Nailfold capillary measurements correlated to NOTCH3 R544C mutation in preclinical CADASIL patients.

BACKGROUND: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary disease caused by NOTCH3 mutation. Nailfold capillaroscopy is a non-invasive technique typically used for rheumatic diseases. It has potential in other conditions linked to vascular pathology. However, capillaroscopy in CADASIL has not been explored. This study aims to investigate whether capillaroscopy measurements can correlate with brain vascular changes in preclinical CADASIL patients, specifically those with NOTCH3 mutation. METHODS: This study included 69 participants from the Taiwan Precision Medicine Initiative (TPMI) dataset who visited Taichung Veterans General Hospital from January to December 2022. All individuals underwent genetic studies, brain imaging and nailfold capillaroscopy. The Mann-Whitney U test was used to compare results of brain imaging between carriers and controls. It was also used to compare measurements in nailfold capillaroscopy within each group. Spearman Rank Correlation Analysis was used to explore the relationship between capillary measurements and brain MRI results. RESULTS: White matter hyperintensities (WMH) expression was positively correlated with capillary dimension and negatively correlated with density. Our results presented that R544C carriers exhibited a diffuse increase in WMH (p < 0.001) and a global reduction in gray matter volume but preserved in specific areas. The white matter lesion scores in all brain regions were higher in the mutation carriers than the controls. (p < 0.001). CONCLUSION: This research highlights the association of nailfold capillaroscopy findings with white matter lesions in preclinical CADASIL patients. Capillaroscopy guides an effective screening strategy in individuals with NOTCH3 mutations.

Mediating role of inhibitory control in relationships between cardiovascular fitness and academic achievement in preadolescents.

Cardiovascular fitness (CRF) has been consistently linked to cognitive performance and academic achievement, and inhibitory control has been recognized as a key predictor of academic success. However, few studies have explored whether inhibitory control mediates the relationship between CRF and academic performance in children, and the existing findings are inconclusive because of certain limitations. This study investigated the mediating role of inhibitory control in the association between CRF and academic achievement among preadolescents while also addressing the related limitations. This study enrolled a total of 175 elementary school students (70 girls, mean age=11.17years, standard deviation=0.7), who participated in a half-mile test for assessing their CRF level. Additionally, inhibitory control was measured using the Stroop Color and Word Test (Stroop test), and language and mathematics tests were administered to measure their academic performance. The results revealed that the participants with higher CRF levels achieved superior performance in tasks requiring a high level of inhibitory control (r=0.291, P<0.001) and in Chinese language (r=-0.415, P<0.001) and mathematics (r=-0.366, P<0.001) tests even when gender, age, and body fat were considered. Furthermore, a mediation analysis revealed that inhibitory control, as measured through the incongruent trials of the Stroop test, partially mediated the relationship between CRF and academic performance (language: indirect effect=-0.013, 95% CI [-0.019, -0.008]; math: indirect effect=-0.013, 95% CI [-0.021, -0.009]). These findings have major implications for child development, emphasizing the key role of inhibitory control in the beneficial effects of CRF on academic achievement.

Association between sodium-glucose cotransporter-2 (SGLT2) inhibitors and macular degeneration in patients with diabetes: a nationwide population-based study in Taiwan.

AIMS: Evidence showed that SGLT2 inhibitors have greater protective effects against retinal diseases compared to other hypoglycemic agents. Thus, we explore the association between SGLT2 inhibitor usage and macular degeneration (MD) in Taiwanese patients with diabetes. METHODS: The National Health Insurance (NHI) program's claim data are released as the National Health Insurance Research Database (NHIRD). This database covers more than 99% of the residents in Taiwan. We included data on patients who were newly diagnosed with type 2 diabetes mellitus (ICD-9-CM: 250, exclude 250.1x; ICD-10-CM: E11), with an age at diagnosis of over 20 years as our study population. Patients who received (sodium-glucose cotransporter 2 inhibitor) SGLT2i (ATC code: A10BK) over 90 days in 2016-2019 were defined as the SGLT2i cohort. Conversely, patients who did never received SGLT2i were defined as the non-SGLT2i cohort. The exclusion criteria were having MD before the index date, receiving SGLT2i within 1-89 days, and missing data on sex, age, or days of SGLT2i usage. Two cohorts were matched by 1:1 propensity score matching, which was based on age, sex, payroll bracket grade, urbanization, comorbidities, and medications. RESULTS: Compared to non-SGLT2i cohort, patients who received SGLT2i had a significantly lower risk of MD (adjusted hazard ratio = 0.70, 95%CI = 0.66-0.75). CONCLUSIONS: We found that SGLT2is has a strong protective effect against MD in patients with diabetes. SGLT2is may have benefits beyond glycemic control in patients with DR. However, additional clinical and experimental studies are required.

Isolation of three different sizes of exosomes in an Asian population with different retinal diseases before and after treatment: preliminary results.

Exosomes are membranous structures measuring between 40-120 nm that are secreted by various cells of the human body into the body fluid system. Exosomes contain proteins, mRNA, miRNA, and signaling molecules, and physiologically they assist in the intercellular transport of proteins and RNA molecules. In this study, we used an immunoaffinity filter paper platform combined with scanning electron microscopy and microfluidic systems to detect the size of exosomes within the aqueous humor. Eight aqueous humor samples showed three distinct sizes of exosomes that were significantly different on scanning electron microscopy(P < 0.01). We further used nanoparticle tracking analysis to assess the size distribution of exosomes within the aqueous humor. We found significantly different distributions of exosomes between patients with three different ocular diseases and patients with normal cataracts as controls. An obvious peak of exomeres(size around 35 nm)was found in the patients with central retinal vein occlusion and vitreous hemorrhage. Flare-ups of large exosomes(size 90-120 nm)were found in the patients with the inflammatory ocular disease pars planitis. No obvious peaks in exomeres or large exosomes were found in the control group. There was a high association between the distribution of exosomes and the pathogenesis of ocular diseases. After intravitreal anti-vascular endothelial growth factor treatment, the aqueous humor from the patients with neovascular diseases showed a significant reduction in exosomes in nanoparticle tracking analysis. These findings suggest that at least three distinct sizes of exosomes exist in the aqueous humor:(1)exomeres:<35 nm;(2)small exosomes:60-80 nm; and (3)large exosomes:90-120 nm. Different sizes of exosomes may have different implications in normal or diseased eyes.

Three different sized exosomes were identified in aqueous humor.The distribution of exosome size was significantly different between the patients with inflammatory and neovascularization retinal diseases.After intravitreal anti-vascular endothelial growth factor treatment, the aqueous humor from patients with neovascular diseases showed a significant reduction in exosomes in nanoparticle tracking analysis.

Non-meningeal, non-pulmonary cryptococcosis with limited posterior uveitis in a kidney organ transplant recipient with antibody-mediated rejection: a case report.

BACKGROUND: Cryptococcosis is one of the most frequent fungal eye infections in patients with immunosuppression. Currently, treatment approaches for non-meningeal, non-pulmonary cryptococcosis are based on those used for cryptococcal meningitis or pneumonia. CASE PRESENTATION: We present a rare case of non-meningeal, non-pulmonary cryptococcosis with clinical manifestations limited to one eye of a cadaveric kidney transplant recipient with chronic-active antibody-mediated rejection. Typical manifestations, diagnosis, and treatments, including antifungal therapies, adjunctive therapies, and immunosuppression reduction, are discussed. After timely diagnosis and treatment, her visual acuity recovered to baseline without recurrence or sequelae of cryptococcosis. CONCLUSIONS: Clinicians should be aware of rare presentations of fungal infections, especially when a kidney transplant recipient with rejection has been treated with intensive immunosuppressants. Early diagnosis with individualized therapies may have a favorable prognosis.

Corneal Biomechanical Characteristics in Osteogenesis Imperfecta With Collagen Defect.

Purpose: To identify the characteristic corneal biomechanical properties of osteogenesis imperfecta (OI), and to compare the corneal biomechanical properties between OI and keratoconus. Methods: We included 46 eyes of 23 patients with OI, 188 eyes of 99 keratoconus patients, and 174 eyes of 92 normal controls to compare corneal biomechanical parameters between OI corneas, keratoconus, and normal controls by using Corneal Visualization Scheimpflug Technology (Corvis ST). Results: Patients with OI had significantly higher Corvis biomechanical index (CBI) (P < 0.001), higher tomographic and biomechanical index (TBI) (P = 0.040), lower Corvis Biomechanical Factor (CBiF) (P = 0.034), and lower stiffness parameter at first applanation (SP-A1) (P < 0.001) compared with normal controls. In contrast, OI group showed lower CBI (P < 0.001), lower TBI (P < 0.001), higher CBiF (P < 0.001), and higher SP-A1 (P = 0.020) than keratoconus group. Notably, the stress-strain index (SSI) was not significantly different between the OI and normal controls (P = 1.000), whereas keratoconus showed the lowest SSI compared with OI group (P = 0.025) and normal controls (P < 0.001). Conclusions: Although the corneal structures of OI patients are less stable and easier to deform as compared to those of the control group, there is no significant difference in material stiffness observed between the OI and normal controls. In contrast, the corneas of keratoconus showed not only lower structural stability and higher deformability but also lower material stiffness compared with those of OI cornea and normal controls. Translational Relevance: The biomechanical alterations are different between OI corneas and keratoconus.

Effects of Coordinative Exercise on Sustained Attention and Perceptual Discrimination in Elementary School Physical Education.

Purpose: This study examined the effects of coordinative exercise on children's sustained attention and perceptual discrimination in a school-based physical education (SBPE) setting. Methods: Seventy-three children received an intervention of moderate-to-vigorous intensity coordinative exercise, and 75 children participated in a moderate-to-vigorous intensity physical activity as part of a regular physical education class. Two neuropsychological tests of executive function (EF) were used to assess attention and perceptual discrimination functions before and after each treatment. Results: The results found that coordinative exercise significantly improved the performances on sustained attention and perceptual discrimination, as evidenced by enhanced response accuracy and improved speed of responding. Specifically, higher progressions in task performance were seen following coordinative exercise relative to regular physical activity. Conclusion: These findings suggest that coordinative exercise could enable more robust improvements in sustained attention and perceptual discrimination among children. Overall, we conclude that structured coordinative exercise, implemented in SBPE settings, may be a promising alternative to promote children's cognitive abilities.

Cognitively engaging movement games improve interference control and academic performance in overweight children: A randomized control trial.

The purpose of this study was to determine the (a) dose-response effects of cognitively engaging movement games (CEMGs) designed to improve aerobic capacity, interference control (IC), and academic performance, (b) relationship between intervention-induced improvements in aerobic capacity, IC, and academic performance, and (c) moderation effect of IC on the relationship between aerobic capacity and academic performance in overweight children. Seventy-five overweight children (aged 11.23 ± 0.60 years; 48% males) participated in this study conducted in Taipei during the 2018/2019 academic year and were randomly assigned to the low-dose (20-min) intervention, high-dose (40-min) intervention, and control groups and completed a Stroop test, half-mile run, and language and mathematics tests before and after a 10-week afterschool program. Both intervention groups showed similar improvements in outcomes of aerobic capacity (ds > 0.80), IC (ds > 0.76), and academic performance (ds > 0.90) from the pretest to posttest, whereas these outcomes were unchanged for the control group. Furthermore, improved IC moderated the association between improvements in aerobic capacity and academic performance. Our findings suggest that CEMG with varying doses is feasible and effective for improving aerobic capacity, IC, and academic performance in overweight children and that the association between improvements in aerobic capacity and academic performance depends on the intervention effects on IC.

The Association between Cholesterol Levels and Severity of Normal Tension Glaucoma.

Purpose: To evaluate the serum lipid levels, including total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) of patients with normal tension glaucoma (NTG) and to investigate the relationship between serum HDL levels and the severity of NTG. Methods: In this cross-sectional, case-control study, 282 NTG subjects and 202 control subjects were enrolled from the outpatient clinic of the Department of Ophthalmology at Taichung Veterans General Hospital in central Taiwan from 2015 to 2021. Fasting cholesterol, HDL, and LDL levels were evaluated using a biochemical analyzer (ARCHITECT c16000). Glaucoma severity was classified by visual field test as mild (mean deviation [MD] ≥ -6.0dB), moderate (-12dB ≤ MD < -6 dB), and severe (MD < -12dB), based on the mean deviation. Results: HDL levels were significantly lower in the NTG group compared with the control subjects (47 ± 18mg/dl versus 53 ± 18mg/dl; p = 0.03). There were no statistically significant differences in total cholesterol or LDL levels between the NTG and control subjects (total cholesterol levels: 194 ± 39mg/dl versus 190 ± 32mg/dl; p > 0.05; LDL levels: 113 ± 30mg/dl versus 110 ± 29mg/dl; p > 0.05). The mean serum HDL levels were lowest in the severe group (41 ± 11mg/dl) followed by the moderate (45 ± 16mg/dl) and mild (50 ± 15mg/dl) groups, with significant differences among the three groups (p = 0.02). The multivariate regression analysis revealed a statistically significant negative correlation between HDL and vertical cup-to-disc ratio (VCDR; B =-0.16, p = 0.03) among all NTG patients and a positive correlation between HDL and retinal nerve fiber layer (RNFL; r = 0.34, p = 0.03) among all NTG patients. Conclusions: A significantly lower serum HDL concentration was found in the NTG patients, which was negatively associated with disease severity. The findings warrant further study to elucidate the role of these phenomena in the pathogenesis of glaucoma.

Corvis Biomechanical Factor Facilitates the Detection of Primary Angle Closure Glaucoma.

Purpose: To characterize the corneal biomechanical properties of primary angle closure glaucoma (PACG) and to investigate the diagnostic performance of combining corneal biomechanical parameters and anterior segment parameters in detecting PACG. Methods: This retrospective cross-sectional study evaluated 79 and 81 eyes of normal controls and patients with PACG, respectively. Corvis Biomechanical Factor (CBiF) and anterior chamber volume (ACV) were measured using the Corvis ST and Pentacam, respectively. We performed multivariable logistic regression, adjusted for age, sex, central corneal thickness, intraocular pressure, and ACV to evaluate the effect of CBiF on PACG. The area under the receiver operating curve (AUC) was calculated to compare the diagnostic performance of ACV, CBiF, and ACV-CBiF combination for detecting PACG. Results: The median CBiF of the control and PACG groups was 6.61 (interquartile range [IQR], 6.39-6.88) and 6.20 (IQR, 5.93-6.48), respectively (P < 0.001). A lower CBiF, suggestive of decreased corneal biomechanical stability, increased the odds of PACG (odds ratio, 0.029; 95% confidence interval [CI], 0.003-0.266; P = 0.002) in the multivariable logistic regression model. The ACV-CBiF combination yielded the highest AUC (0.934; 95% CI, 0.882-0.968) compared with ACV alone (0.878; 95% CI, 0.823-0.928). The ACV-CBiF combination had significantly higher discriminatory ability than that of ACV alone (DeLong test, P = 0.004). Conclusions: Lower CBiF and ACV may act as independent predictors for PACG. Combining ACV and CBiF may enhance detection of PACG. Translational Relevance: The combination of corneal biomechanical parameters and anterior segment parameters enhances the detection of PACG.

Sustained Effects of Acute Resistance Exercise on Executive Function in Healthy Middle-Aged Adults.

The present study examined the sustained effects of acute resistance exercise on inhibitory function in healthy middle-aged adults. Seventy healthy middle-aged adults (mean age = 46.98 ± 5.70 years) were randomly assigned to exercise or control groups, and the Stroop test was administered before, immediately after, and 40 min after exercise. The resistance exercise protocol involved two sets of seven exercises performed for a maximum of 10 repetitions, with 60 s between sets and exercises. Acute resistance exercise resulted in higher Stroop test performance under the incongruent (inhibition) and interference conditions immediately post-exercise and 40 min post-exercise. Furthermore, the difference in scores after 40 min was significant. The findings indicate that a moderately intensive acute resistance exercise could facilitate Stroop performance and has a more beneficial effect on sustaining of cognition that involves executive control at least 40 min.

Deep Learning for Automated Diabetic Retinopathy Screening Fused With Heterogeneous Data From EHRs Can Lead to Earlier Referral Decisions.

Purpose: Fundus images are typically used as the sole training input for automated diabetic retinopathy (DR) classification. In this study, we considered several well-known DR risk factors and attempted to improve the accuracy of DR screening. Metphods: Fusing nonimage data (e.g., age, gender, smoking status, International Classification of Disease code, and laboratory tests) with data from fundus images can enable an end-to-end deep learning architecture for DR screening. We propose a neural network that simultaneously trains heterogeneous data and increases the performance of DR classification in terms of sensitivity and specificity. In the current retrospective study, 13,410 fundus images and their corresponding nonimage data were collected from the Chung Shan Medical University Hospital in Taiwan. The images were classified as either nonreferable or referable for DR by a panel of ophthalmologists. Cross-validation was used for the training models and to evaluate the classification performance. Results: The proposed fusion model achieved 97.96% area under the curve with 96.84% sensitivity and 89.44% specificity for determining referable DR from multimodal data, and significantly outperformed the models that used image or nonimage information separately. Conclusions: The fusion model with heterogeneous data has the potential to improve referable DR screening performance for earlier referral decisions. Translational Relevance: Artificial intelligence fused with heterogeneous data from electronic health records could provide earlier referral decisions from DR screening.

The Clinical Influence after Implementation of Convolutional Neural Network-Based Software for Diabetic Retinopathy Detection in the Primary Care Setting.

Deep learning-based software is developed to assist physicians in terms of diagnosis; however, its clinical application is still under investigation. We integrated deep-learning-based software for diabetic retinopathy (DR) grading into the clinical workflow of an endocrinology department where endocrinologists grade for retinal images and evaluated the influence of its implementation. A total of 1432 images from 716 patients and 1400 images from 700 patients were collected before and after implementation, respectively. Using the grading by ophthalmologists as the reference standard, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to detect referable DR (RDR) were 0.91 (0.87-0.96), 0.90 (0.87-0.92), and 0.90 (0.87-0.93) at the image level; and 0.91 (0.81-0.97), 0.84 (0.80-0.87), and 0.87 (0.83-0.91) at the patient level. The monthly RDR rate dropped from 55.1% to 43.0% after implementation. The monthly percentage of finishing grading within the allotted time increased from 66.8% to 77.6%. There was a wide range of agreement values between the software and endocrinologists after implementation (kappa values of 0.17-0.65). In conclusion, we observed the clinical influence of deep-learning-based software on graders without the retinal subspecialty. However, the validation using images from local datasets is recommended before clinical implementation.

Changes in Intraocular Pressure after Transepithelial Photorefractive Keratectomy and Femtosecond Laser In Situ Keratomileusis.

PURPOSE: To investigate the changes in intraocular pressure (IOP) and biomechanically corrected IOP (bIOP) in patients undergoing transepithelial photorefractive keratectomy (TPRK) and femtosecond laser in situ keratomileusis (FS-LASIK) and to determine the effects of preoperative biomechanical factors on IOP and bIOP changes after FS-LASIK and TPRK. DESIGN: A retrospective comparative study. METHODS: We retrospectively investigated the IOP and corneal biomechanical changes in 93 eyes undergoing FS-LASIK and 104 eyes undergoing TPRK in a clinical setting. Preoperative and postoperative data on ophthalmic and Corvis ST examinations, in vivo Young's modulus, and noncontact tonometry were analyzed. Marginal linear regression models with generalized estimating equations were used for intragroup and intergroup comparisons of IOP and bIOP changes. RESULTS: In the univariate model, IOP reduction after FS-LASIK was 2.49 mmHg higher than that after TPRK. In addition, bIOP reduction after FS-LASIK was 1.85 mmHg higher than that after TPRK. In the multiple regression model, we revealed that IOP reduction after FS-LASIK was 1.75 mmHg higher than that after TPRK. Additionally, bIOP reduction after FS-LASIK was 1.64 mmHg higher than that after TPRK. Postoperative changes in bIOP were less than those in IOP. In addition, Young's modulus and CBI had no significant effect on postoperative IOP and bIOP changes. We establish a biomechanically predictive model using the available data to predict postoperative IOP and bIOP changes after TPRK and FS-LASIK. CONCLUSIONS: Reductions in IOP and bIOP after FS-LASIK were 1.75 mmHg and 1.64 mmHg, respectively, more than those after TPRK, after adjustment for confounders. We revealed that the type of refractive surgery and peak distance (PD) were significant predictors of postoperative IOP and bIOP changes. By contrast, depth of ablation showed a significant effect on only IOP changes.

Effects of Acute Aerobic Exercise on Executive Function in Children With and Without Learning Disability: A Randomized Controlled Trial.

This study examined the effects of acute aerobic exercise on sustained attention and discriminatory ability of children with and without learning disabilities (LD). Fifty-one children with LD and 49 typically developing children were randomly assigned to exercise or control groups. The participants in the exercise groups performed a 30-min session of moderate-intensity aerobic exercise, whereas the control groups watched a running/exercise-related video. Neuropsychological tasks, the Daueraufmerksamkeit sustained attention test, and the determination tests were assessed before and after each treatment. Exercise significantly benefited performance in sustained attention and discriminatory ability, particularly in higher accuracy rate and shorter reaction time. In addition, the LD exercise group demonstrated greater improvement than the typically developing exercise group. The findings suggest that the acute aerobic exercise influenced the sustained attention and the discriminatory function in children with LD by enhancing regulation of mental states and allocation of attentional resources.

Objectively assessed physical activity patterns and physical function in community-dwelling older adults: a cross-sectional study in Taiwan.

OBJECTIVES: To objectively assess light physical activity (PA), moderate-to-vigorous PA (MVPA), step counts and number of 10 min MVPA bouts and their association with physical function among older adults. DESIGN: Cross-sectional design. SETTING: Urban community setting in Taiwan. PARTICIPANTS: 127 Taiwanese older adults aged over 65 years (mean age=70.8±5.3 years; 72% women). PRIMARY AND SECONDARY OUTCOME MEASURES: Triaxial accelerometers were used to measure PA variables for 10 hours/day for seven consecutive days. Then, five physical function components (handgrip strength, single-leg stance, 5-metre walk speed, timed up and go and sit-to-stand test) were measured. Multiple linear regressions were used to perform separate analyses for older men and women. RESULTS: For older women, daily MVPA time (ß: 0.39, 95% CI: 0.12, 0.64; p=0.004), daily step counts (ß: 0.46, 95% CI: 0.12, 0.78; p=0.009) and number of 10 min MVPA bouts (ß: 0.27, 95% CI: 0.001, 0.53; p=0.049) were positively associated with handgrip strength after adjusting for accelerometer wear time, sedentary time and other confounders. Furthermore, daily MVPA time was positively associated with a single-leg stance (ß: 0.25, 95% CI: 0.02, 0.49; p=0.036) and higher daily step counts were associated with shorter walking speed performance (ß: -0.31, 95% CI: -0.57, -0.001; p=0.049). None of the variables of the objectively assessed PA patterns was associated with physical function outcomes among older men due to their small sample size. CONCLUSIONS: Daily MVPA, MVPA bouts of at least 10 min and accumulated daily steps are important for improving physical function among older women. Future prospective research should establish causal associations between PA patterns and functional ability among older adults.

Independent and Joint Associations of Physical Activity and Dietary Behavior with Older Adults' Lower Limb Strength.

Studies have indicated that sufficient physical activity levels and balanced dietary behavior are independently related to physical function in older populations; however, their joint association with physical function remain unclear. This study examined the independent and combined associations of sufficient physical activity and balanced selection of foods with lower limb strength among 122 older Taiwanese adults living in community (mean age: 69.9 ± 5.0 years). The assessments included accelerometer-measured moderate-to-vigorous physical activity (MVPA) and self-reported selection of foods. Lower limb strength performance was measured using the five times sit-to-stand test. Binary logistic regression analyses were performed to estimate the associations in question before and after adjusting for potential confounders. The results showed that in the adjusted model, lower limb strength had no significant independent association with either meeting the recommended level of MVPA or balanced selection of foods. Compared to older adults who neither met the recommended MVPA level nor reported a balanced selection of foods, those who conformed to both these criteria were more likely to have better lower limb strength (odds ratio = 6.28, 95% confidence interval = 1.36-29.01) after adjusting for covariates. Health promotion initiatives addressing disability prevention for older adults need to consider promoting both MVPA and food selection.

Seeking Positive Strengths in Buffering Athletes' Life Stress-Burnout Relationship: The Moderating Roles of Athletic Mental Energy.

In search of positive strengths that bolster athletes' reaction to stress, the purpose of this study was to examine the moderating effects of athletic mental energy on the athletes' life stress-burnout relationship. This study recruited two samples (Study 1 = 230; Study 2 = 159) and administered the College Student-Athlete's Life Stress Scale (CSALSS; Lu et al., 2012), Athletic Mental Energy Scale (AMES; Lu et al., 2018), and Athlete Burnout Questionnaire (ABQ; Raedeke and Smith, 2001). Two separate hierarchical multiple regression analyses found that the emotional and cognitive components of athletic mental energy moderated the athletes' life stress-burnout relationship across the two studies. Results provided the initial evidence that athletic mental energy can be positive strengths in buffering the stress-burnout relationship. Theoretical implications, limitations, practical applications, and future research directions are discussed.

Risk of developing open-angle glaucoma in patients with carotid artery stenosis: A nationwide cohort study.

Whether carotid artery stenosis (CAS) is an independent risk factor for open-angle glaucoma remains unclear. In this study, we investigated the association between CAS and the development of open-angle glaucoma in the Taiwanese population-based cohort derived from a longitudinal database containing claims data from the Taiwan National Health Insurance (NHI) program; this study enrolled 2093 patients with CAS and 8372 patients without CAS matched by age and sex from 1999 to 2010. Diagnoses of open-angle glaucoma (OAG) were identified during a follow-up period lasting through December 31, 2013. A Cox proportional hazards model was applied to evaluate the hazard ratio (HR) for OAG in the CAS cohort compared with the matched cohort. We found that the HR for open-angle glaucoma in the CAS cohort compared with the matched cohort. The adjusted HR for OAG in the CAS cohort was 1.50 (95% confidence interval, 1.11-2.02, P = .008). The Kaplan-Meier analysis revealed that the CAS cohort had a higher cumulative incidence of OAG than did the matched cohort during the follow-up period (log-rank test, P < .001). We concluded that CAS is a significantly independent risk factor for the development of OAG. Our finding is clinically important for the aging population, which has an increasing prevalence of CAS.

Effects of an 8-week yoga program on sustained attention and discrimination function in children with attention deficit hyperactivity disorder.

This study investigated whether a yoga exercise intervention influenced the sustained attention and discrimination function in children with ADHD. Forty-nine participants (mean age = 10.50 years) were assigned to either a yoga exercise or a control group. Participants were given the Visual Pursuit Test and Determination Test prior to and after an eight-week exercise intervention (twice per week, 40 min per session) or a control intervention. Significant improvements in accuracy rate and reaction time of the two tests were observed over time in the exercise group compared with the control group. These findings suggest that alternative therapies such as yoga exercises can be complementary to behavioral interventions for children with attention and inhibition problems. Schools and parents of children with ADHD should consider alternatives for maximizing the opportunities that children with ADHD can engage in structured yoga  exercises.