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Objective: Recent reports in both cervical and endometrial cancer suggest that minimally invasive surgery (MIS) had an unanticipated negative impact on long-term clinical outcomes, including recurrence and death. Given increasing use of robotic surgery since the LAP2 trial, we sought to compare the intermediate and long-term outcomes between those who underwent robotic surgery or laparoscopy for Stage I endometrial cancer., Methods: We performed a retrospective review of patients from a single, large, academic, urban practice who underwent either laparoscopic or robot-assisted MIS (RA-MIS) for the treatment of endometrial carcinoma between 2006 and 2016, ensuring at least 5 years of potential follow-up. To adjust for differences in confounding variables between groups, propensity score-based inverse probability of treatment weighting (IPTW) was performed. Overall and recurrence-free survival were compared using Cox proportional hazards regression models adjusting for confounding weights., Results: 1027 patients were included; 461 received laparoscopy and 566 received RA-MIS. RA-MIS use increased steadily during the study window, which resulted in longer mean surveillance in laparoscopy group (median 8.7 years versus 6.3 years, p < 0.001). RA-MIS was associated poorer recurrence-free (HR: 1.41, 95% CI: 1.12, 1.77) and overall survival (HR: 1.39, 95% CI: 1.06, 1.83). Disease-specific survival was also poorer in the RA-MIS group (HR: 3.51, 95% CI: 2.19, 5.63). Among those who recurred, median time to first recurrence was shorter in the RA-MIS group than the laparoscopy group (16.3 vs. 28.7 months, p = 0.07)., Conclusion: RA-MIS was associated with poorer long-term patient outcomes. Our data in this lower-risk population indicate relevant clinical endpoints may be occurring during intermediate and long-term follow-up windows. These findings support a prospective evaluation of the long-term outcomes of RA-MIS., Competing Interests: Declaration of Competing Interest None of the authors have conflicts, financial or otherwise, with regard to this manuscript., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Leafy green production in high tunnels (HTs) results in increased yields, improved visual quality, and extended production with polyethylene (poly) film and/or shade cloth coverings. However, altering visible and ultra-violet light with HT coverings may reduce phytochemicals, thus influencing plant pigmentation and taste. The objective of this study was to examine various HT coverings on the sensory perceptions, soil temperature, color, and anthocyanin accumulation of red leaf lettuce. The coverings included standard poly, standard poly with removal two weeks prior to harvest (movable), diffuse poly, clear poly, UV-A/B blocking poly (block), standard poly with 55% shade cloth, and the open field. A highly trained descriptive panel evaluated the samples using a scale from 0 (none) to 15 (extremely high) and determined a list of 20 sensory attributes. The color intensity attribute had the most differentiation between coverings, and the open field was higher (i.e., darker) than the others at 7.5 ( p < 0.0001), followed by clear and movable coverings at 6.8, and the shade covering scored a 2. Strong relationships existed between both colorimetric (hue°) and anthocyanin analysis to panelist-based scores (R 2 = 0.847 and 0.640, respectively). The initial crispness was similar for movable, standard, diffuse, and block coverings at 5.3 on average, which was higher than the open field at 4 ( p < 0.01). The open field lettuce grew under cooler soil temperatures, which may have slowed down maturation and resulted in softer tissue. Based on this study, HT growers can implement specific coverings to cater to markets that value visual quality.

Purpose: While the incidence of sexual dysfunction after treatment for gynecologic malignancies is well documented, few studies describe how patients want healthcare providers to address these concerns. The objective of this study was to evaluate changes in sexual function and describe patient preferences regarding healthcare provider roles in addressing and treating sexual dysfunction in gynecologic cancer survivors., Methods: Patients undergoing gynecologic cancer treatment from 2013 to 2014 at a single University-based Gynecologic Cancer clinic were surveyed using a modified Changes in Sexual Function Questionnaire (CSFQ), along with questions relating to healthcare provider interactions and preferences., Results: Among 277 eligible patients approached to participate, 85 (30.7%) completed the survey. The mean age was 52.2 ± 12.3 years; most were non-Hispanic White (78.8%), partnered (73.2%), had endometrial or ovarian cancer (30.6% and 44.7%, respectively), and were in surveillance (57.3%). Most women (64.7%) reported much or great sexual enjoyment 1 year prior to cancer treatment which decreased to 27.4% currently; 33.3% report only rare sexual activity. There were no statistically significant differences in mean total CSFQ scores by treatment modality. A minority wanted healthcare providers to initiate sexual health discussions (25.3%); the remaining reported not wanting sexual health addressed or preferred raising the issue themselves. The most commonly cited barrier to communication was the feeling that there are more important issues to discuss with their oncology providers (46.2%)., Conclusions: While gynecologic cancer patients report changes in sexual function following cancer therapy, many believe there are other issues more paramount to be addressed. Further studies are warranted to develop better strategies for addressing sexual health in women receiving treatment for gynecologic cancers.

The consumer demand for locally grown fresh produce is continuously increasing in the United States. The high tunnel systems have been successfully utilized by small acreage growers for local production. Consumers are typically assessing appearance, freshness, flavor and aroma when purchasing produce. A common perception is that locally grown produce tastes better than nonlocal. However, there is not much evidence for supporting this claim. The objective of this study was to identify consumer acceptability and the sensory characteristics/differences of locally grown spinach in open field or in high tunnel and nonlocal commercially grown spinach. Spinach, Spinacia oleracea cv. "Corvair" was grown in open field and in high tunnel at Kansas State Univ. Olathe Horticulture Research and Extension Center (OHREC) in spring 2017 and the commercially grown spinach was purchased at a local retail store. A consumer study (n = 205) was conducted at Kansas State Univ., Olathe campus, and a descriptive sensory analysis was conducted by a highly trained descriptive analysis panel in the Center for Sensory Analysis and Consumer Behavior at Kansas State Univ., Manhattan campus, in spring 2017. The consumer test showed that high tunnel spinach scored significantly higher in overall liking (P < 0.0001), flavor liking (P < 0.0001), and texture liking (P < 0.05) when compared to open field and store purchased spinach. Descriptive analysis showed that locally grown spinach had higher intensity of attributes that indicate premium quality, such as green color and green/spinach flavors. Our results indicate that locally grown spinach was preferred from the consumers for its high organoleptic quality. PRACTICAL APPLICATION: Locally grown spinach demonstrated high intensity in a set of sensory attributes that suggest a product with premium organoleptic quality. Correspondingly to these results, consumers liked spinach produced locally in high tunnels the most. The results of this study can be used for developing marketing strategies that are aiming specifically to the consumer niche that is seeking fresh produce of high organoleptic quality., (© 2019 Institute of Food Technologists®.)

Root-associated microbes are critical to plant health and performance, although understanding of the factors that structure these microbial communities and the theory to predict microbial assemblages are still limited. Here, we use a grafted tomato system to study the effects of rootstock genotypes and grafting in endosphere and rhizosphere microbiomes that were evaluated by sequencing 16S rRNA. We compared the microbiomes of nongrafted tomato cultivar BHN589, self-grafted BHN589, and BHN589 grafted to Maxifort or RST-04-106 hybrid rootstocks. Operational taxonomic unit (OTU)-based bacterial diversity was greater in Maxifort compared to the nongrafted control, whereas bacterial diversity in the controls (self-grafted and nongrafted) and the other rootstock (RST-04-106) was similar. Grafting itself did not affect bacterial diversity; diversity in the self-graft was similar to that of the nongraft. Bacterial diversity was higher in the rhizosphere than in the endosphere for all treatments. However, despite the lower overall diversity, there was a greater number of differentially abundant OTUs (DAOTUs) in the endosphere, with the greatest number of DAOTUs associated with Maxifort. In a permutational multivariate analysis of variance (PERMANOVA), there was evidence for an effect of rootstock genotype on bacterial communities. The endosphere-rhizosphere compartment and study site explained a high percentage of the differences among bacterial communities. Further analyses identified OTUs responsive to rootstock genotypes in both the endosphere and rhizosphere. Our findings highlight the effects of rootstocks on bacterial diversity and composition. The influence of rootstock and plant compartment on microbial communities indicates opportunities for the development of designer communities and microbiome-based breeding to improve future crop production. IMPORTANCE Understanding factors that control microbial communities is essential for designing and supporting microbiome-based agriculture. In this study, we used a grafted tomato system to study the effect of rootstock genotypes and grafting on bacterial communities colonizing the endosphere and rhizosphere. To compare the bacterial communities in control treatments (nongrafted and self-grafted plants) with the hybrid rootstocks used by farmers, we evaluated the effect of rootstocks on overall bacterial diversity and composition. These findings indicate the potential for using plant genotype to indirectly select bacterial taxa. In addition, we identify taxa responsive to each rootstock treatment, which may represent candidate taxa useful for biocontrol and in biofertilizers., (Copyright © 2019 American Society for Microbiology.)

Background: Widespread metaphors contribute to the public's understanding of health. Prior work has characterized the metaphors used to describe cancer and AIDS. Less is known about the metaphors characterizing cardiovascular disease., Objective: The objective of our study was to characterize the metaphors that Twitter users employ in discussing hypertension and diabetes., Methods: We filtered approximately 10 billion tweets for keywords related to diabetes and hypertension. We coded a random subset of 5000 tweets for the presence of metaphor and the type of metaphor employed., Results: Among the 5000 tweets, we identified 797 (15.9%) about hypertension or diabetes that employed metaphors. When discussing the development of heart disease, Twitter users described the disease as a journey (n=202), as transmittable (n=116), as an object (n=49), or as being person-like (n=15). In discussing the experience of these diseases, some Twitter users employed war metaphors (n=101). Other users described the challenge to control their disease (n=34), the disease as an agent (n=58), or their bodies as machines (n=205)., Conclusions: Metaphors are used frequently by Twitter users in their discussion of hypertension and diabetes. These metaphors can help to guide communication between patients and providers to improve public health., (©Lauren Sinnenberg, Christina Mancheno, Frances K Barg, David A Asch, Christy Lee Rivard, Emma Horst-Martz, Alison Buttenheim, Lyle Ungar, Raina Merchant. Originally published in JMIR Diabetes (http://diabetes.jmir.org), 21.12.2018.)

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer therapy with few efficacious treatments., Methods: We enrolled 70 patients with CIPN in a randomized, double-blinded, sham-controlled, cross-over trial to determine if photobiomodulation (PBM)±physiotherapy reduced the symptoms of neuropathy compared to sham treatment. At the conclusion of follow-up, sham-arm patients could cross-over into a third arm combining PBM and physiotherapy to determine if multimodal treatment had additive effects. Treatment included 30minute sessions 3-times weekly for 6weeks using either PBM or sham therapy. Neuropathy was assessed using the modified total neuropathy score (mTNS) at initiation and 4, 8, and 16weeks after initiating treatment., Results: Sham-treated patients experienced no significant change in mTNS scores at any point during the primary analysis. PBM patients experienced significant reduction in mTNS scores at all time points. Mean changes in mTNS score (and corresponding percent drop from baseline) for sham and PBM-group patients respectively were -0.1 (-0.7%) and -4.2 (-32.4%) at 4weeks (p<0.001), 0.2 (0.0%) and -6.8 (-52.6%) at 8weeks (p<0.001), and 0.0 (0.1%) and -5.0 (-38.8%) at 16weeks (p<0.001). Patients who crossed over into the PBM/PT-group experienced similar results to those treated primarily; changes in mTNS score from baseline were -5.5 (-40.6%) 4weeks (p<0.001), -6.9 (-50.9%) at 8weeks (p<0.001), and -4.9 (-35.9%) at 16weeks (p<0.001). The addition of physiotherapy did not improve outcomes over PBM alone., Conclusion and Relevance: Among patients with CIPN, PBM produced significant reduction in neuropathy symptoms., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: While active smoking is a causal agent in respiratory disease, the independent role of secondhand smoke (SHS) merits further investigation. We investigated associations between lifetime active smoking and exposure to secondhand smoke - studied independently - and current use of 1 or more inhaled medications as a surrogate for prevalent pulmonary disease in post-menopausal women., Study Design: Information on lifetime active and passive tobacco exposure and inhaled pulmonary medication usage at enrollment was collected from 88,185 postmenopausal women aged 50-79 enrolled in the Women's Health Initiative Observational Study from 1993 to 1998 at 40 centers in the United States. Participants were recruited from localities surrounding the study centers using a variety of methods, including informational mailings and mass media campaigns., Main Outcome Measures: Multivariate adjusted regression models were used to estimate odds ratios and 95% CI according to levels of active smoking and SHS exposure, and trends were tested across categories., Results: Ever active smokers had an overall OR of 1.97 (95% CI 1.58-2.45) for having one or more prescribed inhaled medication compared with never-smoking women not exposed to active or passive smoke. The overall OR for using inhalers for never-smoking women exposed to any SHS compared with the same reference group was 1.33 (95% CI 1.07-1.65). In a quantified analysis of SHS, never-smoking women with the highest levels of lifetime SHS exposure had an estimated risk of inhaled medication usage of 1.74 (95% CI 1.32-2.30)., Conclusions: The risk of requiring one or more prescribed inhaled medications for pulmonary disease was significantly higher in post-menopausal women who ever smoked or who had lifetime exposure to SHS., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Bacterial wilt, caused by Ralstonia solanacearum, can result in severe losses to tomato (Solanum lycopersicum) growers in the southeastern United States, and grafting with resistant rootstocks may be an effective strategy for managing this disease. However, R. solanacearum populations maintain considerable diversity, and little information is known regarding the efficacy of commercially available rootstocks to reduce bacterial wilt incidence and subsequent crop loss in the United States. In this study, tomato plants grafted onto 'Dai Honmei' and 'RST-04-105-T' rootstocks had significantly lower area under the disease progress curve (AUDPC) values compared with nongrafted plants (P < 0.05). Across three locations in North Carolina, final bacterial wilt incidence for non- and self-grafted plants was 82 ± 14 to 100%. In contrast, bacterial wilt incidence for the grafted plants was 0 to 65 ± 21%. Final bacterial wilt incidence of plants grafted with Dai Honmei rootstock was 0 and 13 ± 3% at two locations in western North Carolina but 50 ± 3% at a third site in eastern North Carolina. Similarly, grafting onto RST-04-105-T rootstock significantly reduced AUDPC values at two of the three locations (P < 0.05) compared with that of the nongrafted plants, but performed poorly at the third site. Total fruit yields were significantly increased by grafting onto resistant rootstocks at all three sites (P < 0.05). Regression analyses indicated that yield was significantly negatively correlated with bacterial wilt AUDPC values (R 2 was 0.4048 to 0.8034), and the use of resistant rootstocks enabled economically viable tomato production in soils naturally infested with R. solanacearum.

Objectives: To describe perioperative bowel habits of women undergoing gynecologic surgery., Methods: This prospective cohort study included women undergoing gynecologic surgery. Before surgery, participants completed the Bristol Stool Form Scale (BSFS), a validated instrument describing stool characteristics consistent with transit categories: slow (BSFS 1-2), normal (BSFS 3-5), and fast (BSFS 6-7). For 2 weeks after surgery, the participants recorded daily medications and bowel movements (BM), and completed BSFS. The χ(2) test, the Fisher exact test, analysis of variance, t tests, and ordinal regression were used., Results: Preoperatively, most (70%) of 340 women had normal stool transit, with 15% having slow transit and 7% having fast transit. Complete postoperative data were available for 170 (50%). Mean ± SD time to first postoperative BM was 2.8 ± 1.4 days with transit classification: 48% normal, 32% slow, and 20% fast., Conclusions: Most women had normal stool transit both preoperatively and postoperatively. Time to first BM was longer after open surgery by approximately 3 days.

Southern blight (Sclerotium rolfsii) and root-knot nematodes (Meloidogyne spp.) cause severe damage to fresh-market tomato (Solanum lycopersicum) throughout the southeastern United States. Grafting is an emerging technology in U.S. tomato production, and growers require information regarding the resistance characteristics conferred by rootstocks. In this study, southern blight (SB) and root-knot nematodes (RKN) were effectively managed using interspecific hybrid rootstocks. During 2007 and 2008, field trials were carried out at two locations that had soils naturally infested with S. rolfsii. At the end of the growing seasons, the mean SB incidence of nongrafted plants was 27 and 79% at the two sites. SB incidence among plants grafted onto rootstock cultivars Big Power (one location only), Beaufort, and Maxifort ranged from 0 to 5%, and area under the disease progress curve (AUDPC) values were lower than for nongrafted and self-grafted controls (P < 0.01). At one location, soils were naturally infested with RKN, and all three rootstocks reduced RKN AUDPC and RKN soil populations at first harvest (P < 0.01). Big Power was particularly effective at reducing RKN galling and RKN soil populations at final fruit harvest (P < 0.01). Fruit yield was higher when resistant rootstocks were utilized (P < 0.05), and in our study grafting was effective at maintaining crop productivity in soils infested with S. rolfsii and M. incognita.