bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining Spatial Distribution and Spread of Fire Blight in Apple Orchards: Two Case Studies
Authors: Wallis Anna , Cox Kerik D.
Published: July 2021

Fire blight, caused by the bacteria Erwinia amylovora, is an incredibly destructive disease of apples, capable of spreading rapidly through an orchard block. The pathogen is endemic to many apple production regions worldwide, but it is often introduced into newly planted sites on infested host material, while locally it is typically vectored by wind-driven rain, hail, and insects. Here we presented two case studies of orchard blocks infected with fire blight at the Cornell AgriTech Research orchards in which CRISPR pattern characterization was used to identify strains present in the blocks and spatial analyses were used to describe the distribution and spread of the disease over the course of 2 years. Results indicated two very different sources of introduction (a nearby block or planting material) and patterns of spread (from a corner of the field or from focal points within the block). Describing the distribution and spread of fire blight within and between orchard blocks has the potential to improve our understanding of the disease movement, inform appropriate management recommendations, and facilitate traceback efforts.
Biochemical and Histological Insights into the Interaction Between the Canker PathogenNeofusicoccum parvumandPrunus dulcis
Authors: Pouzoulet Jerome , Yelle Daniel J. , Theodory Bassam , Nothnagel Eugene A. , Bol Sebastiaan , Rolshausen Philippe E.
Published: July 2021

The number of reports associated with wood dieback caused by fungi in the Botryosphaeriaceae in numerous perennial crops worldwide has significantly increased in the past years. In this study, we investigated the interactions between the canker pathogen Neofusicoccum parvum and the almond tree host (Prunus dulcis), with an emphasis on varietal resistance and host response at the cell wall biochemical and histological levels. Plant bioassays in a shaded house showed that among the four commonly planted commercial almond cultivars (‘Butte’, ‘Carmel’, ‘Monterey’, and ‘Nonpareil’), there was no significant varietal difference with respect to resistance to the pathogen. Gummosis was triggered only by fungal infection, not by wounding. A two-dimensional nuclear magnetic resonance and liquid chromatography determination of cell wall polymers showed that infected almond trees differed significantly in their glycosyl and lignin composition compared with healthy, noninfected trees. Response to fungal infection involved a significant increase in lignin, a decrease in glucans, and an overall enrichment in other carbohydrates with a profile similar to those observed in gums. Histological observations revealed the presence of guaiacyl-rich cell wall reinforcements. Confocal microscopy suggested that N. parvum colonized mainly the lumina of xylem vessels and parenchyma cells, and to a lesser extent the gum ducts. We discuss the relevance of these findings in the context of the compartmentalization of decay in trees model in almond and its potential involvement in the vulnerability of the host toward fungal wood canker diseases.
Vernal keratoconjunctivitis and keratoconus
Authors: Wajnsztajn Denise , Solomon Abraham
Published: July 2021

Purpose of review

Vernal keratoconjunctivitis (VKC) is a severe allergic inflammatory disease affecting the conjunctiva in children and young adults. Keratoconus (KC) is a progressive corneal disease characterized by thinning of the corneal stroma, increased and asymmetric corneal curvature, with a potential for significant visual deterioration and is one of the most common corneal complications of VKC. We aimed to review the association of these two diseases, with focus on the mechanisms, prevalence, natural history and treatment strategies of KC associated with VKC.

Recent findings

KC is a common complication of VKC. KC prevalence can be as high as 26.8% among VKC patients, whereas abnormal corneal topography may appear in up to 71% of them. It is more severe and progresses faster in the setting of VKC (P < 0.05), with remarkable visual deterioration and with an increased need for keratoplasty. Crosslinking treatment and corneal transplantation appear to be as effective for KC patients with VKC as compared to the patients without VKC. However, postoperative complications are higher in patients with VKC and demand close monitoring, tight control of local inflammation and prompt awareness with consequent restrain of eye rubbing.

Patients with VKC should be closely monitored for KC. Prompt recognition of VKC and KC allows tight control of KC pathogenesis mechanisms, timely management of KC progression and preservation of vision and quality of life of young patients.
Anesthesia, Blood Pressure, and Socioeconomic Status in Endovascular Thrombectomy for Acute Stroke: A Single Center Retrospective Case Cohort
Authors: Hoefnagel Amie L. , Yao Joyce , Rao Dinesh , Kovacs Peter , Brzezicki Grzegorz , Mongan Paul D.
Published: July 2021

Introduction:

Mechanical thrombectomy (MT) is standard for acute ischemic stroke (AIS), with early studies suggesting that general anesthesia (GA) is associated with worse outcomes than monitored anesthesia care (MAC). Socioeconomic deprivation is also a risk factor for worse AIS outcomes. With improvements in MT and blood pressure (BP) management, it remains unclear if GA or socioeconomic deprivation are risk factors for worse outcomes after MT.

Methods:

We retrospectively analyzed 125 consecutive AIS patients presenting for MT at a comprehensive stroke center serving patients with high levels of socioeconomic deprivation. The primary objective was impact of GA versus MAC on functional independence at 90 days. Secondary outcomes included procedural BP, and impact of BP and socioeconomic deprivation (assessed by the area of deprivation index) on outcomes.

Results:

A 90-day outcomes were similar in patients undergoing MT with GA or MAC. The area of deprivation index was similar in GA and MAC groups and in patients with good versus poor 90-day outcomes. There were similar numbers of patients with mean arterial pressure (MAP) <60 mm Hg in the MAC and GA groups (8 vs. 11; P=0.21), but more patients with MAP <70 mm Hg in the GA group (28 vs. 9; P<0.001). Median (interquartile range) duration of MAP <70 mm Hg was 10 (5 to 15) and 20 (10 to 36) minutes in the MAC and GA groups, respectively (P<0.001); however, these MAPs were not associated with worse 90-day outcomes.

Conclusion:

Anesthesia and MAP did not affect MT outcomes. The cohort is unique based on an area of deprivation index in the higher deciles in the United States. While the area of deprivation index was not associated with worse outcomes, further study is warranted.
Effect of Ethical Leadership on Moral Sensitivity in Chinese Nurses
Authors: Zhang Na , Bu Xing , Xu Zhen , Gong Zhenxing , Gilal Faheem Gul
Published: July 2021

To explore the relationship between ethical leadership (a contextual factor at the higher organizational level) and nurses' moral sensitivity (the individual outcome at a lower level), a cross-sectional quantitative study design was used. Participants were 525 nurses at 65 various departments in public tertiary hospitals. These results showed that ethical climate played a mediating role in the relationship between ethical leadership and nurses' moral sensitivity. Moreover, nurses' employment type moderated the mediating effect of ethical leadership on their moral sensitivity. Additionally, the link between ethical climate and moral sensitivity of contract nurses was stronger than that of nurses employed by the state.
Complexities in Studying and Practicing Nursing—A Theoretical Elaboration Based on Reflections by Nurses and Nursing Students
Authors: Öhlén Joakim , Bramstång Annette , Lundin Gurné Frida , Pihlgren Anneli , Thonander Marie , Kirkevold Marit
Published: July 2021

The aim of this study was to explore nursing students' and clinically active nurses' experiential ideas about nursing to provide a foundation for a critical reflection on the complexities involved in studying and practicing nursing. Using a participatory approach, 9 experiential ideas about nursing as a subject, nursing practice, and being a nurse were identified and reflected upon with a total of 238 participants. This was followed by a theoretical analysis in relation to the clinical gaze in nursing and epistemology, which ends in an argument for a rediscovery of the broader Aristotelian view of knowledge in nursing education and practice.
Open Reduction and Internal Fixation for Humeral Shaft Nonunion: Bone Grafting Is Not Routinely Required and Avoids Donor Site Morbidity
Authors: Oliver William M. , Molyneux Samuel G. , White Timothy O. , Clement Nicholas D. , Duckworth Andrew D. , Keating John F.
Published: July 2021

Objectives:

To document union rate, complications and patient-reported outcomes after open reduction and internal fixation (ORIF), with and without bone grafting (BG), for humeral diaphyseal nonunion after failed nonoperative management.

Design:

Retrospective.

Setting:

University teaching hospital.

Patients and Intervention:

From 2008 to 2017, 86 consecutive patients [mean age 59 years (range 17–86), 71% (n = 61/86) women] underwent nonunion ORIF (plate and screws) at a mean of 7 months postinjury (range 3–21.5). Eleven (13%) underwent supplementary BG.

Main Outcome Measurements:

Union rate and complications for 83 patients (97%) at a mean of 10 months (3–61). Patient-reported outcomes (QuickDASH, EQ-5D, EQ-VAS, SF-12, satisfaction) for 53 living, cognitively-intact patients (78%) at a mean of 4.9 years (0.3–9.2).

Results:

Ninety-three percent (n = 77/83) achieved union after nonunion ORIF. Complications included recalcitrant nonunion (7%, n = 6/83), iatrogenic radial nerve palsy (6%, n = 5/83), infection (superficial 7%, n = 6/83; deep 2%, n = 2/83), and iliac crest donor site morbidity (38%, n = 3/8). The union rate with BG was 78% (n = 7/9) and without was 95% (n = 70/74; P = 0.125), and was not associated with the nonunion type (atrophic 91%, n = 53/58; hypertrophic 96%, n = 24/25; P = 0.663). Median QuickDASH was 22.7 (0–95), EQ-5D 0.710 (−0.181-1), EQ-visual analog scale 80 (10–100), SF-12 physical component summary 41.9 (16–60.5), and mental component summary 52.6 (18.7–67.7). Nineteen percent (n = 10/53) were dissatisfied with their outcome.

Conclusions:

ORIF for humeral diaphyseal nonunion was associated with a high rate of union. Routine BG was not required and avoided the risk of donor site morbidity. One in 5 patients were dissatisfied despite the majority achieving union.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Height Gain Prediction in Adolescent Idiopathic Scoliosis Based on Preoperative Parameters
Authors: Smorgick Yossi , Tamir Eran , Mirovsky Yigal , Rabau Oded , Lindner Dror , Anekstein Yoram
Published: July 2021

Background:

The purpose of the study was to identify preoperative parameters which are associated with height gain after corrective surgery for adolescent idiopathic scoliosis (AIS) and their use to preoperatively quantify the potential for height gain after AIS correction.

Methods:

Our study included 87 consecutive patients with AIS who underwent posterior fusion. Patients’ height was measured the day before surgery and before their discharge. Demographic and radiologic variables were analyzed for predictability of height gain.

Results:

The mean height gain was 3.85 cm. We have found a statistically significant correlation between height gain and the following measures: preoperative thoracic curve, preoperative thoracolumbar curve, preoperative thoracic kyphosis, flexibility of the main thoracic and thoracolumbar curves, and number of fused levels (all P<0.05). Patients with Lenke type 1 and 2 had statistically less height gain compared with patients with Lenke type 3, 4, 6.

Conclusion:

Most of the scoliosis patients with Lenke type 1 and 2 will gain up to 3 cm after surgery while most of the patients with Lenke type 3, 4, 6 will gain more than 3 cm. Most patients with Lenke type 3, 4, 6 with a major curve of less than 60 degrees will gain up to 4 cm, while most of those with a major curve of more than 60 degrees will gain more than 4 cm. Patient with a positive thoracic sagittal modifier tend to have more height gain after surgery.
Can Postoperative Distal Adding-On be Predicted in Lenke Type 1B and 1C Curves with Intraoperative Radiographs?
Authors: Fujii Takeshi , Kawabata Soya , Suzuki Satoshi , Tsuji Osahiko , Nori Satoshi , Okada Eijiro , Nagoshi Narihito , Yagi Mitsuru , Michikawa Takehiro , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: July 2021

Study Design.

A retrospective study of consecutive collected data.

Objective.

To investigate risk factors for postoperative distal adding-on (DA) in Lenke Type 1B and 1C curves using intraoperative radiographs.

Summary of Background Data.

In adolescent idiopathic scoliosis (AIS), DA radiographic complication can negatively affect postoperative clinical results. However, few studies have focused on assessing risk factors for DA using intraoperative radiographs.

Methods.

We retrospectively evaluated 69 AIS patients with Lenke Type 1B or 1C curves who underwent posterior selective thoracic fusion. We divided patients into DA and non-DA groups based on radiograph data at 2-year follow-up using Wang et al (Spine 2011) definition of DA. We compared coronal radiographic parameters, including relative positions of end vertebra (EV), stable vertebra (SV), neutral vertebra (NV), and last touching vertebra (LTV) to lowest instrumented vertebra (LIV), and intraoperative radiographic parameters, between the two groups.

Results.

DA was present in 13 patients (18.8%) at 2-year follow-up. The mean LIV–EV, LIV–NV, LIV–SV, and LIV–LTV relative positions were significantly smaller in the DA group than in the non-DA group. Multivariate analysis showed that LIV–LTV was significantly associated with DA (DA: −0.2 ± 0.7, non-DA: 0.6 ± 0.7). Intraoperative radiographs showed that the mean angulation of the first disc below the LIV after final adjustment was significantly larger in the DA group (2.3° ± 1.1°) than in the non-DA group (0.9° ± 0.7°). Patients whose angulation of the first disc below the LIV was more than 3° were significantly associated with DA.

Conclusion.

The LIV selected at more cranial to the LTV may be a risk factor for postoperative DA in Lenke Type 1B and 1C curves. Moreover, it was suggested that LIV extension might be considered when the first disc's angulation below the LIV is >3° in intraoperative radiographs.

Level of Evidence: 3
Six-Month Pulmonary Function After Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 Patients
Authors: Ego Amédée , Taton Olivier , Brasseur Alexandre , Laurent Yves , Taccone Fabio Silvio , Courcelle Romain
Published: July 2021

OBJECTIVES:

Venovenous extracorporeal membrane oxygenation has been largely used in patients with refractory acute respiratory distress syndrome due to coronavirus disease 2019. Few data on long-term pulmonary function among venovenous extracorporeal membrane oxygenation survivors are available.

DESIGN:

Retrospective, observational cohort.

SETTING:

Two mixed medical-surgical tertiary (30 beds) and secondary (22 beds) ICUs.

PATIENTS:

All critically ill adult coronavirus disease 2019 survivors treated with venovenous extracorporeal membrane oxygenation between March 10, and April 30, 2020.

MEASUREMENTS AND MAIN RESULTS:

The last available lung function and 6-minute walking tests, performed after a median of 178 days (ranges, 72–232 d) from ICU admission, were analyzed. Among the 32 coronavirus disease 2019 patients treated by venovenous extracorporeal membrane oxygenation during the study period, 11 (34%; median age 56 yr; median duration of mechanical ventilation and extracorporeal membrane oxygenation therapy of 26 and 15 d, respectively) were successfully weaned and discharged home. Spirometry was performed in nine patients; the volumetric lung function was preserved, that is, median forced vital capacity was 83% of predicted value (51–99% of predicted value), and median forced expiratory volume in 1 second was 82% of predicted value (60–99% of predicted value). Also, the median residual volume and the lung capacity were 100% of predicted value (50–140% of predicted value) and 90% of predicted value (50–100% of predicted value); only the diffusion capacity of the lung for carbon monoxide and 6-minute walking test were decreased (58% of predicted value [37–95% of predicted value] and 468 meters (365–625 meters), corresponding to [63–90% of predicted value], respectively).

CONCLUSIONS:

Among survivors from severe coronavirus disease 2019 pneumonia treated with venovenous extracorporeal membrane oxygenation, preserved long-term volumetric lung function with decreased diffusion capacity of lung carbon monoxide was observed.
Natriuretic Peptide Levels and Clinical Outcomes Among Patients Hospitalized With Coronavirus Disease 2019 Infection
Authors: Aslam M. Imran , Minhas Anum , Ghorbani Anahita , Shade Julie K. , Jani Vivek , Hsu Steven , Sharma Kavita , Cihakova Daniela , Hays Allison G. , Gilotra Nisha A.
Published: July 2021

OBJECTIVES:

There is increasing evidence of cardiovascular morbidity associated with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019). Pro-B-type natriuretic peptide is a biomarker of myocardial stress, associated with various respiratory and cardiac outcomes. We hypothesized that pro-B-type natriuretic peptide level would be associated with mortality and clinical outcomes in hospitalized coronavirus disease 2019 patients.

DESIGN:

We performed a retrospective analysis using adjusted logistic and linear regression to assess the association of admission pro-B-type natriuretic peptide (analyzed by both cutoff > 125 pg/mL and log transformed pro-B-type natriuretic peptide) with clinical outcomes. We additionally treated body mass index, a confounder of both pro-B-type natriuretic peptide levels and coronavirus disease 2019 outcomes, as an ordinal variable.

SETTING:

We reviewed hospitalized patients with coronavirus disease 2019 who had a pro-B-type natriuretic peptide level measured within 48 hours of admission between March 1, and August 31, 2020, from a multihospital U.S. health system.

PATIENTS:

Adult patients (≥ 18 yr old; n = 1232) with confirmed coronavirus disease 2019 admitted to the health system.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

After adjustment for demographics, comorbidities, and troponin I level, higher pro-B-type natriuretic peptide level was significantly associated with death and secondary outcomes of new heart failure, length of stay, ICU duration, and need for ventilation among hospitalized coronavirus disease 2019 patients. This significance persisted after adjustment for body mass index as an ordinal variable. The adjusted hazard ratio of death for log transformed pro-B-type natriuretic peptide was 1.56 (95% CI, 1.23–1.97; p < 0.0001).

CONCLUSIONS:

Further investigation is warranted on the utility of pro-B-type natriuretic peptide for clinical prognostication in coronavirus disease 2019 as well as implications of abnormal pro-B-type natriuretic peptide in the underlying pathophysiology of coronavirus disease 2019–related myocardial injury.
Human papillomavirus distribution and cervical cancer epidemiological characteristics in rural population of Xinjiang, China
Authors: Wang Yan , Cai Ying-Bin , James William , Zhou Jian-Lin , Rezhake Remila , Zhang Qian
Published: July 2021

Background:

Cervical cancer remains a major public health issue for the Uyghur women and other women living mainly in rural areas of Xinjiang. This study aims to investigate the distribution of human papillomavirus (HPV) infection and cervical cancer in rural areas of Xinjiang, China.

Methods:

Cervical cancer screening was performed on rural women aged 35 to 64 years from Xinjiang, China in 2017 through gynecological examination, vaginal discharge smear microscopy, cytology, and HPV testing. If necessary, colposcopy and biopsy were performed on women with suspicious or abnormal screening results.

Results:

Of the 216,754 women screened, 15,518 received HPV testing. The HPV-positive rate was 6.75% (1047/15,518). Compared with the age 35–44 years group, the odds ratios (ORs) of HPV positivity in the age 45–54 years and 55–64 years groups were 1.18 (95% confidence interval [CI]: 1.02–1.37) and 1.84 (95% CI: 1.53–2.21), respectively. Compared with women with primary or lower education level, the ORs for HPV infection rates of women with high school and college education or above were 1.37 (95% CI: 1.09–1.72) and 1.62 (95% CI: 1.23–2.12), respectively. Uyghur women were less likely to have HPV infection than Han women, with an OR (95% CI) of 0.78 (0.61–0.99). The most prevalent HPV types among Xinjiang women were HPV 16 (24.00%), HPV 33 (12.70%), and HPV 52 (11.80%). The detection rate of cervical intraepithelial neoplasia (CIN)2+ was 0.14% and the early diagnosis rate of cervical cancer was 85.91%. The detection rates of vaginitis and cervicitis were 19.28% and 21.32%, respectively.

Conclusions:

The HPV infection rate in Xinjiang is low, but the detection rate of cervical cancer and precancerous lesions is higher than the national average level. Cervical cancer is a prominent public health problem in Xinjiang, especially in southern Xinjiang.
Hippocampus chronic deep brain stimulation induces reversible transcript changes in a macaque model of mesial temporal lobe epilepsy
Authors: Chen Ning , Zhang Jian-Guo , Han Chun-Lei , Meng Fan-Gang
Published: July 2021

Background:

Deep brain stimulation (DBS) has seizure-suppressing effects but the molecular mechanisms underlying its therapeutic action remain unclear. This study aimed to systematically elucidate the mechanisms underlying DBS-induced seizure suppression at a molecular level.

Methods:

We established a macaque model of mesial temporal lobe epilepsy (mTLE), and continuous high-frequency hippocampus DBS (hip-DBS) was applied for 3 months. The effects of hip-DBS on hippocampus gene expression were examined using high-throughput microarray analysis followed by bioinformatics analysis. Moreover, the microarray results were validated using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot analyses.

Results:

The results showed that chronic hip-DBS modulated the hippocampal gene expression. We identified 4119 differentially expressed genes and assigned these genes to 16 model profiles. Series test of cluster analysis showed that profiles 5, 3, and 2 were the predominant expression profiles. Moreover, profile 5 was mainly involved in focal adhesion and extracellular matrix-receptor interaction pathway. Nine dysregulated genes (Arhgap5, Col1a2, Itgb1, Pik3r1, Lama4, Fn1, Col3a1, Itga9, and Shc4) and three genes (Col1a2, Itgb1, and Flna) in these two pathways were further validated by qRT-PCR and Western blot analyses, respectively, which showed a concordance.

Conclusion:

Our findings suggest that hip-DBS could markedly reverse mTLE-induced abnormal gene expression. Findings from this study establish the basis for further investigation of the underlying regulatory mechanisms of DBS for mTLE.
Outcomes of Stereotactic Radiosurgery and Immunotherapy in Renal Cell Carcinoma Patients With Brain Metastases
Authors: Uezono Haruka , Nam David , Kluger Harriet M. , Sznol Mario , Hurwitz Michael , Yu James B. , Chiang Veronica L.
Published: July 2021

Objective:

The impact of immunotherapy and stereotactic radiosurgery (SRS) in treatment of brain metastases (BM) from renal cell carcinoma (RCC) has not been well investigated.

Materials and Methods:

Forty-eight patients with 372 RCC BM were treated with SRS and divided into those ever treated with immunotherapy versus those who never received immunotherapy. Survival and local control (LC) outcomes were studied. χ2 and Mann-Whitney U tests compared categorical and continuous variables, respectively. Kaplan-Meier curves were used to estimate survival and log-rank test was used to compare survival between groups.

Results:

Immunotherapy and nonimmunotherapy groups contained 29 and 19 patients, respectively. Median follow-up was 23.1 months (range, 6 to 93.8 mo). Demographic and treatment variables were similar except median prescribed margin dose was significantly lower in immunotherapy group (20 vs. 22 Gy, P<0.0001). Median overall survival (OS) was 27.2 months (immunotherapy) and 14.9 months (nonimmunotherapy), P=0.14. Furthermore, patients treated with immune checkpoint inhibitor (ICI) had even better median OS compared with those who never received ICI (33 vs. 16.7 mo, P=0.03). Factors associated with improved LC were use of ICI (P=0.002) and lesion size <1000 mm3 (P=0.046). There was no difference in incidence of radiation necrosis between the 2 groups (P=0.67).

Conclusions:

Patients with RCC BM undergoing SRS can experience prolonged survival when treated with ICI. Equally effective LC of BM was achieved when treated with immunotherapy using a 2 Gy decrease in SRS dose without increasing the risk of central nervous system toxicity.
Matched-pair Analysis for Survival Endpoints Between Women With Early-stage Uterine Carcinosarcoma and Uterine Serous Carcinoma
Authors: Yahya Jehan B. , Zhu Simeng , Burmeister Charlotte , Hijaz Miriana Y. , Elshaikh Mohamed A.
Published: July 2021

Objective:

The objective of this study was to compare survival endpoints between women with uterine carcinosarcoma and those with uterine serous carcinoma utilizing matching analysis.

Methods:

Patients with stages I to II who underwent hysterectomy at our institution were included in this analysis. Patients with carcinosarcoma were then matched to patients with serous carcinoma based on stage, and adjuvant management received (observation, radiation treatment alone, chemotherapy alone, or combined modality with radiotherapy and chemotherapy. Recurrence-free survival, disease-specific survival, and overall survival were calculated for the 2 groups.

Results:

A total of 134 women were included (67 women with carcinosarcoma and 67 with serous carcinoma, matched 1:1). There was no statistically significant difference between the 2 groups regarding 5-year recurrence-free survival (59% vs. 62%), disease-specific survival (66% vs. 67%), or overall survival (53% vs. 57%), respectively. The only independent predictor of shorter recurrence-free survival for the entire cohort was the lack of adjuvant combined modality therapy, while lower uterine segment involvement was the only independent predictor for shorter disease-specific survival. Lack of lymph node dissection and lack of adjuvant combined modality therapy were independent predictors of shorter overall survival.

Discussion:

When matched based on stage and adjuvant treatment, our study suggests that there is no statistically significant difference in survival endpoints between women with early-stage carcinosarcoma and serous carcinoma. Adjuvant combined modality treatment is an independent predictor of longer recurrence-free survival and overall survival.
A New Approach for Classifying Fetal Growth Restriction
Authors: Hutcheon Jennifer A. , Riddell Corinne A. , Himes Katherine P.
Published: July 2021

Background:

Fetal growth restriction is commonly defined using small for gestational age (SGA) birth (birthweight < 10th percentile) as a proxy, but this approach is problematic because most SGA infants are small but healthy. In this proof-of-concept study, we sought to develop a new approach for identifying fetal growth restriction at birth that combines information on multiple, imperfect measures of fetal growth restriction in a probabilistic manner.

Methods:

We combined information on birthweight, placental weight, placental malperfusion lesions, maternal disease, and fetal acidemia using latent profile analysis to classify fetal growth in births at the Royal Victoria Hospital in Montreal, Canada, 2001–2009. We examined the clinical characteristics and health outcomes of infants classified as growth-restricted and nongrowth-restricted by our model, and among the subgroup of growth-restricted infants who had a birthweight ≥10th percentile (i.e., would have been missed by the conventional SGA proxy).

Results:

Among 26,077 births, 345 (1.3%) were classified as growth-restricted by our latent profile model. Growth-restricted infants were more likely than nongrowth-restricted infants to have an Apgar score <7 (10% vs. 2%), have hypoglycemia at birth (17% vs. 3%), require neonatal intensive care unit admission (59% vs. 6%), die in the perinatal period (3.8% vs. 0.2%), and require an emergency cesarean delivery (42% vs. 15%). Risks remained elevated in growth-restricted infants who were not SGA, suggesting our model identified at-risk infants not detected using the SGA proxy.

Conclusions:

Latent profile analysis is a promising strategy for classifying growth restriction at birth in fetal growth restriction research.
Can We Reach a Consensus on the Appropriate Use of Before and After Photos in Breast Surgery?
Authors: Valiquette Chantal R. , Forrest Christopher R. , Kasrai Leila , Wanzel Kyle R. , Martou Glykeria , Beber Brett A. , Semple John L. , Constantine Thomas , Ho Emily S. , Somogyi Ron B.
Published: July 2021

Background:

Breast surgery is an area of practice where patients value before and after photographs (BAPs). Consensus is needed to develop guidelines to address the deficit in the literature regarding appropriate use of BAPs, as these may ultimately play a significant role in the breast surgery consent process.

Methods:

Expert breast reconstructive surgeons participated in a modified nominal group technique (NGT) to establish expert consensus on categories and criteria to be used when evaluating appropriate use of BAPs as part of informed consent. Endorsement rate of 75% and coefficients of variance within and between rounds were conducted to determine validity of each criteria item’s rank order.

Results:

Eight experts participated in the NGT in-person meeting and subsequent online survey. five of seven categories were endorsed for discussion: purpose, image type, anatomy, results, and photographic integrity. Overall consensus was obtained for six of 11 criteria. Criteria items found to have consensus were: patients considering surgery being the intended photograph audience (100% endorsement, CV1 – CV2 = 0.01), use of photographic images (75% endorsement, CV1 – CV2 = 0.04), defining the standard clinical photograph by having patients in the same body position (100% endorsement, CV1 – CV2 = 0.14), anonymizing images by removing all digital tags (88% endorsement, CV1 – CV2 = 0.03) and patient identifiers (75% endorsement, CV1 – CV2 = 0.00), not limiting the number of photograph sets needed for sufficient representation (100% endorsement, CV1 – CV2 = 0.07), and representing average outcomes (100%, CV1 – CV2 = 0.06).

Conclusions:

Early use of this validated and effective technique helps identify potential consensus categories and criteria that surgeons recommend for the use of BAPs in the informed consent process. Further study is required.
Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension
Authors: Parati Gianfranco , Stergiou George S. , Bilo Grzegorz , Kollias Anastasios , Pengo Martino , Ochoa Juan Eugenio , Agarwal Rajiv , Asayama Kei , Asmar Roland , Burnier Michel , De La Sierra Alejandro , Giannattasio Cristina , Gosse Philippe , Head Geoffrey , Hoshide Satoshi , Imai Yutaka , Kario Kazuomi , Li Yan , Manios Efstathios , Mant Jonathan , McManus Richard J. , Mengden Thomas , Mihailidou Anastasia S. , Muntner Paul , Myers Martin , Niiranen Teemu , Ntineri Angeliki , O’Brien Eoin , Octavio José Andres , Ohkubo Takayoshi , Omboni Stefano , Padfield Paul , Palatini Paolo , Pellegrini Dario , Postel-Vinay Nicolas , Ramirez Agustin J. , Sharman James E. , Shennan Andrew , Silva Egle , Topouchian Jirar , Torlasco Camilla , Wang Ji Guang , Weber Michael A. , Whelton Paul K. , White William B. , Mancia Giuseppe
Published: July 2021

The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
Effect of Face Mask on Tear Film Stability in Eyes With Moderate-to-Severe Dry Eye Disease
Authors: Arriola-Villalobos Pedro , Burgos-Blasco Barbara , Vidal-Villegas Beatriz , Oribio-Quinto Carlos , Ariño-Gutiérrez Mayte , Diaz-Valle David , Benitez-del-Castillo Jose Manuel
Published: July 2021

Purpose:

The purpose of this study was to evaluate whether tear film stability worsens with the use of masks in patients with dry eye disease, objectively analyzing the tear film stability using noninvasive tear film breakup time (NITBUT) with and without a face mask.

Methods:

A cross-sectional study including patients with moderate or severe dry eye disease was conducted. Tear stability was measured using an Oculus Keratograph 5M (Oculus, Wetzlar, Germany), which records NITBUT, both first and average NITBUT. Two measurements were taken: an initial measurement with a mask and a second measurement after 10 minutes without wearing the face mask.

Results:

Thirty-one patients were included with a mean age of 57.6 ± 11.7 years (range 31–80) and 30 being female (97%). Mean first NITBUT with face mask was 6.2 ± 3.8 seconds (range 2.0–19.8), which increased to 7.8 ± 5.6 seconds (range 2.3–24.0) without the use of mask (P = 0.029), differences being −1.6 ± 0.7 seconds (CI 95% −3.1075 to −0.1770). Mean average NITBUT with a face mask was 12.3 ± 4.8 seconds (range 4.0–19.4) and increased to 13.8 ± 5 seconds (range 5.5–24.0) without the use of mask (P = 0.006), mean difference being −1.5 ± 0.5 seconds (CI 95% −2.5290 to −0.4458).

Conclusions:

Face mask use decreases tear film stability in patients with moderate-to-severe dry eye.
Clinical Outcomes of a New Type of Continuous Intrastromal Corneal Ring for Treatment of Keratoconus
Authors: Jabbarvand Mahmoud , Ahmadzadeh Hooman , Khodaparast Mehdi , Jamali Alireza , Aghamirsalim Mohamadreza
Published: July 2021

Purpose:

The purpose of this study was to evaluate the efficacy and safety of implantation of a new continuous corneal ring in keratoconic corneas of an Iranian population.

Methods:

This study was conducted on 95 contact lens–intolerant keratoconic eyes with clear central corneas. A continuous corneal ring, annular intrastromal corneal inlay (AICI), was inserted using femtosecond laser in all cases. Patients were followed up for 1, 3, and 12 months postsurgery. Visual and subjective refractive outcomes were evaluated in each examination. Besides, keratometry and aberrometric values were recorded before and 12 months after surgery. Finally, vector analysis of refractive astigmatism was performed using the Alpins method.

Results:

The uncorrected and corrected distance visual acuities improved significantly 12 months after surgery from 0.91 ± 0.39 to 0.38 ± 0.22 (P < 0 0.001) and 0.33 ± 0.21 to 0.13 ± 0.11 logMAR (P < 0.001), respectively. Moreover, spherical and cylindrical refractive components reduced from −2.52 ± 2.62 to −0.76 ± 1.78 D (P < 0.001) and −4.14 ± 1.64 to −1.91 ± 1.18 D (P < 0.001), respectively. The mean anterior keratometry had a significant reduction 12 months after AICI insertion (P< 0.001). Primary coma and spherical aberration values showed a significant increase (both, P < 0.05). Our results showed 100% safety (safety index: 1.8) and 45% efficacy (efficacy index: 1).

Conclusions:

AICI implantation seemed to be a safe and effective procedure for improving visual acuity and refractive outcomes in subjects with keratoconus.
Microsporidial Endotheliitis Mimicking Graft Rejection After Deep Anterior Lamellar Keratoplasty
Authors: Gandhi Neha , Das Sujata , Mittal Ruchi , Barik Manas R.
Published: July 2021

Purpose:

The purpose of this study was to report a case of microsporidial endotheliitis masquerading as graft rejection after deep anterior lamellar keratoplasty (DALK).

Methods:

A 36-year-old man visited the clinic with complaints of blurred vision, redness, pain, watering, and whitish appearance of the black portion of his left eye. On evaluation, there was diffuse stromal edema with epithelial defect and hypopyon. Microbial keratitis resolved with macular grade scar. He underwent DALK. After 3 years, he presented with complaints of sudden diminution of vision in the same eye for 10 days. His unaided visual acuity was counting finger 1 meter. The clinical findings were circumcorneal congestion, diffuse graft edema, Descemet membrane folds, and diffuse keratic precipitates. A presumptive diagnosis of left eye graft rejection was made. Topical steroids were administered. There was significant improvement within a week. However, at 1 month, there was an increase in graft edema after the steroids were tapered. At this point, a diagnosis of endotheliitis of viral origin was made. He was then administered oral antivirals and steroids. There were 2 such waxing and waning episodes of graft edema before the graft failed. Patient underwent penetrating keratoplasty with cataract extraction with intraocular lens implantation.

Results:

The previous donor and host Descemet endothelium complex was sent for histopathology and polymerase chain reaction. Both histology and polymerase chain reaction were positive for microsporidia.

Conclusions:

Microsporidial endotheliitis may present as graft rejection. There should be a suspicion of microsporidial infection in cases of features mimicking as endothelial rejection after DALK.
Evaluation of Depression and Quality of Life in Patients With Psoriasis
Authors: Sriramoju Sravani , Dunde Shiva , Eggadi Venkateshwarlu , Koppolu Manasa Sowmya , Bandaru Seshagiri Sharavana Bhava
Published: July 2021

Objective:

To measure the prevalence of depression in patients with psoriasis and to evaluate the relationship between the severity of psoriasis and depression and its effect on patients' quality of life.

Methods:

A total of 154 patients with a confirmed diagnosis of psoriasis were assessed to determine the severity of psoriasis based on the psoriasis area and severity index score, presence, and severity of depression using the patient health questionnaire 9, and quality of life using the dermatology life quality index 10. Pearson correlation coefficient was used to demonstrate the relationship between continuous variables with 95% confidence intervals (CIs); P < 0.00001 was taken to indicate statistical significance.

Results:

The severity of psoriasis was mild in 36.36% of patients, moderate in 25.97%, severe in 32.47%, and very severe in 5.20%. Of the 154 patients, 139 (90.3%) had depression; the severity of depression was mild in most affected patients (46.7%) and severe in 2.6% of patients. Psoriasis had a moderate effect on the quality of life in 37.01% of patients and a very large effect in 33.77% of patients. The severity of psoriasis was positively correlated with depression (Pearson correlation coefficient, r = 0.42, P<0.00001, 95% CI: 0.28-0.54) and quality of life (r = 0.43, P<0.00001, 95% CI: 0.29-0.55).

Conclusion:

Depression is a common comorbidity in patients with psoriasis. The severity of psoriasis is positively correlated with the severity of depression and is associated with poor quality of life.
The Impact of Electronic Health Records and Meaningful Use on Inpatient Quality
Authors: Trout Kate E. , Chen Li-Wu , Wilson Fernando A. , Tak Hyo Jung , Palm David
Published: July 2021

It is unclear if national investments of the HITECH Act have resulted in significant improvements in care processes and outcomes by making “Meaningful Use (MU)” of Electronic Health Record (EHR) systems. The objective of this study is to determine the impact of EHRs and MU on inpatient quality. We used inpatient hospitalization data, American Hospital Association annual survey, and the Centers for Medicare and Medicaid Services attestation records to study the impact of EHRs on inpatient quality composite scores. Agency for Healthcare Research and Quality Inpatient Quality Indicator (IQI) software version 5.0 was used to compute the hospital-level risk-adjusted standardized rates for IQI indicators and composite scores. After adjusting for confounding factors, EHRs that attested to MU had a positive impact on IQI 90 and IQI 91 composite scores with an 8% decrease in composites for mortality for selected procedures and 18% decrease in composites for mortality for selected conditions. Meaningful Use attestation may be an important driver related to inpatient quality. Health care leaders may need to focus on quality improvement initiatives and advanced analytics to better leverage their EHRs to improve IQI 90 composite score for mortality for selected procedures, because we observed a lesser impact on IQI 90 compared with IQI 91.
Health Locus of Control and Neurocognitive Function in Latinx and Non-Latinx White People Living With HIV: A Cross-sectional Study
Authors: Aghvinian Maral , Morris Emily P. , Savin Micah J. , Summers Angela C. , Crook Cara L. , Stiver Jordan , Gonzalez Jairo , Byrd Desiree , Rivera Mindt Monica
Published: July 2021

Research suggests that health locus of control (HLOC) is related to important health and neurocognitive outcomes in people living with HIV. However, the role of ethnicity in these relationships remains poorly understood. This study explored the role of HLOC on neurocognition in a diverse sample of 134 people living with HIV (Latinx: n = 96; non-Latinx White: n = 38) who completed comprehensive neurocognitive evaluations and the Multidimensional HLOC Scale-Form C. Results indicate no ethnocultural differences in HLOC beliefs (ps > .05). External HLOC (i.e., chance and powerful others) related to worse neurocognition in the Latinx group and contributed to significant variance in global neurocognition and learning, memory, and verbal fluency, underscoring the role of external HLOC beliefs on neurocognition, particularly for Latinx individuals. Additional research is needed to better characterize the mechanistic relationship between HLOC beliefs and neurocognitive function and to further explore this relationship among other underrepresented populations also disproportionately affected by HIV.
Credentials and Core Clerkships: Who's Training Our Physician Assistant Students (and Does It Matter)?
Authors: Min Elana A. , Bowden W. Patrick , Gerstner Laura R. , Guthrie Jennifer R.
Published: July 2021

Purpose

Evaluating the effectiveness of supervised clinical practice experiences (SCPEs) is a primary responsibility of the clinical education team. Physician assistant (PA) education is unique because preceptors are not confined to one professional credential. This study evaluated the relationship between students' perceptions of rotation experiences and the professional credentials of the preceptor of record.

Methods

This retrospective data analysis evaluated data from 3 cohorts (2016–2018) across 4 PA programs. Preceptors of record were categorized as MDs/DOs or advanced practice providers (APPs).

Results

Analysis of 209 SCPEs found 91 APP preceptors (43%) and 119 MD/DO preceptors (57%). APP preceptors were most prevalent in family medicine/primary care (57%), internal medicine (50%), and emergency medicine (49%). Students' evaluation scores were higher for APP preceptors compared to MD/DO preceptors, but not statistically significant.

Conclusions

This study showed that a considerable number of APPs are serving as preceptors and were found to have similar student evaluation scores to those of MD/DO preceptors.
Advancing Physician Assistant Faculty Development: A New Model
Authors: Gordes Karen L. , Fleming Shani , Cawley James F. , Kulo Violet
Published: July 2021

Purpose

The purpose of this article is to describe the development, implementation, and evaluation of an innovative physician assistant (PA) faculty development model.

Methods

The Maryland Physician Assistant Leadership and Learning Academy's (PALLA's) executive team developed a 10-month fellowship designed to build a skilled faculty pipeline. The fellowship framework was grounded in the PA educator competencies, the 3 pillars of academia, and the 5th edition Accreditation Standards for Physician Assistant Education. The self-perceived impact of the fellowship was evaluated through multiple surveys.

Results

Survey results show that all of the learning activities met fellows' expectations, and fellows indicated strong agreement in self-perceived achievement in meeting the fellowship outcome goals.

Conclusion

Study results provide evidence that formal training increases self-perceived competence in clinicians transitioning to academia. PALLA can serve as a model for other states to ensure faculty capacity within PA education.
Unmet needs of hypertension care in Nigeria: results of the community action against non-communicable diseases (COMAAND) project preintervention survey
Authors: Obagha Chijioke Emmanuel , Danladi Benjamin , Kamateeka Moreen , Chori Babangida Sylvester , Ogbonnaya Uche , Maduka Doris , Nguku Patrick , Osunkwo Damaris Amarachukwu , Odili Augustine Nonso
Published: July 2021

Objective

Assessing the state of hypertension care remains the first step towards planning a robust health system needed to tackle the rising burden of hypertension. Prior to the commencement of the Community Action Against Non-Communicable Disease project, we assessed hypertension care using the hypertension care cascade (HCC). This will serve as a baseline to evaluate project performance upon completion.

Methods

Hypertensive subjects were grouped into a mutually exclusive care cascade of 5 categories including unscreened and undiagnosed; screened but undiagnosed; diagnosed but untreated; treated but uncontrolled and treated with controlled hypertension.

Results

Of the 372 participants, mean age 48.9 years, 161 (43.3%) were hypertensive, of whom only 12.0% had controlled blood pressure (BP). Among the 88.0% with uncontrolled BP,19.0% were unscreened and undiagnosed, 48.5% were screened but undiagnosed, 13.0% were diagnosed but untreated and 7.5% were treated but BP uncontrolled. The HCC demonstrates that 19% of the hypertensive patients were lost at the screening stage, 60% of those who were screened never diagnosed, 40% of those who were diagnosed did not receive treatment and 60% of those who were on treatment did not reach target BP.

Conclusion

Unmet need of hypertension care is substantially high, thus underpinning the need for intervention with a multifaceted approach