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Laws requiring firms to disclose privacy breaches to their customers have been adopted extensively worldwide. However, the manner in which these laws affect the security protection behavior of firms disclosing a data breach is poorly understood. To shed light on this issue, we leveraged institutional theory and examined how U.S. state data breach notification laws (DBNLs), under which firms must notify customers of personal information breaches, influenced firm-level incidence of security breaches and how such influence manifested heterogeneously across firms. Exploiting the staggered enactments of DBNLs in a difference-in-differences analysis, we found that firms experienced a significant reduction in data breach incidents after the implementation of DBNLs. This effect was more pronounced among firms that were more reliant on sensitive customer data, operated in stricter privacy protection environments, or held more intangible and digital assets. We document evidence that compared to firms not subject to DBNLs, firms subject to these laws are more likely to appoint IT-specialized executives and remediate IT-related internal control weaknesses, which suggests potential channels that may facilitate DBNLs’ curbing of data breaches. We also found that the reduction in breach incidences following DBNL-mandated disclosure policies relates to both endogenous breaches and exogenous cyberattacks. [ABSTRACT FROM AUTHOR]

Impaired microcirculatory function after heart transplantation is associated with increased risk for acute cellular rejection. Microvascular resistance reserve (MRR) is a novel index for assessing microcirculatory function, irrespective of epicardial coronary artery stenosis, but it has not been validated in transplanted hearts. The aim of this study was to investigate the prognostic impact of MRR in heart transplantation. The present study prospectively enrolled 154 heart transplant recipients who underwent scheduled coronary angiography and invasive coronary physiological assessment 1 month after transplantation. Coronary microcirculatory dysfunction was defined as MRR ≤3.0. Elevated microcirculatory resistance was defined as an index of microcirculatory resistance ≥15. The presence of epicardial coronary stenosis was assessed by fractional flow reserve. The primary outcome was a composite of death or biopsy-proven acute cellular rejection of grade ≥ 2R after transplantation. Among the total patients, 22.1% (34 of 154) had impaired microcirculatory function (MRR ≤3.0), and 77.9% (122 of 154) had preserved microcirculatory function (MRR >3.0). During median follow-up of 730 days (Q1-Q3: 730-730 days), patients with MRR ≤3.0 showed increased risk for a composite of death or acute cellular rejection (adjusted HR: 5.31; 95% CI: 2.65-10.64; P < 0.001), acute cellular rejection (adjusted HR: 4.83; 95% CI: 2.20-10.60; P < 0.001), and death (adjusted HR: 5.19; 95% CI: 1.24-21.62; P = 0.024). MRR was significantly associated with increased risk for death or acute cellular rejection, regardless of epicardial coronary artery stenosis (HR adjusted for fractional flow reserve: 1.89 per 1-U decrease in MRR; 95% CI: 1.46-2.46; P < 0.001) or elevated microcirculatory resistance (HR adjusted for index of microcirculatory resistance: 1.90 per 1-U decrease in MRR; 95% CI: 1.43-2.52; P < 0.001). Impaired microcirculatory function, determined by MRR early after heart transplantation, identified patients at high risk for death or acute cellular rejection, regardless of epicardial coronary artery stenosis or elevated microcirculatory resistance. (Physiologic Assessment of Microvascular Function in Heart Transplant Patients; NCT02798731) [Display omitted] [ABSTRACT FROM AUTHOR]

This study analyzed temperature and precipitation from 60 meteorological stations during a half-century (1974–2023) using the Innovative Trend Analysis (ITA) to explore the spatial and temporal trends across South Korea. The ITA illustrated the trends graphically, and the Mann-Kendall (MK) test added statistical significance to these findings, allowing us to better understand climate changes over the past five decades. The ITA analysis showed a statistically significant monotonic warming trend in temperature at nearly all of the stations. While annual and seasonal changes were found to be substantial, the most relative increases were reported during the spring and summer months. There were quite clear spatial and seasonal differences in precipitation trends. The Han River and Jeju Island areas showed significant increases in precipitation during summer and autumn, which may be associated with intensified monsoonal activity. Our findings revealed a consistent warming signal in all regions and significant regional climate variability. The observed temperature increases, especially in the spring season, are likely to have significant impacts on crop yield and altered growing season due to increased heat stress, increased water demand for various activities affecting water resources, heightened risks to public health from heatwaves and broader impacts on societal well-being such as increased energy demands as well as economic costs associated with climate adaptation measures. The complex precipitation patterns revealed the influence of regional topography and oceanic drivers in modulating climate variability in South Korea, which differs from patterns seen in more continental regimes. [ABSTRACT FROM AUTHOR]

Background: In lymphedema, the accumulation of subcutaneous interstitial fluid is the most characteristic feature. Bioimpedance analysis (BIA) is a promising technique to measure the amount of body components using a noninvasive method. In this study, we determined the clinical significance of BIA parameters in upper limb lymphedema with surgical treatment such as lymphovenous anastomosis or vascularized lymph node transfer. Methods and Results: A single-center retrospective study using a multifrequency BIA. Perioperative BIA parameters such as extracellular water ratio or fat-free mass (FFM) ratio and limb volume defined as percentage of excess volume (PEV) were measured. The relationships between the magnitude of change in PEV and BIA parameters during surgery were evaluated. Out of 48 unilateral lymphedema patients, 46 were female and the average age was 55.4 years. PEV and all BIA parameters showed a significant decrease after surgery (p < 0.001). There were significant correlations between ΔPEV and the degree of changes in all BIA parameters. ΔFFM ratio showed the highest correlation with the amount of change in PEV (r = 0.599, p < 0.001). Conclusion: BIA parameters correlated well with the volume change after surgery. BIA could be useful as a quick and easy tool for follow-up after lymphedema surgery. [ABSTRACT FROM AUTHOR]

The role of MR imaging in patients with cognitive impairment is to evaluate each component of Alzheimer's disease (AD), small vessel disease (SVD), and glymphatic function. We want to validate the diagnostic performance of the comprehensive interpretation of these parameters to predict the cognitive impairment stage. This retrospective single-center study included 359 patients with cognitive impairment who had undergone MRI (FLAIR, T2WI, 3D-T1WI, susceptibility-weighted imaging, and diffusion tensor imaging [DTI]) and a neuropsychological screening battery between January 2020 and July 2022. Each AD and SVD-related MR parameter was visually evaluated, and DTI analysis along the perivascular space (ALPS) index was calculated. Volumetry analysis was performed using Neurophet AQUA AI-based software. Using logistic regression analysis, four types of models were developed and compared by adding the components in the following order: (1) clinical factors and AD, (2) SVD, (3) glymphatic function-related MR parameters, and (4) volumetric data. Chi-square automatic interaction detection algorithm was used to develop diagnostic tree analysis (DTA) model to predict late-stage cognitive impairment. APOE4 status, years of education, medial temporal lobe atrophy score, Fazekas scale score, DTI-ALPS index, and white matter hyperintensity were significant predictors of late-stage cognitive impairment. The performance of the prediction model increased from Model 1 to Model 4 (AUC: 0.880, 0.899, 0.914, and 0.945, respectively). The overall accuracy of the DTA model was 87.47%. Integrative brain MRI assessments in patients with cognitive impairment, AD, SVD, and glymphatic function-related MR parameters, improve the prediction of late-stage cognitive impairment. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) in patients with spinal diseases significantly reduces quality of life by causing not only physical disability but also psychological issues. LBP has a high prevalence worldwide and imposes substantial economic and social burdens, making its management critically important. This study aimed to develop and validate a model explaining LBP management behavior in patients with spinal diseases based on Self-Determination Theory (SDT). The hypothetical model of this study was developed based on Deci and Ryan's SDT and a literature review. A cross-sectional online survey was conducted with 220 patients diagnosed with spinal diseases, such as herniated intervertebral disc and spinal stenosis, who were members of a self-help group in South Korea. The survey included a total of 95 items, covering general characteristics, LBP management behavior, healthcare provider's autonomy support (support for making decisions and acting independently), social support, internal health locus of control (belief in one's ability to manage health independently), basic psychological needs (autonomy, competence, relatedness), and autonomous motivation (motivation based on intrinsic values). Data were analyzed using structural equation modeling. Autonomous motivation showed a significant direct and total effect on LBP management behavior (β = 0.60, p <.001). Healthcare provider's autonomy support also had a significant direct (β = 0.20, p =.042) and total effect (β = 0.35, p =.003). Internal health locus of control and basic psychological needs had indirect effects on LBP management behavior (β = 0.18, p =.042; β = 0.33, p =.019), while social support did not show significant direct (β = 0.06, p =.840), indirect (β = 0.07, p =.733), or total effects (β = 0.12, p =.406) on LBP management behavior. These variables collectively explained 52.2% of the variance in LBP management behavior among patients with spinal diseases. This study confirmed that autonomous motivation and healthcare provider's autonomy support significantly influence LBP management behaviors in patients with spinal disease. Additionally, internal health locus of control and basic psychological needs indirectly impacted these behaviors through autonomous motivation. The findings underscore the importance of developing programs that enhance patients' autonomous motivation and providing autonomy-supportive interventions by healthcare providers. By identifying patients' internal health locus of control tendencies and tailoring interventions to meet their psychological needs, healthcare professionals can provide effective support for sustained LBP management behavior in patients with spinal disease. None. [ABSTRACT FROM AUTHOR]

Background: Autologous osteochondral transplantation (AOT) is an option to treat large osteochondral lesions of the talus (OLTs), accompanying subchondral cyst, and previous unsuccessful bone marrow stimulation (BMS) procedures. Although there is extensive literature on the outcomes of surgical interventions for medial osteochondral lesions, research focusing on lateral lesions remains limited. This article presents the intermediate-term clinical and radiologic outcomes following AOT for lateral OLTs. Methods: Twenty-eight patients with lateral OLTs were followed up for a minimum of 3 years after AOT. Clinical evaluations included the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessments evaluated articular surface (subchondral plate) irregularity, progression of degenerative arthritis, and changes in talar tilt and anterior talar translation. The quality of osteochondral graft was evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Results: The average FAOS and FAAM scores significantly increased from 39.6 to 91.2 and from 37.8 to 89.8 points, respectively, at the final follow-up (P <.001). Radiologic assessments revealed 2 patients (7.1%) with articular step-off ≥2 mm and 1 patient (3.6%) with progressive arthritis. The average MOCART score reached 92.8 points. Postoperative complications included 2 patients with wound problems, 1 with a superficial peroneal nerve injury, and 1 with donor site morbidity. The rate of return to preinjury level of sports activity was 82.1%. At a mean follow-up of 68.5 months, no patient required reoperation for OLT or recurrent ankle instability. Conclusion: AOT for lateral OLTs demonstrated favorable intermediate-term clinical and radiologic outcomes. Most lateral OLTs were accessible via lateral ankle ligament division and capsulotomy, with minimal occurrence of iatrogenic complications such as recurrent ankle instability. AOT appears to be an effective surgical option for patients with large lateral osteochondral lesions unresponsive to conservative treatment, large subchondral cysts, and prior unsuccessful BMS procedures. [ABSTRACT FROM AUTHOR]

The impact of vitamin D deficiency (VDD) on cognition remains controversial. Evidences suggest that variability based on apolipoprotein E (APOE) ε4 status and gender, given APOE ε4's influence on vitamin D metabolism and women's heightened vitamin D sensitivity. We investigated the interplay between APOE ε4, gender, and VDD in cognitive decline among older adults. In a population-based cohort of 1547 cognitively normal Koreans aged ≥60 years, Mini Mental State Examination (MMSE) changes were tracked biennially (2010–2020). VDD was defined as serum 25-hydroxyvitamin D < 10 ng/mL. Linear mixed models analyzed VDD effects, with subgroup analyses for APOE ε4 status and gender. VDD was present in 21.3 % at baseline and was linked to faster MMSE decline (estimate = −0.054, 95 % CI [-0.091, −0.017], p = 0.004), particularly in APOE ε4 non-carriers (estimate = −0.070, 95 % CI [-0.112, −0.029], p = 0.001). A gender-based analysis revealed that this effect was significant only in female non-carriers (estimate = −0.097, 95 % CI [-0.156, −0.038], p = 0.001). Conversely, male non-carriers demonstrated an absence of a statistically significant association (estimate = −0.017, 95 % CI [-0.076, 0.041], p = 0.562). VDD accelerates cognitive decline in cognitively normal APOE ε4 non-carriers, particularly women, underscoring the importance of tailored prevention strategies. [ABSTRACT FROM AUTHOR]

A new cytosporin derivative (1) and a new phenolic compound (2), together with cytosporin D (3), were isolated from an EtOAc extract of Apiospora xenocordella culture medium. The isolation workflow was guided by a Molecular Networking-based dereplication strategy. The chemical structures of the new compounds were determined by using MS and NMR spectroscopic techniques, and the absolute configurations were established by the modified Mosher's method and quantum chemical calculation of electronic circular dichroism. UV radiation activates pro-inflammatory cytokines, such as TNF-α, a major contributor to skin aging through ROS generation and MMP-1 secretion. Cytosporin D (3) exhibited the inhibition of TNF-α-induced ROS and MMP-1. UV radiation activates pro-inflammatory cytokines including TNF-α which is a major contributor to skin aging through reactive oxygen species (ROS) generation and matrix metalloproteinase-1 (MMP-1) secretion. Cytosporin D (3) exhibited moderate inhibition against TNF-α-induced ROS and MMP-1. This compound docked computationally into the active site of MMP-1 (−5.9 kcal/mol). Compound 1 , though not tested due to limited quantity, showed a docking simulation result (−6.0 kcal/mol) similar to cytosporin D (3), indicating potential activity. [Display omitted] • Two new compounds were isolated from Apiospora xenocordella culture medium. • The isolation workflow was guided by a Molecular Networking-based dereplication strategy. • Cytosporin D (3) exhibited inhibition of TNF-α-induced ROS and MMP-1. [ABSTRACT FROM AUTHOR]

Patients with moderate or asymptomatic severe aortic stenosis (AS) are at risk of cardiovascular events. The authors investigated the utility of cardiac magnetic resonance (CMR) to identify drivers of outcome in patients with moderate or asymptomatic severe AS. A prospective, international, multicenter cohort (n = 457) of patients with moderate (aortic valve area [AVA]: 1.0-1.5 cm2) or asymptomatic severe AS (AVA ≤1.0 cm2 and NYHA functional class I-II) patients underwent CMR. Diffuse interstitial fibrosis and scar in the myocardium were analyzed with extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The outcome was a composite of mortality and heart failure admission. Median ECV% was 26.6% (IQR: 24.4%-29.9%), and LGE was present in 31.5% (median 0.8%; IQR: 0.1%-1.7%). Greater AS severity was associated with greater left ventricular mass and diastolic dysfunction, but not with ECV% or LGE. During a median 5.7 years of follow-up, 83 events occurred. Patients with events had higher ECV% (median ECV% 26.3% vs 28.2%; P = 0.003). Patients in the highest ECV% tertiles (ECV% >28.6%) had worse outcomes both in the entire cohort and in those with NYHA functional class I moderate or severe AS, and ECV% was independently associated with outcome (adjusted HR: 1.05; P = 0.039). The ECV% had significant incremental prognostic value when added to parameters of AS severity and cardiac function, comorbidities, aortic valve replacement, and LGE (P < 0.05). Increased diffuse interstitial fibrosis of the myocardium is associated with poor outcomes in patients with moderate and asymptomatic severe AS and can help identify those who require closer surveillance for adverse outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

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Objective: To propose a new ypTNM grouping system to address limitations and improve prognostic relevance. Background: The current eighth edition of the American Joint Committee on Cancer (AJCC) ypStage system shows unsatisfactory prognostic relevance in patients with esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (nCRT), followed by esophagectomy. Methods: The study cohort included 501 patients with ESCC who received nCRT, followed by esophagectomy at the Samsung Medical Center in Korea between 1994 and 2018 (development cohort), and 422 patients treated at Asan Medical Center (validation cohort). Recursive partitioning with a tree-structured regression model was used to develop and validate a new ypStage grouping system. Results: In the new ypStage grouping system, ypStage I include ypT0N0 only, ypStage II includes ypTis–T2N0 or ypT0–T2N1, ypStage III includes ypT3N0–N1, and ypStage IV includes ypT4N0–N1 or ypTanyN2–3. This system adequately addressed the limitations of the existing AJCC classification system, including overlapping and reversal of survival rates. Moreover, the discrimination ability of the new system was higher than that of the existing system [concordance-index (C-index): 61.9%] in the development (C-index: 66.6%) and validation (C-index: 66.0%) cohorts. NRIe was 0.17 (95% CI: 0.09–0.26, P < 0.001) and 0.18 (95% CI: 0.10–0.27, P <0.001) in the development and validation cohorts, respectively. Conclusions: The current study proposes a clear revised version of the eighth edition of the AJCC ypStage grouping system that exhibits superior prognostic stratification in patients with ESCC treated with nCRT, followed by esophagectomy. [ABSTRACT FROM AUTHOR]