bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequalities in Smoking and Quitting-Related Outcomes Among Adults With and Without Children in the Household 2013–2019: A Population Survey in England
Authors: Kock Loren , Brown Jamie , Shahab Lion , Tattan-Birch Harry , Moore Graham , Cox Sharon
Published: October 2021

Introduction

Smoking among those who live with children is an important influence on smoking initiation among children. This study assessed socioeconomic inequalities in smoking and quitting-related outcomes among all adults with and without children in the household.

Aims and Methods

Monthly repeat cross-sectional household survey of adults (16+) from 2013–2019 in England (N = 138 583). We assessed the association between cigarette smoking and quitting-related outcomes and having children in the household, and whether these relationships were moderated by occupational social grade (categories AB–E from most to least advantaged). Trends in smoking prevalence among adults with and without children in the household were explored.

Results

In adjusted analysis, the association of having children in the household with smoking prevalence depended on social grade: smoking prevalence was between 0.71 (95% confidence interval 0.66–0.77) and 0.93 (0.88–0.98) times lower among social grades AB–D with children in the household relative to those without. Conversely, it was 1.11 (1.05–1.16) times higher among social grade E. Yearly prevalence declined similarly among those with and without children (both prevalence ratio: 0.98, 95% confidence interval 0.97–0.99). Motivation to stop smoking was higher among those with children than those without, but lower among disadvantaged than more advantaged groups. Social grades D–E had greater heavy smoking, but higher prevalence of past-month quit attempts.

Conclusions

Among the most disadvantaged social grade in England, smoking prevalence was higher in those with children in the household than without. To attenuate future smoking-related inequalities, there is an urgent need to target support and address barriers to quitting and promote longer-term quit success.

Implications

In the most disadvantaged occupational social grade, having children in the household was associated with higher smoking prevalence compared with not having children. This contrasts with all other social grades in which there was lower comparative smoking prevalence among those with than without children in the household. Without attention this disparity could exacerbate existing and future health inequalities related to smoking.
Out of the East (or North or South): A Response to Philip Slavin
Authors: Green Monica H
Published: October 2021

This article responds to Philip Slavin’s ‘Out of the West: Formation of a Permanent Plague Reservoir in South-Central Germany (1349–1356) and Its Implications’. Genetics has transformed the study of plague, one of the most lethal diseases in human history. But this technically demanding science raises questions of what constitutes valid evidence and supportable argument when examining historical phenomena at a microscopic level. Slavin argues that two new lineages of Yersinia pestis, the causative organism of plague, were seeded in central Germany following the Black Death; appearing sequentially, one lineage caused plague outbreaks in the 1350s and early 1360s, only to retreat and be replaced by a second lineage. Here, evidence is adduced to support the early central European proliferation of one lineage of Y. pestis, but also to suggest that the second lineage arose simultaneously in a different locale, outside Europe and within different epidemiological parameters. Because of the inherent rarity of biological evidence, the reconstruction of epidemiological phenomena will always require consilience with archaeological and documentary sources. Establishing ‘best practices’ of analysis and verification in this emerging multidisciplinary field has implications not only for Europe’s four hundred-year experience with plague, but for all fields of global health history.
High-Light-Induced Stress Activates Lipid Deacylation at the Sn-2 Position in the Cyanobacterium Synechocystis Sp. PCC 6803
Authors: Kojima Kouji , Matsumoto Ui , Keta Sumie , Nakahigashi Kenji , Ikeda Kazutaka , Takatani Nobuyuki , Omata Tatsuo , Aichi Makiko
Published: October 2021

Cyanobacterial mutants defective in acyl-acyl carrier protein synthetase (Aas) produce free fatty acids (FFAs) because the FFAs generated by deacylation of membrane lipids cannot be recycled. An engineered Aas-deficient mutant of Synechocystis sp. PCC 6803 grew normally under low-light (LL) conditions (50 µmol photons m−2 s−1) but was unable to sustain growth under high-light (HL) conditions (400 µmol photons m−2 s−1), revealing a crucial role of Aas in survival under the HL conditions. Several-times larger amounts of FFAs were produced by HL-exposed cultures than LL-grown cultures. Palmitic acid accounted for ∼85% of total FFAs in HL-exposed cultures, while C18 fatty acids (FAs) constituted ∼80% of the FFAs in LL-grown cultures. Since C16 FAs are esterified to the sn-2 position of lipids in the Synechocystis species, it was deduced that HL irradiation activated deacylation of lipids at the sn-2 position. Heterologous expression of FarB, the FFA exporter protein of Neisseria lactamica, prevented intracellular FFA accumulation and rescued the growth defect of the mutant under HL, indicating that intracellular FFA was the cause of growth inhibition. FarB expression also decreased the ‘per-cell’ yield of FFA under HL by 90% and decreased the proportion of palmitic acid to ∼15% of total FFA. These results indicated that the HL-induced lipid deacylation is triggered not by strong light per se but by HL-induced damage to the cells. It was deduced that there is a positive feedback loop between HL-induced damage and lipid deacylation, which is lethal unless FFA accumulation is prevented by Aas.
Maintaining the Chloroplast Redox Balance through the PGR5-Dependent Pathway and the Trx System Is Required for Light-Dependent Activation of Photosynthetic Reactions
Authors: Okegawa Yuki , Tsuda Natsuki , Sakamoto Wataru , Motohashi Ken
Published: October 2021

Light-dependent activation of chloroplast enzymes is required for the rapid induction of photosynthesis after a shift from dark to light. The thioredoxin (Trx) system plays a central role in this process. In chloroplasts, the Trx system consists of two pathways: the ferredoxin (Fd)/Trx pathway and the nicotinamide adenine dinucleotide phosphate (NADPH)–Trx reductase C (NTRC) pathway. In Arabidopsis (Arabidopsis thaliana) mutants defective in either pathway, the photoreduction of thiol enzymes was impaired, resulting in decreased carbon fixation. The close relationship between the Fd/Trx pathway and proton gradient regulation 5 (PGR5)-dependent photosystem I cyclic electron transport (PSI CET) in the induction of photosynthesis was recently elucidated. However, how the PGR5-dependent pathway is involved in the NTRC pathway is unclear, although NTRC has been suggested to physically interact with PGR5. In this study, we analyzed Arabidopsis mutants lacking either the PGR5 or the chloroplast NADH dehydrogenase-like complex (NDH)-dependent PSI CET pathway in the ntrc mutant background. The ntrc pgr5 double mutant suppressed both the growth defects and the high non-photochemical quenching phenotype of the ntrc mutant when grown under long-day conditions. By contrast, the inactivation of NDH activity with the chlororespiratory reduction 2-2 mutant failed to suppress either phenotype. We discovered that the phenotypic rescue of ntrc by pgr5 is caused by the partial restoration of Trx-dependent reduction of thiol enzymes. These results suggest that electron partitioning to the PGR5-dependent pathway and the Trx system needs to be properly regulated for the activation of the Calvin–Benson–Bassham cycle enzymes during the induction of photosynthesis.
What do the Rural Folks Think? Perceptions of Police Performance
Authors: Ruddell Rick , O’Connor Christopher
Published: October 2021

Several highly publicized incidents have drawn the public’s attention to the problem of rural crime in Canada, and this focus is appropriate given that rates of rural crime in most provinces are higher than in urban areas. This study reports the results of an examination of urban and rural residents’ perceptions of the police in Saskatchewan, Canada. Controlling for their socio-demographic characteristics, prior victimization, perceptions of crime, and contact with the police, the results of 1,791 phone surveys reveal that rural residents are less likely than their urban counterparts to indicate their police do a good job of enforcing the laws, promptly responding to calls for service, providing them with crime prevention information, ensuring their safety, or cooperating with them to address their concerns. We also found that both urban and rural residents who felt their communities were unsafe or neutral (neither safe nor unsafe) were less likely to indicate the police did a good job in all the seven categories of police performance examined in this research. Implications for rural policing practice and research are identified considering these findings.
Rational engineering of an erythropoietin fusion protein to treat hypoxia
Authors: Lee Jungmin , Vernet Andyna , Gruber Nathalie G , Kready Kasia M , Burrill Devin R , Way Jeffrey C , Silver Pamela A
Published: October 2021

Erythropoietin enhances oxygen delivery and reduces hypoxia-induced cell death, but its pro-thrombotic activity is problematic for use of erythropoietin in treating hypoxia. We constructed a fusion protein that stimulates red blood cell production and neuroprotection without triggering platelet production, a marker for thrombosis. The protein consists of an anti-glycophorin A nanobody and an erythropoietin mutant (L108A). The mutation reduces activation of erythropoietin receptor homodimers that induce erythropoiesis and thrombosis, but maintains the tissue-protective signaling. The binding of the nanobody element to glycophorin A rescues homodimeric erythropoietin receptor activation on red blood cell precursors. In a cell proliferation assay, the fusion protein is active at 10−14 M, allowing an estimate of the number of receptor–ligand complexes needed for signaling. This fusion protein stimulates erythroid cell proliferation in vitro and in mice, and shows neuroprotective activity in vitro. Our erythropoietin fusion protein presents a novel molecule for treating hypoxia.
ASSESSMENT OF EXTERNAL OCCUPATIONAL DOSE OF PHOSPHATE MINE WORKERS IN SAUDI ARABIA USING THERMOLUMINESCENT DOSEMETERS
Authors: Shubayr N , Alashban Y , Al-Shehri S , Almurayshid M
Published: October 2021

Workers in the mining industry face the problem of radiation exposure from naturally occurring radioactive materials. Thus, this study aimed to estimate a Hp (10) doses for mine workers in the phosphate mining industry in Saudi Arabia. The personal dose equivalent [Hp (10)] of 606 mine workers in the phosphate mining industry in Saudi Arabia were obtained from 2016 to 2019 using thermoluminescent dosemeters (TLDs). The results showed that the annual mean Hp (10) of all mine workers averaged over the study period was 0.66 mSv (SD = 0.45), which is within the range of occupational doses reported worldwide. Most of the Hp (10) were <0.49 mSv, and the maximum Hp (10) was 3.55 mSv. Nonetheless, internal exposure should be evaluated along with external exposure to estimate a comprehensive baseline occupational dose for mine workers in the phosphate mining industry in Saudi Arabia.
Channeling Good Images but Not Substantive Blessings? Education and Social Contact on Pro-Migrant Sentiments in an Internal Migration Setting
Authors: Tong Yuying , Nie Tianzhu , Piotrowski Martin
Published: October 2021

Education and intergroup contact are two of the most influential channels for reducing host society members’ hostility toward immigrants, but recent studies suggest that these two channels are only able to shift their impressions. Yet, a shift in impression does not necessarily translate into endorsement of integration policies, resulting in a “principle-policy paradox” in multiracial societies. Little is known about whether this paradox holds in circumstances where racial boundaries are less salient and rigid. In this study, we examine whether such a paradox exists in urban China, where racial/ethnic hostility is negligible but the Hukou system has created institutional segregation between local residents and migrants. Using data collected from twelve middle-size cities and one metropolis, we examine urban residents’ attitudes toward rural migrants from multiple domains. We find that education is positively associated with locals’ positive judgments about rural migrants, with concern about social justice playing a mediating role. However, there is a lack of association between education and the endorsement of integration policy or social distance. Compared with education, social contact, in particular kinship contact, is associated with support in more substantive domains, ranging from integration policies to a closer social distance. Nevertheless, social contact does not lead to the support for the most pivotal policy change of granting Hukou. The findings indicate that both education and social contact are limited in engendering the extension of benefits to migrants across contexts, but intergroup contact is more capable of doing so in a society with a more fluid group boundary.
Spatial and temporal coevolution of N2 neuraminidase and H1 and H3 hemagglutinin genes of influenza A virus in US swine
Authors: Zeller Michael A , Chang Jennifer , Vincent Amy L , Gauger Phillip C , Anderson Tavis K
Published: October 2021

The neuraminidase (NA) and hemagglutinin (HA) are essential surface glycoproteins of influenza A virus (IAV). In this study, the evolution of subtype N2 NA paired with H1 and H3 subtype HA in swine was evaluated to understand if the genetic diversity of HA and NA were linked. Using time-scaled Bayesian phylodynamic analyses, the relationships of paired swine N2 with H1 or H3 from 2009 to 2018 were evaluated. These data demonstrated increased relative genetic diversity within the major N2 clades circulating in swine in the USA (N2.1998 between 2014 and 2017 and N2.2002 between 2010 and 2016). Preferential pairing was observed among specific NA and HA genetic clades. Gene reassortment between cocirculating influenza A strains resulted in novel pairings that persisted. The changes in genetic diversity in the NA gene were quantified using Bayesian phylodynamic analyses, and increases in diversity were observed subsequent to novel NA–HA reassortment events. The rate of evolution among NA–N2 clades and HA–H1 and HA–H3 clades were similar. Bayesian phylodynamic analyses demonstrated strong spatial patterns in N2 genetic diversity, but frequent interstate movement of rare N2 clades provided opportunity for reassortment and emergence of new N2–HA pairings. The frequent regional movement of pigs and their influenza viruses is an explanation for the documented patterns of reassortment and subsequent changes in gene diversity. The reassortment and evolution of NA and linked HA evolution may result in antigenic drift of both major surface glycoproteins, reducing vaccine efficacy, with subsequent impact on animal health.
Association of Preoperative Depression and Anxiety With Long-term Opioid Use After Hysterectomy for Benign Indications
Authors: Carey Erin T. , Moore Kristin J. , Young Jessica C. , Bhattacharya Manami , Schiff Lauren D. , Louie Michelle Y. , Park Jihye , Strassle Paula D.
Published: October 2021

OBJECTIVE:

To assess whether preoperative depression or anxiety is associated with increased risk of long-term, postoperative opioid use after hysterectomy among women who are opioid-naïve.

METHODS:

We conducted an observational cohort study of 289,233 opioid-naïve adult women (18 years or older) undergoing hysterectomy for benign indications from 2010 to 2017 using IBM MarketScan databases. Opioid use and refills in the 180 days after surgery and preoperative depression and anxiety were assessed. Secondary outcomes included 30-day incidence of emergency department visits, readmission, and 180-day incidence of opioid complications. The association of depression and anxiety were compared using inverse-probability of treatment weighted log-binomial and proportional Cox regression.

RESULTS:

Twenty-one percent of women had preoperative depression or anxiety, and 82% of the entire cohort had a perioperative opioid fill (16% before surgery, 66% after surgery). Although perioperative opioid fills were relatively similar across the two groups (risk ratio [RR] 1.07, 95% CI 1.06–1.07), women with depression or anxiety were significantly more likely to have a postoperative opioid fill at every studied time period (RRs 1.44–1.50). Differences were greater when restricted to persistent use (RRs 1.49–2.61). Although opioid complications were rare, women with depression were substantially more likely to be diagnosed with opioid dependence (hazard ratio [HR] 5.54, 95% CI 4.12–7.44), and opioid use disorder (HR 4.20, 95% CI 1.97–8.96).

CONCLUSION:

Perioperative opioid fills are common after hysterectomy. Women with preoperative anxiety and depression are more likely to experience persistent use and opioid-related complications.
Complications of Morbid Obesity in the Treatment of Acetabular Fractures: Re-evaluating Outcomes a Decade Later
Authors: Robertson Michael J. , Lee Rowdy C. , Bergin Patrick F. , Graves Matthew L. , Russell George V.
Published: October 2021

Objectives:

To determine the rate of perioperative complications between morbidly obese (body mass index greater than 40 kg/m2) and nonmorbidly obese patients undergoing operative treatment of acetabular fractures across 2 periods (2000–2005 and 2012–2019).

Design:

Retrospective, case–control study.

Setting:

Level I academic trauma center.

Patients:

Four hundred thirty-five consecutive patients from 2000 to 2005 and 216 consecutive patients from 2012 to 2019 with acetabular fractures treated by a single surgeon.

Intervention:

Operative fixation of acetabular fracture.

Main Outcome Measurements:

Outcome variables include positioning time, operative time, estimated blood loss, hospital stay, wound complications, and perioperative complications.

Results:

Twenty-eight morbidly obese and 188 nonmorbidly obese patients from 2012 to 2019, as well as 41 morbidly obese patients and 394 nonmorbidly obese patients from 2000 to 2005 were included in the study. The relative risk (RR) of wound complications between 2012 and 2019 groups was significantly higher for morbidly obese patients (RR = 5.31, P = 0.009) but has decreased significantly for morbidly obese patients between 2000–2005 and 2012–2019 (RR = 0.31, P = 0.017). The rate of total perioperative complications was similar between morbidly obese and nonmorbidly obese groups from 2012 to 2019 (21% vs. 8%, P = 0.230). For morbidly obese patients, the rate of total perioperative complications decreased significantly between 2000–2005 and 2012–2019 (63% vs. 21% P = 0.010).

Conclusion:

Acetabular fracture surgery can be safely performed in morbidly obese patients. Although obesity remains a significant risk factor for wound complications, the risk for morbidly obese patients has decreased significantly since our initial investigation because of adaptations to surgical techniques and surgeon's experience.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Are Serum Ion Levels Elevated in Pediatric Patients With Metal Implants?
Authors: Mathew Smitha E. , Xie Yong , Bagheri Leila , Claton Liam E. , Chu Lin , Badreldin Amr , Abdel Matthew P. , van Wijnen Andre J. , Haft Geoffrey F. , Milbrandt Todd A. , Larson A. Noelle
Published: October 2021

Background:

Previous studies report elevated serum titanium (Ti) levels in children with spinal implants. To provide additional data on this topic, we sought to assess serum ion levels at multiple timepoints in pediatric patients with growing spine devices, spinal fusion instrumentation, and extremity implants placed for fracture treatment. We hypothesized that serum Ti, cobalt (Co), and chromium (Cr) levels would be elevated in pediatric patients with growing spine devices compared with patients with extremity implants.

Methods:

Pediatric patients undergoing any primary spine implant placement, those with spine implant revision or removal surgery and patients with other appendicular implant removal had serum Ti, Co, and Cr ion levels drawn at the time of surgery. Fifty-one patients (12 growing spine devices, 13 fusions, and 26 extremity implants) had one set of labs, 31 of whom had labs drawn both preoperatively and postoperatively. Biopsies obtained from tissue specimens at the time of implant revision were analyzed histologically for the presence of metal debris and macrophage activity.

Results:

Patients with growing spine implants had elevated serum Ti (3.3 vs. 1.9 ng/mL, P=0.01) and Cr levels (1.2 vs. 0.27 ng/mL, P=0.01) in comparison to patients with fusion rods or extremity implants. With respect to patients with extremity implants, patients with growing spine devices had elevated serum Ti (3.3 vs. 0.98 ng/mL, P=0.013), Co (0.63 vs. 0.26 ng/mL, P=0.017), and Cr levels (1.18 vs. 0.26 ng/mL, P=0.005). On matched pairs analysis, patients who had labs drawn before and after spine implantation had significant increase in serum Ti levels (0.57 vs. 3.3 ng/mL, P=0.02). Histology of tissue biopsies adjacent to growing spine implants showed presence of metal debris and increased macrophage activity compared with patients with extremity implants.

Conclusion:

Serum Ti, Co, and Cr levels are elevated in children with spinal implants compared with those with extremity implants, particularly in those with growing spine devices. However, the clinical significance of these findings remains to be determined.

Level of Evidence:

Level II—prospective comparative study.
End-of-Life Care During the Coronavirus Disease 2019 Pandemic: The 3 Wishes Program
Authors: Neville Thanh H. , Bear Danielle K. , Kao Yuhan , Xu Xueqing Sherry , Hjelmhaug Kristen , Quebral Desiree , Sanaee Natalie , Hainje Jessica , Arriola Genevieve , Granone Maria Carmela , White Elizabeth , Chaturvedi Apurva , Yu Shuyi , Clarke France , Cook Deborah J.
Published: October 2021

OBJECTIVES:

Patient- and family-centered end-of-life care can be difficult to achieve in light of visitation restrictions and infection-prevention measures. We evaluated how the 3 Wishes Program evolved to allow continued provision of compassionate end-of-life care for critically ill patients during the coronavirus disease 2019 pandemic.

DESIGN:

This is a prospective observational study where data were collected 1 year prior to the coronavirus disease 2019 pandemic and 1 year after (from March 1, 2019, to March 31, 2021). The number of deceased patients whose care involved the 3 Wishes Program, their characteristics, and wishes were compared between prepandemic and pandemic periods.

SETTING:

Six adult ICUs of a two-hospital health system in Los Angeles.

PATIENTS:

Deceased patients whose care involved the 3 Wishes Program.

INTERVENTIONS:

The 3 Wishes Program is a palliative care intervention in which individualized wishes are implemented for dying patients and their families.

MEASUREMENTS AND MAIN RESULTS:

During the study period, the end-of-life care for 523 patients involved the 3 Wishes Program; more patients received the 3 Wishes Program as part of their end-of-life care during the pandemic period than during the prepandemic study period (24.8 vs 17.6 patients/mo; p = 0.044). Patients who died during the pandemic compared with prepandemic were less likely to have family at the bedside and more likely to have postmortem wishes fulfilled for their families. Compared with the 736 wishes implemented during the prepandemic period, the 969 wishes completed during the pandemic were more likely to involve keepsakes. Wishes were most commonly implemented by bedside nurses, although the 3 Wishes Program project manager (not involved in the patient’s clinical care) was more likely to assist remotely during the pandemic (24.8% vs 12.1%; p < 0.001).

CONCLUSIONS:

Bedside innovations, programmatic adaptations, and institutional support made it possible for healthcare workers to continue the 3 Wishes Program and provide compassionate end-of-life care in the ICU during this pandemic.
Connective tissue panniculitis and vitiligo in a patient with stage IV melanoma achieving complete response to dabrafenib and trametinib combination therapy
Authors: Gargiulo Luigi , Chiara Tronconi Maria , Grimaudo Maria S. , Pavia Giulia , Valenti Mario , Manara Sofia , Costanzo Antonio , Borroni Riccardo G.
Published: October 2021

The combination of BRAF and MEK inhibitors, such as dabrafenib and trametinib, respectively, is an established treatment option for patients with advanced BRAF
V600-mutated melanoma. With the wide adoption of these therapies, a range of cutaneous adverse effects has been reported. We describe the case of a 47-year-old woman with BRAF
V600E-mutated stage IV melanoma treated with dabrafenib and trametinib for 30 months who presented to our attention for painful skin lesions that had been present on her limbs since the start of targeted therapy. We also observed vitiligo-like lesions on the extensor surface of both legs. Despite achieving a complete oncological response, the patient had to discontinue the treatment because of persisting fever, nausea and painful skin nodules that significantly impaired her quality of life. The recognition of cutaneous signs of efficacy of such drugs for advanced melanoma is of primary importance in order to identify patients with potential long-term clinical benefits.
The impact of deceased versus living donor graft status on kidney transplant outcomes: A Johannesburg single-center 48 years experience of 1685 patients
Authors: Milwid Tanya G , Fabian June , Adam Ahmed
Published: October 2021

Background

This study is aimed to determine the impact of living donor (LD) versus deceased donor (DD) kidney transplantation on renal graft survival and patient overall survival rates within Johannesburg, South Africa.

Materials and methods

A retrospective assessment was conducted of all 1685 adult first kidney-alone kidney transplant recipients transplanted between the years 1966 and 2013 in a single center. The patients were divided according to the source of the transplant: LD versus DD. Demographics and post-transplantation follow-up data were determined and tabulated. Graft and overall survival plots were generated.

Results

Of the recipients enrolled, 84.1% were DD recipients and 15.9% were LD recipients. Living donor recipient status was significantly associated with younger age (p ≤ 0.0001), a higher proportion of white, Asian, or mixed race compared to black race (p ≤ 000.1), a higher proportion of urologic etiology of disease (p = 0.015), and a lower proportion with hypertension (p ≤ 0.0001) as the cause of end stage kidney disease. Results showed a decreased risk of graft failure (hazard ratio, 0.55; 95% confidence interval, 0.45–0.66) and a decreased risk of death (hazard ratio, 0.47; 95% confidence interval, 0.36–0.61) among LD graft recipients as compared to DD graft recipients.

Conclusions

In keeping with internationally reported trends, LD recipients continue to have enhanced patient and graft survival outcomes as compared to DD recipients within our local experience. This Johannesburg experience will serve as a foundation for future related studies in this region of the world.
Neuroadrenergic activation in obstructive sleep apnea syndrome: a systematic review and meta-analysis
Authors: Quarti-Trevano Fosca , Biffi Annalisa , Bonzani Matilde , Seravalle Gino , Corrao Giovanni , Mancia Giuseppe , Grassi Guido
Published: October 2021

Background:

Neuroadrenergic overdrive occurs in obstructive sleep apnea syndrome (OSAS). However, the small sample size of the microneurographic studies, heterogeneity of the patients examined, presence of comorbidities, represented major weaknesses not allowing to precisely define the main features of the phenomenon, particularly in nonobese patients.

Objective:

This meta-analysis evaluated 850 participants recruited in 26 microneurographic studies, based on muscle sympathetic nerve activity (MSNA) quantification in uncomplicated OSAS of different clinical severity.

Methods:

The evaluation was extended to the relationships of MSNA with heart rate (HR), anthropometric and blood pressure (BP) values, metabolic variables, apnea–hypopnea index (AHI) and oxygen saturation.

Results:

MSNA is activated markedly and almost homogeneously between studies, showing a progressive increase from the healthy state to mild, moderate and severe OSAS (41.6, 48.3, 65.5 and 70.7 bursts/100 heart beats, respectively, P < 0.01). Of special interest are the findings that first, MSNA is significantly related to the AHI, a marker of OSAS severity (r = 0.55, P < 0.02) and O2 saturation but not to body weight and BMI, as it occurs in OSAS associated with obesity; and second, HR is significantly and directly related to MSNA and AHI (r = 0.56 and 0.46, P < 0.03 for both), thus representing a surrogate marker of the sympathetic overdrive.

Conclusion:

OSAS, even when uncomplicated by other cardiometabolic disease, displays a marked sympathetic activation, reflected by the MSNA and HR behavior, becoming a target of therapeutic interventions aimed at exerting sympathomoderating effects, such as continuous positive airway pressure.
CENTRAL SEROUS CHORIORETINOPATHY
Authors: Gerardy Melvin , Yesilirmak Nilufer , Legras Richard , Behar-Cohen Francine , Bousquet Elodie
Published: October 2021

Purpose:

To investigate cone density in the asymptomatic fellow eye of patients with unilateral central serous chorioretinopathy (CSCR).

Methods:

Seventeen asymptomatic fellow eyes of patients with unilateral CSCR and 17 eyes of aged-matched and gender-matched healthy controls underwent adaptive optics ophthalmoscopy. Cone density and spacing were assessed at the fovea. Clinical and multimodal imaging findings were also recorded.

Results:

In the CSCR group, the patient mean age was 48.9 ± 9.8 years. The mean (±SD) subfoveal choroidal thickness was 417.8 ± 125.2 µm. The foveal external limiting membrane and ellipsoid zone were intact in all patients. Adaptive optics fundus imaging showed a significant decrease in cone density at 2° of eccentricity nasal and temporal to the fovea in asymptomatic fellow eyes of patients with unilateral CSCR compared with controls (P = 0.001 and P = 0.027, respectively). No statistically significant difference in cone density was found at 4° of eccentricity nasal and temporal to the fovea between both groups.

Conclusion:

Asymptomatic fellow eyes of patients with unilateral CSCR showed a reduced density of foveal cones in the absence of a decreased visual acuity and photoreceptor line disruption on optical coherence tomography. These results suggest that the photoreceptors could be damaged independently of the occurrence of a serous retinal detachment.
Peripheral Hypertrophic Subepithelial Corneal Degeneration
Authors: Raber Irving M. , Eagle Ralph C.
Published: October 2021

Purpose:

The purpose of this study was to report a large series of patients with peripheral hypertrophic subepithelial corneal degeneration (PHSCD) and differentiate the condition from Salzmann nodular degeneration (SND).

Methods:

We retrospectively reviewed the charts of 49 patients diagnosed with PHSCD and reported their clinical, refractive, and topographic/tomographic findings.

Results:

Most of the eyes were white and quiet. Minimal variable injection was present in a few eyes usually in the presence of pseudopterygium. Typical corneal involvement consists of peripheral circumferential-elevated whitish subepithelial opacities with fine superficial vessels along the limbus and linear deposits of iron in the epithelium along the central edge of the opacification. The typical topographic/tomographic findings consist of flattening directly over the corneal opacification with central flattening aligning with the axis of the opacification. In all subjects, the mean refractive astigmatism was significantly less than the mean topographic/tomographic Sim K astigmatism. Thirty-five eyes underwent surgical excision. The surgical eyes demonstrated significantly less astigmatism and better best-spectacle corrected visual acuity than pre-op. Moreover, all the eyes that underwent surgery for discomfort experienced significant improvement in their symptoms. Histopathology of the keratectomy specimens demonstrated paucicellular subepithelial fibrosis with overlying epithelium that was variable in caliber.

Conclusions:

PHSCD is distinct from SND, primarily occurring in middle-aged women, bilateral and fairly symmetric with larger more peripheral opacities than SND, and absence of inflammatory signs and symptoms.
Modified procedure for Loading “Flat” DMEK Grafts Into an Injector
Authors: Straiko Megan M. W. , Dye Philip K. , Hikes Matthew T. , Tran Khoa D. , Terry Mark A.
Published: October 2021

Purpose:

The aim of this study was to determine whether loading a Descemet membrane endothelial keratoplasty (DMEK) graft using a drop-in procedure results in more endothelial cell loss (ECL) than the standard suction procedure.

Methods:

Pairs of donor corneas with equivalent preprocessing endothelium were prepared using the standard protocol of our eye bank. One member of each pair was loaded into an injector using the standard suction protocol. The mate graft was loaded using a drop-in protocol, in which the edge of the graft was gently grasped with a forceps, lifted to the edge of the injector, and dropped inside. Grafts were evaluated for ECL and examined for grab marks or other loading-associated damage.

Results:

There was no difference in mean ECL of grafts prepared for DMEK using the standard protocol (20.6% ± 4.5%) compared with that of mate grafts prepared using the drop-in loading protocol (19.5% ± 4.8%, P = 0.59). There was no consistent pattern of damage in the drop-in–loaded grafts, as grab marks or other tissue damage associated with the drop-in loading protocol were not consistently identified by a trained corneal surgeon.

Conclusions:

ECL was not significantly different in grafts prepared using a drop-in loading procedure compared with grafts prepared using the standard suction protocol. The drop-in loading protocol may be particularly useful to surgeons who load their own grafts and eye bank processing technicians who encounter a “flat” DMEK graft that does not scroll or a loosely scrolled DMEK graft.
Opioid Prescribing Patterns for Ulcerative Keratitis
Authors: Thibodeau Alexa R. , Niziol Leslie M. , Tannen Bradford L. , Ballouz Dena , Woodward Maria A.
Published: October 2021

Purpose:

The purpose of this study was to characterize rates of opioid prescription for different ulcerative keratitis types.

Methods:

This cohort study included patients diagnosed with ulcerative keratitis according to the University of Michigan electronic health record data between September 1, 2014 and December 22, 2020. Ulcerative keratitis was categorized by etiologic type (bacterial, fungal, viral, acanthamoeba, inflammatory, polymicrobial, or unspecified) using rule-based data classification that accounted for billing diagnosis code, antimicrobial or antiinflammatory medications prescribed, laboratory results, and manual chart review. Opioid prescriptions were converted to morphine milligram equivalent and summed over 90 days from diagnosis. Opioid prescription rate and amount were compared between ulcerative keratitis types.

Results:

Of 3322 patients with ulcerative keratitis, 173 (5.2%) were prescribed at least 1 opioid for pain management within 90 days of diagnosis. More patients with acanthamoeba (32.4%), fungal (21.1%), and polymicrobial (25.0%) keratitis were treated with opioids compared with bacterial (6.7%), unspecified (2.9%), or viral (1.8%) keratitis (all Bonferroni adjusted P < 0.05). For the 173 patients who were prescribed opioids, a total of 353 prescriptions were given within 90 days of diagnosis, with half given within the first week after diagnosis. The quantity of opioid prescribed within 90 days from diagnosis was not significantly different between ulcerative keratitis types (P = 0.6559). Morphine milligram equivalent units prescribed ranged from 97.5 for acanthamoeba keratitis to 112.5 for fungal keratitis.

Conclusions:

The type of ulcerative keratitis may influence the opioid prescription rate. Providers can better serve patients needing opioids for pain management through improved characterization of pain and development of more tailored pain management regimens.
Psychometric Properties of the Korean Family Reported Outcome Measure for Family Members of Patients With Acquired Brain Injury
Authors: Oh Hay Young , Shin Yong Soon
Published: October 2021

BACKGROUND: Acquired brain injury (ABI) affects not only survivors but also their family members’ quality of life in various ways. The Family Reported Outcome Measure (FROM-16), a self-reported instrument, has been developed to evaluate the impact of diseases on the lives of family members of patients. This study aimed to assess the reliability and validity of the Korean FROM-16 for family members of individuals with ABI. METHODS: A total of 200 family members of patients with ABI in South Korea participated in this study. Internal consistency was assessed using Cronbach α. To establish the validity, we evaluated the semantic equivalence, content, known-group, conduct, concurrent, and convergent validity of the Korean FROM-16. For exploratory factor analysis, common factor analysis with oblique rotation, parallel analysis, an eigenvalue greater than 1.0, and a scree plot were used. RESULTS: Exploratory factor analysis revealed 2 factors for the 16 items, which explained 67.4% of the total variance. Concurrent validity was established by comparison with the Korean World Health Organization Quality of Life Scale Brief (r = −0.57), and regarding the convergent validity, the Korean FROM-16 score positively correlated with the Korean Neurobehavioral Functioning Inventory. Known-group validity was confirmed by showing that family members with advanced age, the burden of caring, and insufficient income, as well as spouses, had a statistically higher score in the Korean FROM-16. Cronbach α was .92, indicating high internal consistency reliability. CONCLUSION: The Korean FROM-16 is a valid and reliable instrument for evaluating the impact of diseases on family members of individuals with ABI in South Korea.
Employee Job Satisfaction and Performance in Association With Workplace Responses to the 9/11 Attacks on New York City's World Trade Center
Authors: Miu Adriana S. , Davis Anna J. , Raitt Josh M. , Lee Min Hyung , Pedrazine Anthony , Canan Fatih , Pollio David E. , North Carol S.
Published: October 2021

Objective:

Research is needed on disaster-affected workplaces, particularly on employee job satisfaction and performance, to inform workplace responses promoting employee postdisaster adjustment and wellbeing.

Methods:

Quantitative and qualitative data were collected from a volunteer sample of 255 employees of eight workplaces affected by the 9/11 attacks on New York City's World Trade Center nearly 3 years post disaster.

Results:

The effects of 9/11 on both job satisfaction and job performance were more negative than positive, especially for the Ground Zero employees. Effects on job satisfaction and job performance were generally congruent. Workplace responses focused on individual needs were perceived as positive and those focused on workplace needs as negative.

Conclusions:

Workplace responses focused on business improvement intended to improve workplace performance may not have the desired effect and may reduce employee job satisfaction and performance.
Evaluation of efficacy and safety of chemotherapy in the treatment of recurrent or resistant gestational trophoblastic neoplasia
Authors: Luo Fang , Li Li , Gao Qing , Li Yu-Xia
Published: October 2021

Background:

Gestational Trophoblastic Neoplasia (GTN) is a spectrum of pregnancy-associated tumours emerging from placental tissue. Generally, GTN patients are considered to have a high rate of recovery. However, almost 25 per cent of GTN tumours resist, or have a high probability of relapsing following the first line of chemo treatment. Thus, tumours that resist or relapse requires salvage chemotherapy, sometimes accompanied by surgery. Globally, clinicians utilize a range of salvage regimens. Currently, ongoing debates are centred around choosing the best regimens in terms of safety and efficacy. Therefore, the current research aims to appraise the success and level of safeness using chemotherapy to treat patients with resistant or recurrent GTN.

Methods:

The authors will conduct a methodological exploration in online-based databases to find Randomized Controlled Trials related to the adoption of chemotherapy agents as treatment for resistant or recurrent GTN patients. The databases are as follows: EMBASE, PubMed, Cochrane Database Central, UpToDate, Chinese National Knowledge Infrastructure, Web of Science, and WanFang Database. The search will be limited to articles published in either English or Chinese. Moreover, the authors will also perform a search for ongoing trials on online-based clinical trial registries. Two independent authors will screen and select articles for review. A similar process will be followed by two independent authors to complete the extraction of data and evaluate the bias risk. In relevant cases, the authors will contract trial investigators to obtain related, unpublished data. The authors will use the random-effects model for pooling data in RevMan software (v5.3).

Results:

The present systematic review aims to evaluate the efficacy and level of safeness associated with using chemotherapy for resistant or recurrent GTN patients.

Conclusion:

The results of the proposed systematic analysis could summarize the most recent evidence for the use of chemotherapy agents on GTN patients.

Ethics and dissemination:

Since the proposed study uses pre-published data, an ethical approval is not required.

Review registration number:

Aug 25, 2021.osf.io/rgzbn. (https://osf.io/rgzbn/).
Validation of the National Early Warning Score (NEWS)-2 for adults in the emergency department in a tertiary-level clinic in Colombia
Authors: Vergara Peter , Forero Daniela , Bastidas Alirio , Garcia Julio-Cesar , Blanco Jhosep , Azocar Jorge , Bustos Rosa-Helena , Liebisch Hans
Published: October 2021

The National Early Warning Score (NEWS)-2 is an early warning scale that is used in emergency departments to identify patients at risk of clinical deterioration and to help establish rapid and timely management. The objective of this study was to determine the validity and prediction of mortality using the NEWS2 scale for adults in the emergency department of a tertiary clinic in Colombia.

A prospective observational study was conducted between August 2018 and June 2019 at the Universidad de La Sabana Clinic.

The nursing staff in the triage classified the patients admitted to the emergency room according to Emergency Severity Index and NEWS2. Demographic data, physiological variables, admission diagnosis, mortality outcome, and comorbidities were extracted.

Three thousand nine hundred eighty-six patients were included in the study. Ninety-two (2%) patients required intensive care unit management, with a mean NEWS2 score of 7. A total of 158 patients died in hospital, of which 63 were women (40%). Of these 65 patients required intensive care unit management. The receiver operating characteristic curve for NEWS2 had an area of 0.90 (CI 95%: 0.87–0.92). A classification and score equivalency analysis was performed between triage and the NEWS2 scale in terms of mortality. Of the patients classified as triage I, 32.3% died, and those who obtained a NEWS2 score greater than or equal to 10 had a mortality of 38.6%.

Among our population, NEWS2 was not inferior in its area under the receiver operating characteristic curve when predicting mortality than triage, and the cutoff point for NEWS2 to predict in-hospital mortality was higher.
Novel WTX nonsense mutation in a family diagnosed with osteopathia striata with cranial sclerosis
Authors: Jeong Changhoon , Kim Myungshin , Yim Jisook , Park Il-Jung , Lee Jiwon , Lee Jaeyoung
Published: October 2021

Rationale: Osteopathia striata with cranial sclerosis is characterized by linear striations in the metaphysis of the long bones and pelvis with cranial sclerosis. It is an X-linked dominant sclerosing bone dysplasia and affected males show fetal or neonatal lethality. Mutations in the gene encoding Wilms tumor on the X chromosome (WTX) was identified as the cause of X-linked osteopathia striata with cranial sclerosis. About 30 pathogenic mutations in WTX have been reported recently. We have identified a novel nonsense mutation in the family diagnosed as osteopathia striata with cranial sclerosis.

Patient concerns:

The proband came to our attention at age 9 for the evaluation of toe-out gait and planovalgus deformity. Clinically, the proband showed coarse facial features including frontal bossing, ocular hypertelorism, wide depressed nasal bridge, dental malocclusion, mild macrocephaly and low set ears. Radiologically, sclerotic linear striations were seen in the X-rays of the pelvis and the metaphyseal region of femur and tibia and the cranial sclerosis was observed. The proband's mother presented similar facial features and the X-rays of the pelvis, femur, and tibia revealed same sclerotic linear striations as the proband's.

Diagnoses:

Osteopathia striata with cranial sclerosis.

Interventions:

A genetic analysis was conducted on genomic DNA isolated from peripheral blood leukocytes of the proband and the mother for confirming the clinical suspicion of osteopathia striata with cranial sclerosis. WTX on Xq11.2 gene was analyzed in direct sequencing for coding exons including intron-exon boundaries.

Outcomes:

One novel nonsense mutation (c.1003C>T, p.Gln335∗) and known single nucleotide variant were observed in a heterozygous form.

Lessons:

We found a novel nonsense mutation in a family diagnosed as osteopathia striata with cranial sclerosis. The relationship between various clinical features and genetic mutations can be clarified by accumulation of genetic database.
Primary diffuse large B-cell lymphoma of the uterus
Authors: Ensor Allyne M. , Sanchez Cesar Gentille , Ensor Joe E. , Anand Kartik
Published: October 2021

Uterine diffuse large B-cell lymphoma (DLBCL) is a rare clinical condition. Most studies for uterine DLBCL are derived from case reports and series. Our main objective was to present a new case while also investigating the demographic, clinical characteristics, and survival of women with primary uterine DLBCL as compared to non-uterine DLBCL using the Surveillance, Epidemiology, and End Results incidence database. We queried the Surveillance, Epidemiology, and End Results database for women aged 18 years or older with a diagnosis of primary DLBCL from 1975 to 2017. The most common site of primary uterine DLBCL is the cervix uteri not otherwise specified, followed by endometrium, uterus not otherwise specified, corpus uteri, myometrium and isthmus uteri. Non-uterine DLBCL cases tend to be older than uterine DLBCL cases. Uterine DLBCL is most common among women aged 40 to 64 years. Patients with uterine DLBCL showed greater survival than non-uterine DLBCL patients, and patients treated in the rituximab era also exhibited a survival benefit. Both the elderly and African American cohorts experienced worse overall survival.