New anterior controllable antedisplacement and fusion surgery for cervical ossification of the posterior longitudinal ligament: a biomechanical study

OBJECTIVE The traditional anterior approach for multilevel severe cervical ossification of the posterior longitudinal ligament (OPLL) is demanding and risky. Recently, a novel surgical procedure—anterior controllable antedisplacement and fusion (ACAF)—was introduced by the authors to deal with these problems and achieve better clinical outcomes. However, to the authors’ knowledge, the immediate and long-term biomechanical stability obtained after this procedure has never been evaluated. Therefore, the authors compared the postoperative biomechanical stability of ACAF with those of more traditional approaches: anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF). METHODS To determine and assess pre- and postsurgical range of motion (ROM) (2 Nm torque) in flexion-extension, lateral bending, and axial rotation in the cervical spine, the authors collected cervical areas (C1–T1) from 18 cadaveric spines. The cyclic fatigue loading test was set up with a 3-Nm cycled load (2 Hz, 3000 cycles). All samples used in this study were randomly divided into three groups according to surgical procedures: ACDF, ACAF, and ACCF. The spines were tested under the following conditions: 1) intact state flexibility test; 2) postoperative model (ACDF, ACAF, ACCF) flexibility test; 3) cyclic loading (n = 3000); and 4) fatigue model flexibility test. RESULTS After operations were performed on the cadaveric spines, the segmental and total postoperative ROM values in all directions showed significant reductions for all groups. Then, the ROMs tended to increase during the fatigue test. No significant crossover effect was detected between evaluation time and operation method. Therefore, segmental and total ROM change trends were parallel among the three groups. However, the postoperative and fatigue ROMs in the ACCF group tended to be larger in all directions. No significant differences between these ROMs were detected in the ACDF and ACAF groups. CONCLUSIONS This in vitro biomechanical study demonstrated that the biomechanical stability levels for ACAF and ACDF were similar and were both significantly greater than that of ACCF. The clinical superiority of ACAF combined with our current results showed that this procedure is likely to be an acceptable alternative method for multilevel cervical OPLL treatment.

Interrupting the crossover effect of leader's role overload on employee's negative affect: the moderating role of self-concordance goal

PurposeThe purpose of the study is to examine the crossover effect of leader's role overload on employee's negative affect. More importantly, the stuy will identify the buffering role of self-concordance goal on the relationship between leader's role overload and employee's negative affect.Design/methodology/approachThe study builds the crossover impact of leader's role overload on employee's negative affect as well as the moderating effect of self-concordance goal. By a two-wave and paired data from 51 leaders and 225 employees, the study examines the hypothesis using cross-level analysis.FindingsResults show that leader's role overload tends to reduce negative affect for employees who pursue high-level self-concordance goal and increase negative affect for employees who pursue low-level self-concordance goal.Practical implicationsIt is important for employees to get rid of negative affect in the workplace. The study informs managers the benefits of pursuing self-concordance goals in helping employees alleviate the negative effect of leader's role overload.Originality/valueFindings of the present study can enrich the literature of the crossover process from leader to employee and offer management strategy for enterprises about how to buffer the damaging effect of leader's role overload on employees.

Sedentary work and participation in leisure–time physical activity

Objective Demanding psychosocial work characteristics, such as high job demands, can have a detrimental impact on leisure–time physical activity (LTPA), with adverse consequences for employee health and well-being. However, the mechanisms and moderators of this crossover effect are still largely unknown. We therefore aimed to identify and test potential mediating and moderating factors from within and outside the work environment. Based on the previous research, we expected job demands to be negatively related to LTPA through fatigue. In addition, we expected that job control and worktime control would attenuate the relationship between job demands and fatigue. Furthermore, we hypothesized that autonomous exercise motivation and spontaneous action planning would attenuate the relationship between fatigue and LTPA. In addition to these cross-sectional hypotheses, we expected the same effects to predict a change in LTPA in the following year. Methods To investigate these assumptions, a preregistered longitudinal survey study was conducted among a large sample of Dutch employees in sedentary jobs. Participants reported on the constructs of interest in 2017 and 2018 (N = 1189 and 665 respectively) and the resulting data were analyzed using path analyses. Results Our cross-sectional analyses confirm a weak indirect, negative association between job demands and LTPA, via fatigue. However, this finding was not observed in our longitudinal analyses and none of the other hypotheses were confirmed. Conclusion This study shows that, among employees with relatively healthy psychosocial work characteristics (i.e., high job control), the evidence for an impact of these work characteristics on participation in LTPA is limited.

The impact of media use on the spillover and crossover effect of couple conflict

This 5-day daily diary study examined the influence of media use on the spillover and crossover effect of couple conflict among married and dating couples. Couples aged 18–38 years recorded their daily overload, negative mood, couple conflict, media use, flooding, and satisfaction. The results showed negative spillover and crossover effects: individuals reported more negative moods and couple conflict in response to their own and their partners’ increase in daily overload. Following media synchronicity theory, the more synchronous media couples used in conflict, the more they resolved the conflict. In addition, the more couples segmented their channels, the less they flooded and the more they resolved the conflict. The results suggest that dating and married couples might benefit from managing conflict associated with spillover and crossover effects using synchronous channels that are segmented.

Final overall survival for the phase III KN177 study: Pembrolizumab versus chemotherapy in microsatellite instability-high/mismatch repair deficient (MSI-H/dMMR) metastatic colorectal cancer (mCRC).

3500 Background: In the phase III, randomized open-label KEYNOTE-177 (NCT02563002) study 1L pembrolizumab (pembro) versus chemotherapy (chemo) provided superior progression-free survival (PFS) at second interim analysis (IA2) in patients (pts) with MSI-H/dMMR mCRC. The study continued to final analysis of overall survival (OS), planned after 190 OS events or 12 months after IA2, whichever occurred first. We present results of the final analysis of OS, 12 months after IA2. Methods: A total of 307 pts with MSI-H/dMMR mCRC and ECOG PS 0 or 1 were randomized 1:1 to 1L pembro 200 mg Q3W for up to 2y or investigator’s choice of mFOLFOX6 or FOLFIRI Q2W ± bevacizumab or cetuximab. Treatment continued until PD, unacceptable toxicity, pt/investigator decision to withdraw, or completion of 35 cycles (pembro only). Pts receiving chemo could crossover to pembro for up to 35 cycles after confirmed PD. Primary end points were OS and PFS (RECIST v1.1, central review). Secondary end points included ORR, duration of response (DOR) (RECIST v1.1, central review), and safety. For OS significance, the p-value had to meet a prespecified α of 0.0246 (one-sided). Sensitivity analyses to adjust for crossover effect were performed. Data cut-off for final analysis was Feb 19, 2021. Results: Median (range) study follow-up was 44.5 mo (36.0-60.3) with pembro vs 44.4 mo (36.2-58.6) with chemo. 56 (36%) pts crossed over from chemo to pembro, with 37 more receiving anti-PD-1/PD-L1 therapies off study (60% effective crossover rate in the ITT). The HR for OS favored pembro vs chemo with a trend toward reduction in the risk of death (HR 0.74; 95% CI, 0.53-1.03; P=0.0359; median not reached [NR] vs 36.7 mo); this difference did not reach statistical significance. Sensitivity analysis by the rank-preserving structure failure time model and inverse probability of censoring weighting showed OS HRs of 0.66 (95% CI 0.42-1.04) and 0.77 (95% CI 0.44-1.38), respectively. Pembro vs chemo met the prespecified criteria for PFS superiority at IA2. At final analysis, median PFS was 16.5 mo vs 8.2 mo (HR 0.59; 95% CI, 0.45-0.79), but was not formally tested per analysis plan. Confirmed ORR was 45.1% (20 CR, 49 PR) vs 33.1% (6 CR, 45 PR). Median (range) DOR was NR (2.3+ to 53.5+) vs 10.6 mo (2.8 to 48.3+), respectively. Treatment-related adverse events (TRAEs) occurred in 79.7% vs 98.6% of pts; 21.6% vs 66.4%, respectively, had grade ≥3 TRAEs. Conclusions: As 1L therapy for pts with MSI-H/dMMR mCRC, pembro vs chemo provides statistically superior PFS with fewer TRAEs, and is associated with a trend toward reduced mortality that did not meet statistical significance likely due to the high crossover rate from chemo to anti-PD1/PD-L1 therapies. Together these data confirm pembro as a new standard-of-care in the 1L for pts with MSI-H/dMMR mCRC. Clinical trial information: NCT02563002.

Personalities in sync: The covariation of psychological resources in leader–follower dyads

Based on a two-week daily diary study of 31 leader–follower dyads, this article demonstrates that within-person variation in the leader’s level of state core self-evaluations is associated with within-person variation in the follower’s level of state core self-evaluations. Moreover, we provide tentative evidence that this crossover effect might be mediated by transformational leadership behavior. Our study contributes to personality and leadership research by exploring within-leader, within-follower, and within-dyad personality processes. By showing that the personality states of leader and follower fluctuate in sync, we shed light on a new way in which leaders and followers connect.

Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

Background Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. Methods We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. Results At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. Conclusions The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.

Electrically-induced quadriceps fatigue in the contralateral leg impairs ipsilateral knee extensors performance

Muscle fatigue induced by voluntary exercise, which requires central motor drive, causes central fatigue that impairs endurance performance of a different, non-fatigued muscle. This study investigated the impact of quadriceps fatigue induced by electrically-induced (no central motor drive) contractions on single-leg knee-extension (KE) performance of the subsequently exercising ipsilateral quadriceps. On two separate occasions, eight males completed constant-load (85% of maximal power-output) KE exercise to exhaustion. In a counterbalanced manner, subjects performed the KE exercise with no pre-existing quadriceps fatigue in the contralateral leg on one day (No-PreF), while on the other day, the same KE exercise was repeated following electrically-induced quadriceps fatigue in the contralateral leg (PreF). Quadriceps fatigue was assessed by evaluating pre- to post-exercise changes in potentiated twitch force (ΔQtw,pot; peripheral-fatigue), and voluntary muscle activation (ΔVA; central-fatigue). As reflected by the 57±11% reduction in electrically-evoked pulse force, the electrically-induced fatigue protocol caused significant knee-extensors fatigue. KE endurance time to exhaustion was shorter during PreF compared to No-PreF (4.6±1.2 vs 7.7±2.4 min; p<0.01). While ΔQtw,pot was significantly larger in No-PreF compared to PreF (-60% vs -52%, p<0.05), ΔVA was greater in PreF (-14% vs -10%, p<0.05). Taken together, electrically-induced quadriceps fatigue in the contralateral leg limits KE endurance performance and the development of peripheral fatigue in the ipsilateral leg. These findings support the hypothesis that the crossover-effect of central fatigue is mainly mediated by group III/IV muscle afferent feedback and suggest that impairments associated with central motor drive may only play a minor role in this phenomenon.

Influence of Leader Mindfulness on the Emotional Exhaustion of University Teachers: Resources Crossover Effect

This study combined conservation of resources theory with the job demands-resources model to explore the influence of leader mindfulness on the emotional exhaustion of university teachers Using a time-lagged research design, 388 paired data sets were gathered. Multiple regression and bootstrapping were used to test each hypothesis. The results showed that first, leader mindfulness significantly reduces the emotional exhaustion of university teachers. Second, the results showed that workplace telepressure partially mediates the relationship between leader mindfulness and the emotional exhaustion of university teachers. Third, university teacher mindfulness positively moderates the relationship between leader mindfulness and workplace telepressure. Finally, the results of this study indicate that self-efficacy in managing negative emotions negatively moderates the relationship between workplace telepressure and the emotional exhaustion of university teachers. This study empirically examined the interpersonal influence of leader mindfulness and the initial resources effect of university teacher mindfulness and self-efficacy in managing negative emotions from the bilateral perspective of leaders and university teachers.

Survival analysis of advanced lung cancer patients undergoing personalised treatment or chemotherapy in a real clinic

IntroductionThe importance of modern treatments for the extension of overall survival in advanced lung cancer (LC) patients is rarely reported in clinical trials (crossover effect). Recent clinical trials have compared experimental treatment methods and shown that chemotherapy is no longer a comparator. We studied the relevance of innovative treatment to the extension of overall survival in Polish lung cancer patients.Material and methodsWe described the outcome in 1463 patients diagnosed and treated for advanced LC. The study included patients receiving all available forms of treatment, i.e. chemotherapy, immunotherapy, EGFR tyrosine kinase inhibitors, ALK inhibitors, and best supportive care (BSC).ResultsMedian OS (mOS) for the whole group of patients was 6.5 months. mOS was significantly higher in patients with SCC (8.0 months) and AC (7.0 months) compared to patients with SCLC (6 months) and NSCLC NOS (3.5 months). mOS was 30 months for EGFR TKI-treated patients, 34 months for patients receiving second-line immunotherapy, 8.5 months for chemotherapy patients, and 1.0 month for patients who received BSC. mOS for patients treated with ALK inhibitors and first-line immunotherapy was not reached. The use of targeted therapies or immunotherapies significantly (p < 0.0001) reduced the risk of death compared to chemotherapy (HR = 0.373, 95% CI: 0.288–0.484 and HR = 0.313, 95% CI: 0.255–0.385).ConclusionsThe use of modern therapies in one of the treatment lines compared to chemotherapy significantly increased the long-term survival of advanced LC patients (34.5 vs. 8.5 months, HR = 0.336, 95% CI: 0.284– 0.397, p < 0.0001). Correct and early LC diagnosis is required, because patients with late diagnosis have a particularly poor prognosis.