions using analytic properties of the Lerch zeta function. Among other things we obtain an asymptotic expansion of wide moments of Dirichlet L-functions (with arbitrary twists) extending results of Heath-Brown. We also give applications to non-vanishing.
Sustained glucocorticoid tapering in the phase 3 trials of anifrolumab: apost hocanalysis of the TULIP-1 and TULIP-2 trials
Authors: Bruce Ian N , van Vollenhoven Ronald F , Morand Eric F , Furie Richard A , Manzi Susan , White William B , Abreu Gabriel , Tummala Raj
Published: August 2022

Objectives

Glucocorticoid sparing is a key priority for SLE management. We evaluated the effects of sustained glucocorticoid tapering in patients with SLE.

Material and methods

This was a post hoc analysis of the randomized, placebo-controlled, 52-week phase 3 Treatment of Uncontrolled Lupus via the Interferon Pathway (TULIP)-1 and TULIP-2 trials of anifrolumab (300 mg i.v. once every 4 weeks for 48  weeks) plus standard therapy in patients with moderate to severe SLE. In a cohort of patients receiving glucocorticoids (prednisone or equivalent) 10 mg or more per day at baseline, we assessed changes in glucocorticoid dosage, patient-reported outcomes (PROs) and safety. Outcome measures were compared between sustained glucocorticoid taper responders (7.5 mg or less per day by week 40 sustained through week 52) and non-responders, regardless of treatment group, and between patients receiving anifrolumab or placebo.

Results

Among the 726 patients in the TULIP trials, 375 patients received glucocorticoids 10 mg or more per day at baseline, and of these, 155 (41%) patients were sustained glucocorticoid taper responders. Compared with non-responders (n = 220), sustained glucocorticoid taper responders reduced their mean cumulative glucocorticoid dose by 32%, improved PRO scores, reduced blood pressure and experienced fewer serious adverse events. Sustained glucocorticoid tapering was achieved by 51% (96/190) of patients receiving anifrolumab vs 32% (59/185) receiving placebo. Compared with placebo, more anifrolumab-treated patients achieved both sustained glucocorticoid taper and reduced overall disease activity [38% (72/190) vs 23% (43/185)].

Conclusions

Sustained glucocorticoid tapering is associated with clinical benefits. Anifrolumab treatment has potential to reduce disease activity and glucocorticoid exposure, a key goal of SLE management.

Study Registration

ClinicalTrials.gov identifier: NCT02446912 and NCT02446899.
A systematic review and meta-analysis of the prevalence of poor sleep in inflammatory bowel disease
Authors: Barnes Alex , Mountifield Réme , Baker Justin , Spizzo Paul , Bampton Peter , Andrews Jane M , Fraser Robert J , Mukherjee Sutapa
Published: August 2022

Study Objectives

Poor sleep-in people with inflammatory bowel disease (IBD) has been associated with worse quality of life, along with anxiety, depression, and fatigue. This meta-analysis aimed to determine the pooled prevalence of poor sleep-in IBD.

Methods

Electronic databases were searched for publications from inception to November 1st 2021. Poor sleep was defined according to subjective sleep measures. A random effects model was used to determine the pooled prevalence of poor sleep-in people with IBD. Heterogeneity was investigated through subgroup analysis and meta-regression. Publication bias was assessed by funnel plot and Egger’s test.

Results

519 Studies were screened with 36 studies included in the meta-analysis incorporating a total of 24 209 people with IBD. Pooled prevalence of poor sleep-in IBD was 56%, 95% CI (51–61%) with significant heterogeneity. The prevalence did not differ based on the definition of poor sleep. Meta-regression was significant for increased prevalence of poor sleep with increase in age and increased of prevalence of poor sleep with objective IBD activity but not subjective IBD activity, depression, or disease duration.

Conclusions

Poor sleep is common in people with IBD. Further research is warranted to investigate if improving sleep quality in people with IBD will improve IBD activity and quality of life.
The impact of maturity stages on yield, quality, and nutritive value of ensiled Johnsongrass [Sorghum halepense (L.) Pers]
Authors: da Silva Camila S , Tucker Jennifer J , Maia Fabio J , Lourenço Jeferson M , Bass Morgan L , Seidel Darren S , Callaway Todd R , Hancock Dennis W , Stewart R Lawton
Published: August 2022

Johnsongrass [Sorghum halepense (L.) Pers.] is a non-native, invasive species that causes substantial losses in row crops and hay fields, which could be minimized by using Johnsongrass as a conserved forage. Two experiments were conducted to evaluate the yield and quality of Johnsongrass ensiled at four maturities: harvested every 3 weeks (3WK), boot stage (BOOT), flower stage (FLOWER), and dough (DOUGH) stages. In experiment 1, yield, botanical composition, nutritive value, and fermentation characteristics of Johnsongrass were measured. In experiment 2, Johnsongrass silage was incubated for 48 h for assessment of gas production, pH, in vitro dry matter digestibility (IVDMD), and volatile fatty acids. The experimental area consisted of 16 plots (2.74 m × 4.57 m) divided into four blocks, and treatment was randomly assigned to plot within block. Each year, silage was prepared for each plot from the two cutting closest to July 1. After 10 weeks, the silos were opened, and silage samples were frozen for further analysis. Data from both experiments were tested for the effects of maturity stage and harvest timing (first and second harvest). The results from experiment 1 showed an increase (P < 0.0001) in dry matter yield from 3WK stage to DOUGH. Johnsongrass, as a proportion of the total botanical composition, declined at the end of the growing season for 3WK but increased in FLOWER (P = 0.0010). In the first harvest, 3WK and BOOT stage silages had the greatest concentrations of crude protein and total digestible nutrients and lowest of fiber (neutral detergent fiber and acid detergent fiber; P < 0.0001). In the second harvest, differences in nutrient content were significant only for 3WK silages, which showed the best nutritive value (P < 0.0001). In experiment 2, IVDMD of silage followed the same trends described for nutritive value from experiment 1. Overall, these results demonstrate that Johnsongrass can be successfully ensiled, but to optimize forage nutritive value and quantity, Johnsongrass should be ensiled before it reaches the flower stage.
Does Routine Subspecialty Consultation Before High-Risk Pediatric Spine Surgery Decrease the Incidence of Complications?
Authors: Visser Timothy G. , Lehman Erik B. , Armstrong Douglas G.
Published: August 2022

Background:

Children with neuromuscular disorders and syndromic scoliosis who require operative treatment for scoliosis are at increased risk for postoperative complications. Complications may include surgical site infection and pulmonary system problems including respiratory failure, gastrointestinal system disorders, and others. The purpose of our study was to determine the effect of a standardized perioperative pathway specifically designed for management of high-risk pediatric patients undergoing surgery for scoliosis.

Methods:

The High-Risk Protocol (HRP) at our institution is a multidisciplinary process with subspecialty consultations before scoliosis surgery. This was a retrospective chart and radiographic review at a single institution. Inclusion criteria were high-risk subjects, age 8 to 18 years old, who underwent surgery between January, 2009 and April, 2009 with a minimum 2-year follow-up. Diagnoses included neuromuscular scoliosis or Syndromic scoliosis.

Results:

Seventy one subjects were analyzed. The mean age was 13 (±2 SD) years. Follow-up was 63 (±24 SD) months. The study group consisted of 35 subjects who had fully completed the HRP and the control group consisted of 36 subjects who did not. Nine of the 35 (26%) subjects in the HRP had surgery delayed while interventions were performed. Compared with controls, the study group had larger preoperative and postoperative curve magnitudes: 90 versus 73 degrees (P=0.002) and 35 versus 22 degrees (P=0.001). Pulmonary disease was more common in the HRP, 60 versus 31% (P=0.013). The overall incidence of complications in the study group was 29% (10 of 35 subjects) and for controls 28% (10 of 36). There were no differences between groups for types of complications or Clavien-Dindo grades. Three subjects in the study group and 1 in the controls developed surgical site infection. Eleven subjects required unplanned reoperations during the study period.

Conclusions:

The findings of our study suggest a structured pathway requiring routine evaluations by pediatric subspecialists may not reduce complications for all high-risk pediatric spine patients. Selective use of consultants may be more appropriate.

Level of Evidence:

Level III, Retrospective Cohort study.
Ligament Reconstruction and Interposition Arthroplasty of the Acromioclavicular Joint
Authors: Patel Shaan S. , Piggott Robert P. , Spasojevic Milos , Hughes Jeff S.
Published: August 2022

Distal clavicle excision (DCE) for acromioclavicular (AC) joint primary osteoarthritis and post-traumatic arthritis has been shown to have good to excellent outcomes. However, there are studies that report significant rates of residual AC joint pain and distal clavicle instability after open and arthroscopic techniques. We describe a surgical technique for management of AC joint primary osteoarthritis, post-traumatic arthritis, and revision DCE that involves DCE with ligament reconstruction and tendon interposition arthroplasty. It provides distal clavicle stability and can theoretically reduce residual AC joint pain secondary to acromial abutment after DCE.
Complete transurethral resection of bladder tumor before radical cystectomy is not a risk factor for organ-confined bladder cancer: A case-control study
Authors: Yuan Xiaoxu , Chen Mingkun , Yang Jing , Ye Yunlin
Published: August 2022

Objectives

To investigate the role of complete transurethral resection of bladder tumor (TURBT) before radical cystectomy (RC) for organ-confined bladder cancer.

Materials and methods

Data of patients who underwent RC in our center from January 2008 to December 2018 were retrospectively reviewed. Patients with >T2N0M0 disease and positive surgical margins and those who received neoadjuvant/adjuvant chemotherapy or radiotherapy were excluded. Complete TURBT was defined as no visible lesion under endoscopic examination after TURBT or in the bladder specimen after RC. Kaplan-Meier curves and log-rank tests assessed disease-free survival (DFS). Logistic and Cox regression analyses were performed to identify potential predictors.

Results

A total of 236 patients were included in this review, including 207 males, with a median age of 61 years. The median tumor size was 3 cm, and a total of 94 patients had identified pathological T2 stage disease. Complete TURBT was correlated with tumor size (p = 0.041), histological variants (p = 0.026), and down-staging (p < 0.001). Tumor size, grade, and histological variants were independent predictors of complete TURBT. During a median follow-up of 42.7 months, 30 patients developed disease recurrence. Age and histological variants were independent predictors of DFS (p = 0.022 and 0.032, respectively), whereas complete TURBT was not an independent predictor of DFS (p = 0.156). Down-staging was not associated with survival outcome.

Conclusions

Complete TURBT was correlated with an increased rate of down-staging before RC. It was not associated with better oncologic outcomes for patients with organ-confined bladder cancer.
Extent of Low-density Lipoprotein Cholesterol Reduction and All-cause and Cardiovascular Mortality Benefit: A Systematic Review and Meta-analysis
Authors: Ennezat Pierre Vladimir , Guerbaai Raphaëlle-Ashley , Maréchaux Sylvestre , Le Jemtel Thierry H. , François Patrice
Published: August 2022

Lipid-modifying agents steadily lower low-density lipoprotein cholesterol (LDL-C) levels with the aim of reducing mortality. A systematic review and meta-analysis were conducted to determine whether all-cause or cardiovascular (CV) mortality effect size for lipid-lowering therapy varied according to the magnitude of LDL-C reduction. Electronic databases were searched, including PubMed and ClinicalTrials.gov, from inception to December 31, 2019. Eligible studies included randomized controlled trials that compared lipid-modifying agents (statins, ezetimibe, and PCSK-9 inhibitors) versus placebo, standard or usual care or intensive versus less-intensive LDL-C–lowering therapy in adults, with or without known history of CV disease with a follow-up of at least 52 weeks. All-cause and CV mortality as primary end points, myocardial infarction, stroke, and non-CV death as secondary end points. Absolute risk differences [ARD (ARDs) expressed as incident events per 1000 person-years], number needed to treat (NNT), and rate ratios (RR) were assessed. Sixty randomized controlled trials totaling 323,950 participants were included. Compared with placebo, usual care or less-intensive therapy, active or more potent lipid-lowering therapy reduced the risk of all-cause death [ARD −1.33 (−1.89 to −0.76); NNT 754 (529–1309); RR 0.92 (0.89–0.96)]. Intensive LDL-C percent lowering was not associated with further reductions in all-cause mortality [ARD −0.27 (−1.24 to 0.71); RR 1.00 (0.94–1.06)]. Intensive LDL-C percent lowering did not further reduce CV mortality [ARD −0.28 (−0.83 to 0.38); RR 1.02 (0.94–1.09)]. Our findings indicate that risk reduction varies across subgroups and that overall NNTs are high. Identifying patient subgroups who benefit the most from LDL-C levels reduction is clinically relevant and necessary.
GDF11 Is a Novel Protective Factor Against Vascular Calcification
Authors: Sheng Ying , Zhang Chenming , Liu Yehong , Xu Baida , Jin Tianhui , Ye Ting , Liu Jie , Wu Gangyong , Chen Liang , Zong Gangjun
Published: August 2022

Vascular calcification (VC) occurs via an active cell-mediated process, which involves osteogenic differentiation, apoptosis, and phenotypic transformation of vascular smooth muscle cells (VSMCs). As a member of the transforming growth factor-β family, growth differentiation factor 11 (GDF11) can inhibit apoptosis and osteogenic differentiation and maintain the stability of atherosclerotic plaques. In this study, coronary artery calcium score (CACS) of participants with GDF11 measurements was measured using computed tomography angiography and was scored according to the Agatston score. β-glycerophosphate (10 mM), dexamethasone (100 nM), and l-ascorbic acid (50 µg/mL) [osteogenic medium (OM)] were used to induce calcification of human aortic smooth muscle cells. We found that CACS was negatively correlated with serum GDF11 levels in patients and GDF11 was a strong predictor of elevated CACS (OR = 0.967, 95% CI: 0.945–0.991; P = 0.006), followed by age (OR = 1.151, 95% CI: 1.029–1.286; P = 0.014), triglycerides (OR = 4.743, 95% CI: 1.170–19.236; P = 0.029), C-reactive protein (OR = 1.230, 95% CI: 1.010–1.498; P = 0.04), and hypertension (OR = 7.264, 95% CI: 1.099–48.002; P = 0.04). Furthermore, exogenous GDF11 inhibited OM-induced calcification by inhibiting osteogenic differentiation, the phenotypic transformation and apoptosis of human aortic smooth muscle cells. Our study demonstrates that GDF11 plays a crucial role in reducing vascular calcification and serves as a potential intervention target to vascular calcification.
Systemic Delivery of Clopidogrel Inhibits Neointimal Formation in a Mouse Vein Graft Model
Authors: Shi LinSheng , Chen XiaoLi , Wang HuiMin , Xu YiMing , Din ShengGuang , Liu Jun , Zhang Qing , Zhang Li
Published: August 2022

Clopidogrel inhibits platelet aggregation and has beneficial effects on patients undergoing coronary artery bypass grafting surgery, but it is unknown whether clopidogrel inhibits the neointima formation of grafted veins. In this study, we used a murine vein graft model to study the effect of clopidogrel on intima hyperplasia of the vein graft. Vein grafting was performed among C57BL/6J mice, immediately after surgery; 1 mg/kg clopidogrel and vehicle control were used to inject mice peritoneally daily for 2 weeks. As compared with the vehicle, clopidogrel significantly inhibited the neointima formation of vein grafts at 4 weeks after surgeries. The immunohistochemistry study showed that as compared with the vehicle, clopidogrel significantly decreased the rate of proliferating cell nuclear antigen–positive cells in the wall of vein grafts and significantly increased the expression of vascular smooth muscle cell (VSMC) contractile protein markers (α-smooth muscle actin, calponin, and SM22) within the neointima area of vein grafts. Clopidogrel significantly decreased the plasma interleukin 6 (IL-6) level at 1 week after surgery as compared with the vehicle. We isolated VSMCs from mouse aortic arteries. As compared with the vehicle, clopidogrel significantly inhibited thrombin-induced VSMC proliferation and migration, significantly decreased IL-6 mRNA expression and protein secretion, and increased intracellular cyclic adenosine monophosphate generation in a dose-dependent manner. In conclusion, systemic delivery of clopidogrel inhibits neointima formation of the mouse vein graft, the mechanisms of which are associated with its inhibitory effects on VSMC proliferation, migration, and the tendency to synthetic phenotype after vein graft surgery, reducing the expression of IL-6 and increasing the intracellular cyclic adenosine monophosphate level.
Increasing Collaboration between Headache Medicine and Plastic Surgery in the Surgical Management of Chronic Headache
Authors: Blake Pamela , ElHawary Hassan , Janis Jeffrey E.
Published: August 2022

Introduction:

Chronic headache is one of the most disabling conditions afflicting humankind. The management of chronic headaches has, to date, been only partially successful. The goal of this paper is to highlight the importance of collaboration between surgeons and headache physicians in treating this condition.

Methods:

We present a narrative review of migraine pathophysiology, its medical and surgical treatment options, and the important role of collaboration between headache physicians and surgeons.

Results:

Migraine headaches can be treated with both medication-based regimens and surgery. Novel medications such monoclonal antibodies directed at the CGRP molecule or its receptor have recently been FDA approved as an effective treatment modality in chronic migraines. However, these medications are associated with a high cost, and there is a paucity in data regarding effectiveness compared to other treatment modalities. The pathophysiology of headache likely exists along a spectrum with peripheral — extracranial and meningeal — factors at one end and central — brain — factors at the other, with anatomic and physiologic connections between both ends. Recent evidence has clearly shown that surgical decompression of extracranial nerves improves headache outcomes. However, appropriate patient selection and preoperative diagnosis are of paramount importance to achieve excellent outcomes.

Conclusions:

Surgeons and headache physicians who are interested in providing treatment for patients with chronic headache should strive to form a close collaboration with each other in order to provide the optimal plan for migraine/headache patients.
Targeted Muscle Reinnervation Does Not Increase the Risk of Postsurgical Complication or Overall Cost
Authors: Deeyor Sorka T. , Kisana Haroon M. , Hui Clayton H. , Stecher Chad , Hustedt Joshua W.
Published: August 2022

Background:

Targeted muscle reinnervation (TMR) has shown promise in reducing postsurgical limb pain in amputees. However, there has been little evidence on the increased risk of complications and cost as compared with traditional amputations. This study was designed to assess the rate of complications and healthcare costs between those treated with TMR and traditional amputations.

Methods:

Patients undergoing amputation were selected from the PearlDiver Mariner dataset and categorized into one of two treatment groups depending on the use of TMR versus traditional amputation. Rates of postsurgical complications and overall healthcare costs were compared between the two groups, while controlling for differences in patient demographics and comorbidities.

Results:

One hundred sixteen TMR procedures and 76,412 traditional amputations were included in the study. The rate of complications did not differ between groups, with a complication rate of 77% in the TMR and 87% in the traditional amputation groups. Overall healthcare costs also did not differ 1 year after surgery, with an average cost of $32,632 in the TMR group and $36,219 in the traditional amputation group.

Conclusions:

Amputees experience high rates of postsurgical complications, morbidity, and mortality. However, there is no increased risk of complications or cost with the use of TMR. TMR has the potential benefits of reducing overall postsurgical pain and reestablishing activities of daily living. Although TMR is more expensive up front, it may reduce the overall healthcare costs by reducing the need for subsequent care. Further work is needed in large, randomized trials to examine these findings.
A CASE OF EALES DISEASE OBSERVED BY WIDEFIELD OCTA
Authors: Nakamura Kosuke , Akiyama Hideo , Tokui Shunsuke , Saito Kazuma , Nitta Keisuke
Published: August 2022

Purpose:

To report a 30-year-old female with Eales disease, showing bilateral proliferative tissue. The retinal vessels were evaluated using widefield optical coherence tomography angiography (widefield OCTA), which has a wider angle of view compared to conventional instruments.

Methods:

A case report.

Results:

Widefield OCTA showed an extensive nonperfusion area and A-V shunt in both eyes, and a vascular structure in the left eye that appeared to be retinal neovascularization. Ultra-widefield fluorescein angiography revealed no filling delay in the early phase, a vast nonperfusion area from the mid-periphery to the ora serrata in bilateral eyes, and retinal neovascularization in the left eye. Based on the results of ultra-widefield angiography, OCTA examination and systemic examination, a diagnosis of Eales disease was finally made after all of the differential diseases had been excluded.

Conclusion:

In a patient with Eales disease, the peripheral nonperfusion area and retinal neovascularization that were consistent with the ultra-widefield angiography findings were noninvasively confirmed by widefield OCTA. Widefield OCTA is useful in the detection of peripheral changes of the fundus.
Evolution of the ‘omega sign’ on optical coherence tomography
Authors: Ramakrishnan Meera S. , Naguib Mina M. , Modi Yasha S.
Published: August 2022

Purpose:

To present the early post-operative evolution of retained subretinal perfluoro-n-octane (PFO) as captured on OCT.

Methods:

Case report of a patient.

Results:

A 58-year-old woman was noted to have subretinal PFO after undergoing autologous retinal graft for macular hole closure under PFO tamponade. Serial OCT identified the subretinal PFO as early as the first postoperative day and demonstrates progressive consolidation and encapsulation of the PFO bubble by the surrounding outer retina.

Conclusion:

Subretinal PFO is usually seen several weeks in the postoperative course once the gas endotamponade has resorbed sufficiently for OCT imaging. In this case, PFO tamponade enabled its imaging early. Its subsequent evolution into the classic “omega sign” may suggest a granulomatous encapsulation of the PFO bubble.
A TITANIUM MACULAR BUCKLE IMPLANT DESIGNED FOR AN EASY PLACEMENT IN MYOPIC MACULAR HOLES
Authors: Akduman Levent
Published: August 2022

Purpose:

A new easy-to-place titanium macular buckle implant and the surgical technique for placing it in myopic macular holes are presented. A 60-year-old patient with pathologic myopia presented with macular holes in both eyes. The hole in the right eye was recurrent and long-standing since the initial diagnosis, which was over 5 years ago. He refused surgery for the better seeing left eye. The vision of the right eye was 20/200. The patient only wanted macular hole repair in the right eye if a macular buckle could be incorporated in the surgery.

Methods:

Because there was no commercially available macular buckle in the United States, a custom-made titanium buckle was designed and manufactured for this patient. In addition to the standard pars plana vitrectomy, internal limiting membrane peel, and gas tamponade, the titanium macular buckle was placed externally to provide indentation over the macula.

Results:

The titanium macular buckle provided approximately 1 mm of indentation, shortening the axial length from 28.88 mm to 27.94 mm. The macular hole was closed postoperatively. Postoperative best-corrected visual acuity was 20/200 at 1 month with no complications from the titanium macular buckle implant or the surgical technique. There was no improvement in the final visual acuity, which was attributed to foveal atrophy because of the long-standing nature of the macular hole.

Conclusion:

This titanium macular buckle implant designed for an easy placement could be an invaluable addition for surgical success in myopic macular pathologies, including myopic macular holes.
Repeatability of new optical biometer and agreement with 2 validated optical biometers, all based on SS-OCT
Authors: Galzignato Alice , Lupardi Enrico , Hoffer Kenneth J. , Barboni Piero , Schiano-Lomoriello Domenico , Savini Giacomo
Published: August 2022

Purpose:

To evaluate the repeatability of the measurements provided by a new optical biometer (EyeStar 900) based on swept-source optical coherence tomography (SS-OCT) and their agreement with the measurements given by 2 validated biometers based on the same technology, the IOLMaster 700 and Argos.

Setting:

IRCCS G.B. Bietti Foundation, Rome, Italy.

Design:

Prospective evaluation of diagnostic test.

Methods:

In a series of unoperated eyes, 3 consecutive scans were acquired with the EyeStar 900, and 1 with the IOLMaster 700 and the Argos. The following biometry parameters were analyzed: axial length (AL), keratometry (K), corneal astigmatism, central corneal thickness, corneal diameter (CD), anterior chamber depth (ACD), lens thickness (LT), and lens tilting. Repeatability was assessed using test–retest variability, the coefficient of variation (CoV), and the intraclass correlation coefficient (ICC); agreement was based on the 95% limits of agreement.

Results:

56 eyes of 56 patients were analyzed. High repeatability was achieved for all measured parameters, as the CoV was <1% in most cases and ICC was >0.95 for all parameters. Good to high agreement was found among the measurements of the 3 optical biometers, although some statistically significant differences were detected between the EyeStar 900 and Argos (mean K, ACD, LT, and CD were higher with the Argos). The Argos measured a shorter AL in eyes >25 mm.

Conclusions:

The new generation SS-OCT EyeStar 900 optical biometer produces highly repeatable measurements that are in good agreement with those provided by 2 previously validated instruments.
Outcomes of LASIK versus PRK Enhancement in eye with prior cataract surgery
Authors: Rohlf Derek , La Nasa Anthony , Terveen Daniel , Shafer Brian , Thompson Vance , Berdahl John
Published: August 2022

Purpose:

To compare post-enhancement visual acuity between patients that underwent post-cataract LASIK or PRK.

Setting:

A private, tertiary referral practice in Sioux Falls, South Dakota, USA.

Design:

Three-year, retrospective chart review.

Methods:

Patients that underwent post-cataract extraction excimer laser enhancement surgery targeted for emmetropia (±0.50 D). Post-enhancement uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) was recorded for all available follow ups and compared for both groups.

Results:

822 post-cataract enhanced eyes (491 LASIK; 331 PRK). For patients with at least six months follow up, mean UDVA was 0.05 ± 0.13 logMAR in LASIK-enhanced patients and 0.15 ± 0.20 in PRK-enhanced patients (p<0.001). Mean absolute value MRSE was 0.22 ± 0.36 and 0.48 ± 0.62 for LASIK- and PRK-enhanced patients at or beyond six months, respectively (p<0.001). A total of 330 (67%) of LASIK-enhanced patients achieved 20/20 or better post-enhancement UDVA, compared to 142 (43%) PRK-enhanced patients (p<0.001). Controlling for pre-enhancement UDVA, LASIK-enhanced patients showed significantly better post-enhancement UDVA than PRK-enhanced patients, except in those with pre-enhancement vision of 20/20 or better, or those worse than 20/50. LASIK-enhanced virgin corneas had mean post-enhancement of 0.05 ± 0.14 UDVA compared to 0.13 ± 0.19 UDVA in PRK-enhanced virgin cornea patients (p<0.001).

Conclusion:

LASIK provides better and more predictable outcomes in UDVA than PRK in post-cataract enhancement patients, even when controlling for pre-enhancement visual acuity and prior ocular procedures.
Dual study on the sum-of-segments method for axial length measurement: is it better?
Authors: Olsen Thomas
Published: August 2022

Purpose:

To evaluate the sum-of-segments (SOS) method for optical axial length (AL) measurements.

Setting:

Department of Ophthalmology, University of Aarhus, Denmark and Private practice, Copenhagen ; Design: Retrospective, observational study.

Methods:

The present study involved 2 retrospective datasets. The first dataset comprised 1491 university cataract cases measured with the Lenstar LS900 (Haag-Streit AG) preoperatively as well as 1 – 4 months after surgery. The second dataset comprised 904 lens surgery cases with refractive follow-up to study the accuracy of IOL power calculation. The prediction accuracy was evaluated as the difference between the observed and the expected refraction.

Results:

The mean difference between the pre- and the postoperative AL readings was - 0.06 mm and - 0.020 mm for the standard and the SOS AL method, respectively, however with a larger variation for the SOS AL method (p < 0.01). For the second dataset, the SOS method was found to increase the accuracy of the SRK/T and the Holladay formulas. With the Olsen formula, the SOS method was found to be worse (p < 0.01). The highest accuracy was found using standard AL with the Olsen formula with a mean absolute error of 0.24 D and 89.8 % the cases within + 0.5 D.

Conclusions:

The SOS method improved the accuracy of the classical formulas probably because the optical path is a better representative of the true AL. The Olsen formula already incorporates an optical path correction and this may be the reason for the lack of improvement with the SOS method.