bluuebunny/crossref_metadata_2025 huggingface dataset:
Circ-USP9X Inhibition Reduces Oxidized Low-density Lipoprotein–induced Endothelial Cell Injury via the microRNA 599/Chloride Intracellular Channel 4 Axis
Authors: Peng Huaiyu , Sun Jihu , Li Yi , Zhang Ye , Zhong Yongjin
Published: July 2021

Atherosclerosis (AS) is the common pathological basis of cardiovascular disease. Circular RNA circ-USP9X (hsa_circ_0090231) has been discovered to be upregulated in oxidized low-density lipoprotein (ox-LDL)–induced human umbilical vein endothelial cells (HUVECs), but the role of circ-USP9X in ox-LDL–induced endothelial cell injury is indistinct. The purpose of the research was to investigate the role and regulatory mechanism of circ-USP9X in ox-LDL–-induced endothelial cell injury. Expression of circ-USP9X was examined by quantitative real-time polymerase chain reaction. Loss-of-function experiments were performed to assess the impacts of circ-USP9X inhibition on viability, cell cycle progression, apoptosis, and tube formation, inflammation, and oxidative stress of ox-LDL–induced HUVEC. The regulatory mechanism of circ-USP9X predicted by bioinformatics analysis and verified by dual-luciferase reporter or RNA immunoprecipitation assays. We observed that circ-USP9X was upregulated in AS patients' serum and ox-LDL–induced HUVEC. Inhibition of circ-USP9X elevated viability, promoted cell cycle progression and angiopoiesis, and decreased apoptosis, inflammation, and oxidative stress of ox-LDL–induced HUVEC. Mechanically, circ-USP9X regulated chloride intracellular channel 4 (CLIC4) messenger RNA expression by sponging microRNA (miR)-599. Furthermore, miR-599 inhibitor overturned circ-USP9X silencing-mediated influence on ox-LDL–induced HUVEC injury. Also, CLIC4 overexpression reversed miR-599 elevation–mediated effect on ox-LDL–induced HUVEC injury. In conclusion, circ-USP9X silencing decreased ox-LDL–induced endothelial cell injury via the miR-599/CLIC4 axis, which offered a novel molecular mechanism to comprehend the pathology of AS.
Global burden of cardiovascular diseases attributable to hypertension in young adults from 1990 to 2019
Authors: Liu Jing , Bu Xiang , Wei Linyan , Wang Xiqiang , Lai Lulu , Dong Caijuan , Ma Aiqun , Wang Tingzhong
Published: July 2021

Background:

Hypertension grows into a serious public health problem among young adults, linking to a set of life-threatening cardiovascular diseases (CVDs). Young adults are not well represented in current knowledge about the CVDs burden attributable to hypertension.

Methods:

In this analysis of data from the GBD (Global Burden of Disease) study 2019, we focus on young adults and provide the first comprehensive and comparative assessment of the hypertension attributable CVDs burden, in terms of its mortality and years of living with disability (YLD) from 1990 to 2019, stratified by location, sex, and development status.

Results:

Globally in 2019, the death and YLD numbers caused by hypertension-related CVDs were 640 239 and 2 717 474 in young adults, marking a 43.0 and 86.6% increase from 1990, respectively. The corresponding mortality rate dropped by 10.5%, whereas the YLD rate increased by 16.8% during the same period. V-shaped association between CVDs burden and social development status was observed. The largest burden and the most pronounced increase were borne by middle-income countries, while high-income countries had the lowest death/YLD rate with a quicker annual decline. Men largely outpaced women in hypertension attributable CVDs mortality. Ischemic heart disease and stroke were the leading cause for death and YLD burden, correspondingly.

Conclusions:

Hypertension attributable CVDs burden in young adults has greatly increased from 1990 to 2019, with considerably spatiotemporal and sexual heterogeneity. The largest burden was borne by middle-income countries, especially by men. Establishment of geographically and sexually tailored strategies were needed to prevent hypertension-related CVDs in young adults.
ASSOCIATION BETWEEN EPIRETINAL MEMBRANE, EPIRETINAL PROLIFERATION, AND PROGNOSIS OF FULL-THICKNESS MACULAR HOLE CLOSURE
Authors: Yang Jee Myung , Choi Sang Uk , Kim Yoon Jeon , Kim Ryul , Yon Dong Keon , Lee Seung Won , Shin Jae Il , Lee Joo Yong , Kim June-Gone
Published: July 2021

Purpose:

To demonstrate the effects of epiretinal membrane (ERM) and epiretinal proliferation on surgical outcomes for full-thickness macular hole.

Methods:

Nested case–control study with propensity score matching. Patients operated on for full-thickness macular hole between January 2011 and March 2020 were enrolled. The primary outcome was failure of the macular hole closure, and the secondary outcome was unfavorable hole closure (V or λ type closure) at 6 months after the surgery.

Results:

Five hundred and thirty-four eyes of 534 patients met the inclusion criteria. After 1:1 propensity score matching (127 pairs), patients demonstrating ERM were more likely to have a failure of hole closure (adjusted odds ratio, 2.71; 95% confidence interval, 1.19–6.14) and unfavorable hole closure (adjusted odds ratio, 2.07; 95% confidence interval, 1.16–3.71). Epiretinal membrane spanning the hole margin (hole marginal ERM) greatly increased the likelihood of unfavorable hole closure (adjusted odds ratio, 2.13; 95% confidence interval, 1.12–4.07). Patients with hole marginal-ERM + epiretinal proliferation were more likely to have a failure of hole closure (38.4%) compared with those with no ERM (11.8%).

Conclusion:

Patients with ERM had a higher risk for adverse surgical outcomes for full-thickness macular hole closure. The location of the ERM relative to the macular hole and the presence of epiretinal proliferation might affect the surgical outcomes for full-thickness macular hole closure.
Hypervirulent Klebsiella pneumoniae Infections in Pediatric Populations in Beijing (2017–2019)
Authors: Li Yue , Dong Limin , Gao Wei , Zhen Jinghui , Dong Fang , Yao Kaihu
Published: July 2021

Background:

Hypervirulent variants of Klebsiella pnuemoniae (hvKp) are emerging globally causing life-threatening infectious diseases; however, comprehensive studies on pediatric hvKp strains and related infections are still lacking.

Methods:

Clinical data were collected from medical records. Genotype (multilocus sequence typing), capsular serotype, virulence gene profile and carbapenemase of the isolates were determined by PCR and DNA sequencing. Broth microdilution method was adopted to test the antimicrobial susceptibility. Hypermucoviscosity phenotype and the virulence of the strains were evaluated by string test and Galleria mellonella larvae killing assay.

Results:

Among 319 K. pneumoniae strains, 26 (8.2%) hvKp were identified, the detection rates in 2017, 2018 and 2019 were 1.8%, 5.2% and 11.3%. The majority of hvKp infections were found in school-age children and adolescents (57.7%). Pneumonia was the most common diagnosis (38.5%). Single fatal case was hvKp caused liver abscess complicated with bacteremia. hvKp were dominated by ST23 (30.8%) and ST11 (30.8%). Eight carbapenem-resistant hvKp (CR-hvKp) were found, which all belonged to ST11. Virulence gene profile revealed that ST11 hvKp might carry incomplete pLVPK-like plasmids, but they exhibited comparable in vivo virulence to the other hvKp.

Conclusions:

The infections caused by hvKp are not frequent among pediatric populations, but the detection rate of hvKp in pediatric populations is increasing rapidly in recent years. The emerging and dissemination of ST11 CR-hvKp should be monitored continuously.
Visual outcomes and safety of an extended depth-of-focus intraocular lens: results of a pivotal clinical trial
Authors: Chang Daniel H. , Janakiraman Devi Priya , Smith Pamela J. , Buteyn Anne , Domingo Joy , Jones Jason J. , Christie William C.
Published: July 2021

Purpose:

To compare the effectiveness and safety of the TECNIS Symfony intraocular lens (IOL; ZXR00) with the TECNIS 1-piece monofocal IOL (ZCB00).

Setting:

15 sites in the United States.

Design:

Prospective, randomized, patient-masked/evaluator-masked clinical trial.

Methods:

Randomized participants received either the ZXR00 or ZCB00 IOL bilaterally. The 6-month postoperative outcomes included monocular and binocular distance, intermediate, and near visual acuity (VA), spherical equivalent refraction and refractive cylinder, spectacle wear, and visual symptoms.

Results:

Overall, 299 patients were implanted with a study IOL (ZXR00 IOL, n = 148; ZCB00 IOL control, n = 151). At the 6-month follow-up, mean binocular uncorrected distance VA was comparable between ZXR00 and ZCB00 IOL recipients (P = .1011). The ZXR00 IOL group had significantly better mean binocular uncorrected intermediate VA and uncorrected near VA (both P < .0001) than the ZCB00 IOL group. The mean binocular distance-corrected intermediate VA and distance-corrected near VA were also better in the ZXR00 IOL group (both P < .0001). More ZXR00 IOL recipients reported wearing spectacles none of the time or a little of the time for overall vision at 6 months compared with the ZCB00 IOL group (85.0% vs 59.9%, P < .0001). In the ZXR00 IOL–implanted patients, low incidence rates of night glare (mild to moderate, 2.7%), halo (mild to moderate, 13.6%; severe, 2.7%), and starbursts (mild to moderate, 7.5%; severe, 1.4%) were reported.

Conclusions:

The TECNIS Symfony IOL provided comparable distance vision and improved uncorrected and distance-corrected intermediate and near vision, along with decreased spectacle wear and low incidence rates of dysphotopsia, compared with the TECNIS 1-piece monofocal IOL.
Prognostic factors, symptom evolution, and quality of life of posttraumatic trigeminal neuropathy
Authors: Van der Cruyssen Fréderic , Peeters Frederik , De Laat Antoon , Jacobs Reinhilde , Politis Constantinus , Renton Tara
Published: July 2021

Neurosensory disturbances (NSDs) caused by injury to the trigeminal nerve can affect many aspects of daily life. However, factors affecting the persistence of NSDs in patients with posttraumatic trigeminal neuropathies (PTTNs) remain largely unknown. The identification of such risk factors will allow for the phenotyping of patients with PTTNs, which is crucial for improving treatment strategies. We therefore aimed to identify the prognostic factors of NSD persistence, pain intensity, and quality of life (QoL) in patients with PTTNs and to use these factors to create a prognostic prediction model. We first performed a bivariate analysis using retrospective longitudinal data from 384 patients with NSDs related to posttraumatic injury of the trigeminal nerve (mean follow-up time: 322 ± 302 weeks). Bivariate and multivariate analyses were performed. The multivariable prediction model to predict persistent NSDs was able to identify 76.9% of patients with persistent NSDs, with an excellent level of discrimination (area under the receiver operating characteristic curve: 0.84; sensitivity: 81.8%; specificity: 70.0%). Furthermore, neurosensory recovery was significantly associated with sex; injury caused by local anesthesia, extraction, third molar surgery, or endodontic treatment; and the presence of thermal hyperesthesia. Pain intensity and QoL analysis revealed several factors associated with higher pain levels and poorer QoL. Together, our findings may aid in predicting patient prognosis after dental, oral, and maxillofacial surgery and might lead to personalized treatment options and improved patient outcomes.
Proposed Mitigation and Adaptation Strategies Related to Climate Change: Guidance for OEM Professionals
Authors: Nabeel Ismail , Caraballo-Arias Yohama , Perkison William Brett , McCarthy Ronda B. , Saberi Pouné , Berenji Manijeh , Goldman Rose H. , Laestadius Jasminka Goldoni , Sokas Rosemary K. , Das Rupali , Senay Emily , Wilkenfeld Marc , Cook-Shimanek Margaret
Published: July 2021

Climate change is an urgent challenge amplified by socioeconomic factors that demands thoughtful public health responses from OEM professionals. This guidance statement from the American College of Occupational and Environmental Medicine focuses on the different strategies that these health professionals can implement to protect workers from health impacts associated with climate change hazards, foster workplace resilience in the face of rapidly changing environments, and take the necessary steps to mitigate the effects of global climate change.
Self-Reported Physical Demands Associated With Crops and Job Tasks Among Latinx Hired Child Farmworkers
Authors: Quandt Sara A. , Arnold Taylor J. , Arcury Thomas A. , Talton Jennifer W. , Daniel Stephanie S.
Published: July 2021

Objective:

Physical demands of work performed by Latinx hired child farmworkers are poorly understood. This paper describes crops, tasks performed, and the most common dimensions of physical demands of work in this population.

Methods:

Survey interviews were conducted in 2017 with 202 Latinx children aged 10 to 17 years employed on North Carolina farms. Analysis focused on job characteristics for the past week and included factor analysis of an 18-item questionnaire on physical work demands.

Results:

The most common crops and tasks reported were topping/suckering tobacco and picking sweet potatoes or berries. Three factors (awkward postures, repetitive motion, strenuous work) accounted for 53% of the variance in physical demands.

Conclusions:

Follow-up of hired child farmworkers should be undertaken to understand the long-term effects of physical work demands on their health.
Negative Employment Changes During the COVID-19 Pandemic and Psychological Distress
Authors: Matthews Timothy A. , Chen Liwei , Chen Zhuo , Han Xuesong , Shi Lu , Li Yan , Wen Ming , Zhang Donglan , Li Hongmei , Su Dejun , Li Jian
Published: July 2021

Objective:

We examined associations of negative employment changes during the COVID-19 pandemic with mental health in a national sample of U.S. workers, and whether the associations differed by race.

Methods:

Data were from the Health, Ethnicity, and Pandemic Study, a cross-sectional survey. The effects of negative employment changes on psychological distress in 1510 workers were examined via linear regression, and stratified analyses were conducted across racial subgroups.

Results:

After adjustment for covariates, compared to workers with no change in employment, those who experienced permanent job loss had the highest psychological distress (β and 95% CI = 3.27 [1.89, 4.65]). Permanent job loss had the greatest effect on psychological distress in Blacks and Asians.

Conclusion:

Negative employment changes related to the pandemic may have deleterious impacts on workers’ mental health, with disproportionate effects on racial minorities.
Admission Rates Following Day-Case Major Otologic Surgery: A Systematic Review
Authors: Derks Laura S. M. , Borgstein Isabelle L. A. , Lammers Marc J. W. , Kamalski Digna M. A. , Thomeer Hans G. X. M. , Grolman Wilko , Stokroos Robert J. , Wegner Inge
Published: July 2021

Objective:

To assess whether day-case major otologic ear surgery is a safe and feasible alternative to inpatient surgery, while maintaining equal complication rates, and to identify causes of admission after day-case surgery.

Data sources:

PubMed, Embase, and Cochrane.

Review methods:

A systematic search was conducted. Studies reporting original data on the effect of day-case ear surgery on admission rate, patient satisfaction, and/or postoperative complications were included. Risk of bias of the selected articles was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias.

Results:

A total of 1,734 unique studies were retrieved of which 35 articles discussing 34 studies were eligible for data extraction. The admission rates ranged from 0% to 88% following day-case endaural surgery, 0% to 13% following day-case stapes surgery, 0% to 82% following day-case mastoid surgery, and 0% to 15% following day-case cochlear implant surgery. Patient and parent satisfaction regarding day-case surgery ranged from 67% to 99%. Five studies comparing day-case and inpatient otologic surgery showed no difference in hearing outcome, postoperative complications, or patient satisfaction.

Conclusion:

The highest pooled admission rate was seen following day-case mastoid surgery. Studies comparing day-case and inpatient care suggest hearing results and postoperative complication rates in day-case otologic surgery are similar to inpatient otologic surgery in both children and adults. Therefore, day-case major otologic surgery seems to be a safe and feasible alternative to inpatient surgery for both children and adults.
Current Evidence for Simulation-Based Training and Assessment of Myringotomy and Ventilation Tube Insertion: A Systematic Review
Authors: Hovgaard Lisette Hvid , Al-Shahrestani Fahd , Andersen Steven Arild Wuyts
Published: July 2021

Objective:

Myringotomy and ventilation tube insertion (MT) is a key procedure in otorhinolaryngology and can be trained using simulation models. We aimed to systematically review the literature on models for simulation-based training and assessment of MT and supporting educational evidence.

Databases Reviewed:

PubMed, Embase, Cochrane Library, Web of Science, Directory of Open Access Journals.

Methods:

Inclusion criteria were MT training and/or skills assessment using all types of training modalities and learners. Studies were divided into 1) descriptive and 2) educational interventional/observational in the analysis. For descriptive studies, we provide an overview of available models including materials and cost. Educational studies were appraised using Kirkpatrick's level of educational outcomes, Messick's framework of validity, and a structured quality assessment tool.

Results:

Forty-six studies were included consisting of 21 descriptive studies and 25 educational studies. Thirty-one unique physical and three virtual reality simulation models were identified. The studies report moderate to high realism of the different simulators and trainees and educators perceive them beneficial in training MT skills. Overall, simulation-based training is found to reduce procedure time and errors, and increase performance as measured using different assessment tools. None of the studies used a contemporary validity framework and the current educational evidence is limited.

Conclusion:

Numerous simulation models and assessment tools have been described in the literature but educational evidence and systematic implementation into training curricula is scarce. There is especially a need to establish the effect of simulation-based training of MT in transfer to the operating room and on patient outcomes.
Parametric Assessment of the Effect of Cochlear Implant Positioning on Brain MRI Artefacts at 3 T
Authors: Dewey Rebecca Susan , Dineen Robert A. , Clemence Matthew , Dick Olivier , Bowtell Richard , Kitterick Padraig T.
Published: July 2021

Background:

Brain magnetic resonance imaging in patients with cochlear implants (CIs) is impacted by image artefacts.

Hypothesis:

The optimal positioning of the CI to minimize artefacts is unknown. This study aimed to characterize the dependence of the extent and distribution of the artefact on CI positioning.

Methods:

Three normally hearing individuals underwent magnetic resonance imaging using a standard T1-weighted 3D sequence. Scans were acquired with a non-functioning CI placed underneath a swimming cap at four plausible scalp positions on each side, and without the CI in situ. The artefact in each image was assessed quantitatively using voxel-based techniques. Two radiologists also independently rated the likely impact of the artefact on the detection of pathology for 20 neuroradiological locations.

Results:

The procedure was well tolerated. The most postero-inferior CI positions resulted in the smallest apparent artefacts. Radiological evaluations suggested that artefacts would likely limit pathology detection in the ipsilateral temporal, parietal, and occipital lobes, regardless of CI location. Pathology detection in contralateral structures and anterior corpus callosum was rarely affected. Certain CI locations appeared to selectively spare ipsilateral structures, for example, postero-inferior CI locations selectively spared ipsilateral midbrain, deep grey matter, and frontal lobes.

Conclusion:

A CI placed under a swimming cap is a feasible tool for observing the effect of CI location on image usability within a single subject and potentially informing surgical planning. Regardless of CI placement, artefacts involving ipsilateral parietal, temporal, and occipital lobes severely limited diagnostic image utility. Between 35% and 70% of neuroradiological features were deemed unaffected by the implant.
Disulfiram repurposing in the combined chemotherapy of Chagas disease
Authors: Saraiva Roberto Magalhães , Portela Luciana Fernandes , Silveira Gabriel Parreiras Estolano da , Gomes Natalia Lins da Silva , Pinto Douglas Pereira , Silva Aline Campos de Azevedo da , Sangenis Luiz Henrique Conde , Carneiro Fernanda Martins , Almeida-Silva Juliana , Marinho Patricia Wink , Sperandio-Silva Gilberto Marcelo , Estrela Rita de Cássia Elias , Hasslocher-Moreno Alejandro Marcel , Mediano Mauro Felippe Felix , Moreira Otacilio C. , Britto Constança , Perez Sandra Aurora Chavez , Viçosa Alessandra Lifsitch , Suarez-Fontes Ana Márcia , Vannier-Santos Marcos André
Published: July 2021

Background:

Chagas disease (CD) has high morbimortality and the available trypanocidal treatment, including benznidazole (BZ), has limited efficacy in chronic patients. Furthermore, BZ causes adverse effects (AE) that prevent treatment completion in up to 30% of patients. The use of repositioned drugs or drug combination may provide an effective trypanocidal treatment. Disulfiram (DF) may enhance BZ activity and decrease BZ related AE. This study aims to assess the safety of a new combination of drugs for CD therapy, assuming BZ as the drug of choice plus DF as repositioned drug.

Methods:

This single-centre, open-label, phase I/II clinical trial was designed to evaluate the safety of the combined use of BZ plus DF for CD therapy. Participants are adults with indeterminate form of chronic CD, both sexes, aged from 18 to 70 years old and Trypanosoma cruzi polymerase chain reaction-positive. The primary outcome will be the occurrence of serious AE. The secondary outcome will be post-treatment Trypanosoma cruzi polymerase chain reaction negativization. Six groups of 9 patients will be sequentially tested. The first group will be allocated to receive BZ 100 mg/d + DF 250 mg/d for 60 days. Upon safety confirmation (<1/3 of participants with serious AE), the combination dose will be gradually increased and dispensed to 5 groups (group II:BZ 200 mg/day+DF 250 mg/d; group III:BZ 300 mg/d + DF 250 mg/d; group IV:BZ 100 mg/d + DF 500 mg/d; group V:BZ 200 mg/d + DF 500 mg/d; group VI: BZ 300 mg/d + DF 500 mg/d) for 60 days in order to determine the maximum tolerated dose.

Discussion:

Our hypothesis is that the drug combination will be well tolerated and allow the proposal of phase II trials in larger scale to test the efficacy of the new drug combination in CD. We expect that the studied combination will have less AEs with an efficacy similar or superior to the current treatment. This will allow the successful treatment of a greater number of patients while decreasing the treatment cost as less patients will need treatment for AEs.

Trial registration:

This study was registered on the Brazilian Clinical Trials Database - REBEC (RBR-5n4htp). Registered 7 January 2020. UTN Number: U1111-1246-1293. http://www.ensaiosclinicos.gov.br/rg/RBR-5n4htp/
Corticospinal Tract Microstructure Predicts Distal Arm Motor Improvements in Chronic Stroke
Authors: Kim Bokkyu , Schweighofer Nicolas , Haldar Justin P. , Leahy Richard M. , Winstein Carolee J.
Published: July 2021

Background and Purpose:

The corticospinal tract (CST) is a crucial brain pathway for distal arm and hand motor control. We aimed to determine whether a diffusion tensor imaging (DTI)-derived CST metric predicts distal upper extremity (UE) motor improvements in chronic stroke survivors.

Methods:

We analyzed clinical and neuroimaging data from a randomized controlled rehabilitation trial. Participants completed clinical assessments and neuroimaging at baseline and clinical assessments 4 months later, postintervention. Using univariate linear regression analysis, we determined the linear relationship between the DTI-derived CST fractional anisotropy asymmetry (FAasym) and the percentage of baseline change in log-transformed average Wolf Motor Function Test time for distal items (ΔlnWMFT-distal_%). The least absolute shrinkage and selection operator (LASSO) linear regressions with cross-validation and bootstrapping were used to determine the relative weighting of CST FAasym, other brain metrics, clinical outcomes, and demographics on distal motor improvement. Logistic regression analyses were performed to test whether the CST FAasym can predict clinically significant UE motor improvement.

Results:

lnWMFT-distal significantly improved at the group level. Baseline CST FAasym explained 26% of the variance in ΔlnWMFT-distal_%. A multivariate LASSO model including baseline CST FAasym, age, and UE Fugl-Meyer explained 39% of the variance in ΔlnWMFT-distal_%. Further, CST FAasym explained more variance in ΔlnWMFT-distal_% than the other significant predictors in the LASSO model.

Discussion and Conclusions:

CST microstructure is a significant predictor of improvement in distal UE motor function in the context of an UE rehabilitation trial in chronic stroke survivors with mild-to-moderate motor impairment.

Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A350).
Review: Approaches to Visual-motor Control in Baseball Batting
Authors: Gray Rob
Published: July 2021

SIGNIFICANCE

This review evaluates model-based online approaches to visual-motor control in baseball batting in light of research studies on this topic.

Throughout the history of research on baseball batting, there has been a presumptive winner in terms of how visual-motor control occurs for this complex skill. Because of the severe time constraints and the short duration of the action, it has been assumed that a baseball swing must involve model-based control. That is, hitting involves using an open-loop, pre-programmed movement that is parameterized based on situational probabilities, advance cues from the pitcher's delivery, and information early in the ball flight, which are used by an internal model to predict the future location of the ball. In this review, the author contrasts two variants of this type of model-based control (a 3D world model and spatial memory of trajectories) with an online control approach in which the batter uses only currently available perceptual information to control the swing prospectively via information-movement coupling. It is shown that the assumed necessity of predictive control in baseball batting is based on too narrow of a conception of online control. Although work still needs to be done to elucidate the specifics of the control, it is argued here that online control provides an account of visual-motor control in baseball batting that is both more parsimonious and more consistent with published research findings.
Visual and Ocular Characteristics of eSports Participants
Authors: Fogt Jennifer Swingle , Onate James , Emerson Angela , Kraemer William , Fogt Nick
Published: July 2021

SIGNIFICANCE

The popularity of competitive video game play is growing rapidly. Little is known about the ocular characteristics of esports participants. Refractive error and binocular measures in young adult gamers were similar to population norms. However, tear breakup time was lower, and accommodative lag was higher.

PURPOSE

In a recent report, very young video game players were found to have greater levels of refractive error and heterophoria and reduced stereopsis. The purpose of this study was to assess the visual and ocular characteristics of a group of recreational esports athletes to determine if the findings in young children were similar to findings in a group of young adult video game players.

METHODS

Vision tests were performed on 36 college students during a video game combine event. Testing included high- and low-contrast visual acuity, autorefraction at distance and at 33 cm, stereoacuity, near heterophoria, and tear breakup time. Participants also indicated their level or rank in the game Overwatch.

RESULTS

Fifteen participants were myopic, and 21 did not wear vision correction. The mean local stereopsis was 31.9 seconds. The mean of the esophoric value was 3.2 prism diopters, and the mean of the exophoric value was 5.7 prism diopters. The mean lag of accommodation was 0.81 D. The mean tear breakup time was 5.8 seconds. Average hours of play did not differ between those who wore vision correction and those who did not. There were no significant relationships between the hours of play and the ocular findings.

CONCLUSIONS

The prevalence of refractive error and the mean heterophoria were similar to population norms, and the mean stereoacuity was normal. However, accommodative lag was slightly higher, and the tear breakup time was lower than expected. Differences in these latter values were also noted between high- and low-level Overwatch players.
Pre-participation Vision Screening and Comprehensive Eye Care in National Collegiate Athletic Association Athletes
Authors: Weise Katherine K. , Galt Sarah J. , Hale M. Heath , Springer Daniel B. , Swanson Mark W.
Published: July 2021

SIGNIFICANCE

Pre-participation physical evaluation and its vision screenings have been the mainstay of medical clearance for competitive play for decades. The ability of screening to address athlete's sports-specific vision needs is unknown.

METHODS

Fifty-eight intercollegiate football players consented to participate in a comprehensive, sports-specific eye examination in addition to the standard pre-participation vision screening. Sensitivity, specificity, and positive and negative predictive values were determined for screening's ability to detect athletes whose vision might improve with correction, athletes who had significant ocular findings that impact safety, and either of the two conditions together. The effect no recent eye examination added to pre-participation vision screening results was evaluated for change in screening yield. Descriptive statistics of the cohort and associations with no recent comprehensive eye examination were generated.

RESULTS

The pre-participation vision screening was able to identify three athletes not meeting visual acuity requirements for medical clearance to play without a comprehensive assessment. A failed screening was poorly able to identify athletes who might benefit from improved acuity (sensitivity, 9.1%; specificity, 100%), have sports-specific significant ocular findings (sensitivity, 10.5%; specificity, 97.3%), or have either together (sensitivity, 7.5%; specificity, 100%). Sixty percent (33/55) of athletes reported never having a comprehensive examination or one within the last 10 years. Fifty-eight percent (34/58) had improved best-corrected visual acuity after comprehensive examination, and 81% (47/58) had improved acuity or a sports-specific significant finding.

CONCLUSIONS

The pre-participation vision screening was largely able to identify athletes meeting the minimum visual acuity requirement for athlete clearance. It poorly identified those who might benefit from improved vision with refractive correction and those in whom sport-specific significant eye findings were noted. Comprehensive eye care had a clear benefit for the majority of athletes tested. This benefit needs to be balanced with the potential added costs and time constraints to players and athletic department staff.
Differences between Primary and Revision Rhinoplasty: Indications, Techniques, Grafts, and Outcomes
Authors: Hacker Stefan , Pollock Jonathan , Gubisch Wolfgang , Haack Sebastian
Published: July 2021

Background:

The nose is at the center of the face and has essential functional and aesthetic properties. Over recent years, rhinoplasty has gained increasing popularity through the influence of “selfies” and social media. As a result, a growing demand for secondary correction has also emerged. Revision rhinoplasty is more complex than primary cases and often requires the use of extranasal grafting material. The authors sought to analyze the indications, techniques, and outcomes after primary and revision rhinoplasty.

Methods:

A total of 245 patients (153 primary cases and 92 revisions) undergoing surgery at the authors’ specialized clinic for facial plastic surgery were included. All patients were treated by an experienced facial plastic surgeon according to the authors’ established clinic standards. A retrospective data analysis was performed to evaluate the differences between the groups regarding the indications, intraoperative techniques, and postoperative outcomes.

Results:

Although more patients sought revision surgery for aesthetic reasons alone than isolated functional issues, almost two-thirds of the revision patients had functional and aesthetic problems in combination. Complex reconstructive techniques, extracorporeal septoplasties, and extranasal grafts were more commonly used in revision cases. The occurrence of another revision during the follow-up period was significantly higher after revision surgery compared to primary rhinoplasty cases (primary rhinoplasty, 10.5 percent; revision surgery, 23.9 percent; p = 0.006).

Conclusions:

There are differences between primary and revision rhinoplasty that must be appreciated by the treating surgeon. The patient should be informed about the increased complexity of the secondary procedure, the possible need for extranasal grafts, and the increased risk of a further revision.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Treatment Outcomes and Trajectories of Change in Patients Attributing Their Eating Disorder Onset to Anti-obesity Messaging
Authors: Mensinger Janell L. , Cox Shelbi A. , Henretty Jennifer R.
Published: July 2021

Objective

Given the increased prevalence of eating disorders (EDs) among individuals higher on the weight spectrum, we aimed to 1) report the prevalence of ED patients in higher levels of care (residential, partial hospitalization, and intensive outpatient) attributing the onset of their ED to anti-obesity messaging, 2) report the most commonly recollected sources of those messages, and 3) determine if those attributing the onset of their ED to anti-obesity messaging a) enter, b) exit, and c) respond to treatment differently from peers who did not.

Methods

This retrospective cohort study used data from 2901 patients receiving ED treatment in higher levels of care at a US-based center between 2015 and 2018. Multilevel models examined differences in ED symptoms and trajectories of change over time. NVivo was used to analyze the patients’ comments about sources of messages.

Results

Eighteen percent attributed their ED onset to anti-obesity messaging, 45% did not, and 37% were unsure. Of those providing comments, the most common sources included the following: educational curriculum/school context (45.9%), media/Internet (24.7%), health care (10.4%), family (9%), and peer bullying (3.7%). At admission, patients attributing their ED onset to anti-obesity messaging had more severe ED symptoms than those who did not (γ = 0.463, standard error [SE] = 0.086, p < .001) and those who were unsure (γ = 0.288, SE = 0.089, p < .001); no differences were evident at discharge (p > .483). During phase 2 of treatment, patients attributing their ED onset to anti-obesity messaging improved faster than those who did not (γ = 0.003, SE = 0.001, p = .008) and those who were unsure (γ = 0.003, SE = 0.001, p = .014).

Conclusions

Anti-obesity messaging may put vulnerable individuals at risk for EDs. We recommend increasing weight bias training for school personnel and health care professionals. To reduce health disparities, we also suggest the promotion of weight-neutral health-enhancing self-care practices in media and public health campaigns, legislative policies, and health care overall.
The Cumulative Impact of Chronic Stressors on Risks of Myocardial Infarction in US Older Adults
Authors: Dupre Matthew E. , Farmer Heather R. , Xu Hanzhang , Navar Ann Marie , Nanna Michael G. , George Linda K. , Peterson Eric D.
Published: July 2021

Objective

This study aimed to investigate the association between cumulative exposure to chronic stressors and the incidence of myocardial infarction (MI) in US older adults.

Methods

Nationally representative prospective cohort data of adults 45 years and older (n = 15,109) were used to investigate the association between the cumulative number of chronic stressors and the incidence of MI in US older adults. Proportional hazards models adjusted for confounding risk factors and differences by sex, race/ethnicity, and history of MI were assessed.

Results

The median age of participants was 65 years, 714 (4.7%) had a prior MI, and 557 (3.7%) had an MI during follow-up. Approximately 84% of participants reported at least one chronic stressor at baseline, and more than half reported two or more stressors. Multivariable models showed that risks of MI increased incrementally from one chronic stressor (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.20–1.37) to four or more chronic stressors (HR = 2.71, 95% CI = 2.08–3.53) compared with those who reported no stressors. These risks were only partly reduced after adjustments for multiple demographic, socioeconomic, psychosocial, behavioral, and clinical risk factors. In adults who had a prior MI (p value for interaction = .038), we found that risks of a recurrent event increased substantially from one chronic stressor (HR = 1.30, 95% CI = 1.09–1.54) to four or more chronic stressors (HR = 2.85, 95% CI = 1.43–5.69).

Conclusions

Chronic life stressors are significant independent risk factors for cardiovascular events in US older adults. The risks associated with multiple chronic stressors were especially high in adults with a previous MI.
Perceived Social Support and Latent Herpesvirus Reactivation: Testing Main and Stress-Buffering Effects in an Ethnically Diverse Sample of Adults
Authors: Jiang Yanping , Zilioli Samuele , Stowe Raymond P. , Rubinstein Rebecca , Peek M. Kristen , Cutchin Malcolm P.
Published: July 2021

Objective

Perceived social support is consistently associated with physical health outcomes, and one potential physiological mechanism underlying this association is immune function. In this study, we tested both the main and stress-buffering effects of perceived social support on cellular immunity measured via latent herpesvirus reactivation.

Methods

Data were collected from a community-based sample of 1443 ethnically diverse adults between the ages of 25 and 90 years. Participants self-reported measures of perceived social support, stressful life events, daily hassles, and perceived stress, and provided a blood sample to assess antibody titers to the herpes simplex virus type 1 and Epstein-Barr virus (EBV).

Results

In accordance with the main effect hypothesis, results indicated that perceived social support was directly associated with EBV viral capsid antigen antibody titers (β = −0.06, 95% confidence interval = −0.12 to −0.01, p = .029). Perceived social support, however, did not interact with stressful life events, daily hassles, or perceived stress to influence latent herpesvirus reactivation (p values > .05). Neither race/ethnicity nor age moderated any of the interactions between perceived social support and the stress measures on latent herpesvirus reactivation (p values > .10).

Conclusions

Overall, the current study supports the main effect hypothesis, according to which higher levels of perceived social support were associated with lower levels of herpesvirus antibody titers.
Brief Report: Polymorphisms in TNF-α/TNFR1 Pathway Genes Are Associated With CD4+ T-Cell Recovery in HIV-1–Infected Individuals on Antiretroviral Therapy
Authors: Celerino da Silva Ronaldo , Alves Neyla M. Pereira , Gondim Silva Maria L. , Agrelli Almerinda , Coelho Antonio V. Campos , Guimarães Rafael L. , Arraes Luiz C. , Crovella Sergio , Brandão Lucas A. Cavalcanti
Published: July 2021

Background:

Antiretroviral therapy (ART) is an important hallmark of HIV-1 treatment, enabling viral load suppression to undetectable levels and CD4+ T-cell recovery. However, some individuals do not recover the CD4+ T-cell count to normal levels, despite viral suppression. We hypothesize that variation in genes involved in extrinsic apoptosis pathways may influence interindividual immune recovery during ART.

Methods:

We assessed clinical-epidemiological variables and the allelic/genotypic distribution of functional single nucleotide polymorphisms in genes involved in extrinsic apoptosis pathways (TNFRSF1A: rs1800692 and rs767455; TNFAIP3: rs2270926; NFKBIA: rs8904; and TNF-α: rs1800629) and their relationship with immune recovery in ART-treated (1 year) HIV-1–infected individuals. We enrolled 155 HIV-1–infected individuals, with 102 individuals showing immunological success and 53 with immunological failure.

Results:

Through univariate analysis, we observed that the male sex (60.4%, P = 0.002) showed a higher median of age at treatment onset (34.8 years, P = 0.034) and higher time until virological suppression (6 months, P = 0.035), both risk factors for immune failure. Survival analysis revealed that individuals who started ART treatment with CD4+ T-cell count <200 cells/mm3 took a longer time to immunological recovery (median time = 27 months, P = 0.029). ART containing zidovudine also was associated with immune recovery in univariate e multivariate analysis. Variants in TNFRSF1A (rs767455: T and TT; rs1800692-rs767455: T-T combination) and NFKBIA (rs8904: A) genes were associated with immune failure, whereas NFKBIA (rs8904: GA) and TNF-α (rs1800629: GA) were with CD4+ T-cell recovery.

Conclusions:

Clinical-epidemiological variants in genes involved in extrinsic apoptosis pathways might influence the CD4+ T-cell immune recovery.
Ductal Variant of Prostate Cancer
Authors: Alabed Yazan Z.
Published: July 2021

A 51-year-old man with high-grade ductal variant of prostate cancer with normal prostate-specific antigen (PSA) levels underwent radical prostatectomy. Follow-up 18F–prostate-specific membrane antigen-targeted ligand 1007 (PSMA-1007) PET/CT revealed enlarged PSMA-expressing left common iliac node. Patient was placed on androgen deprivation therapy and was lost to follow-up. Repeat 18F-PSMA PET/CT scan after 16 months showed disease progression. PSA levels were still within normal limits. This case highlights the utility of 18F-PSMA PET/CT for staging and follow-up of patients with this rare ductal variant prostate cancer with normal PSA levels.
99mTc-Pyrophosphate Retention in Atelectatic Pulmonary Tissues of a Patient With Transthyretin Cardiac Amyloidosis
Authors: Pan Yu , Wang Yue , Zhou Yilei , Xi Yun , Zhang Yifan
Published: July 2021

A 61-year-old man was hospitalized for suspected cardiac amyloidosis. 99mTc-Pyrophosphate scintigraphy showed intense radiotracer uptake in the heart compared with the ribs, suggestive of transthyretin cardiac amyloidosis. Subsequent genetic test showed missense mutations in the transthyretin gene, which confirmed the diagnosis. Incidentally, a regional radiotracer uptake was seen in the bilateral lungs, respectively, corresponding to areas of atelectasis on the localizing CT of the SPECT/CT. Attention should be paid to radiotracer retention in lung atelectasis as it influences the H/CL (heart–to–contralateral lung) ratio calculation and may hinder the diagnosis of cardiac amyloidosis based on the quantitative H/CL ratio.
DOTATATE Uptake in an Axillary Lymph Node After COVID-19 Vaccination
Authors: Brophy James , Henkle Gregory , Rohren Eric M.
Published: July 2021

A 58-year-old man underwent DOTATATE PET/CT scan for follow-up of pulmonary neuroendocrine tumor after resection and adjuvant chemotherapy. On screening paperwork, the patient indicated having received the Johnson & Johnson/Janssen COVID-19 vaccine (Janssen Biotech, Inc) 1 day previously, administered in the right deltoid muscle. Reactive changes in regional lymph nodes is a known response for all 3 currently Food and Drug Administration–approved COVID-19 vaccines. Recent published data have demonstrated FDG PET-avid axillary lymphadenopathy subsequent to COVID-19 vaccination, and included here is a report of DOTATATE PET-avid axillary lymph node after injection of the Johnson & Johnson COVID-19 vaccine.
Differentiation of Pulmonary Lymphoma Manifestations and Nonlymphoma Infiltrates in Possible Invasive Fungal Disease Using Fast T1-weighted Magnetic Resonance Imaging at 3 T Comparison of Texture Analysis, Mapping, and Signal Intensity Quotients
Authors: Jensen Laura J. , Kim Damon , Elgeti Thomas , Steffen Ingo G. , Hamm Bernd , Nagel Sebastian N.
Published: July 2021

Purpose:

This study aimed to evaluate the diagnostic performance of texture analysis (TA), T1 mapping, and signal intensity quotients derived from fast T1-weighted gradient echo (T1w GRE) sequences for differentiating pulmonary lymphoma manifestations and nonlymphoma infiltrates in possible invasive fungal disease in immunocompromised hematological patients.

Materials and Methods:

Twenty patients with hematologic malignancies and concomitant immunosuppression (including 10 patients with pulmonary lymphoma manifestations and 10 patients with nonlymphoma infiltrates) prospectively underwent 3 T magnetic resonance imaging using a conventional T1w GRE sequence and a T1w GRE mapping sequence with variable flip angle. A region of interest was placed around the most representative lesion in each patient. TA was performed using PyRadiomics. T1 relaxation times were extracted from precompiled maps and calculated manually. Signal intensity quotients (lesion/muscle) were calculated from conventional T1w GRE sequences.

Results:

Of all TA features, variance, mean absolute deviation, robust mean absolute deviation, interquartile range, and minimum were significantly different between the 2 entities (P<0.05), with excellent diagnostic performance in receiver operating characteristic analysis (area under the curve [AUC] >80%). Neither T1 relaxation times from precompiled maps (AUC=63%; P=0.353) nor manual calculation (AUC=63%; P=0.353) nor signal intensity quotients (AUC=70%; P=0.143) yielded significant differences.

Conclusions:

TA from fast T1w GRE images can differentiate pulmonary lymphoma manifestations and nonlymphoma infiltrates in possible invasive fungal disease with excellent diagnostic performance using the TA features variance, mean absolute deviation, robust mean absolute deviation, interquartile range, and minimum. Combining a fast T1w GRE sequence with TA seems to be a promising tool to differentiate these 2 entities noninvasively.