bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of Adverse Pregnancy Outcomes Among Pregnant Individuals With Gestational Diabetes by Race and Ethnicity in the United States, 2014–2020
Authors: Venkatesh Kartik K. , Lynch Courtney D. , Powe Camille E. , Costantine Maged M. , Thung Stephen F. , Gabbe Steven G. , Grobman William A. , Landon Mark B.
Published: October 2022

(Abstracted from JAMA 2022;327:1356–1367)

In 2016, gestational diabetes mellitus (GDM) affected 6% of pregnancies in the United States. In 2015, maternal and neonatal adverse outcomes occurred in approximately 33% of pregnancies affected by GDM and in approximately 25% of infants born from pregnancies affected by GDM.
Single Nucleotide Polymorphism Array Versus Karyotype for Prenatal Diagnosis in Fetuses With Abnormal Ultrasound: A Systematic Review and Meta-analysis
Authors: Kamath Vandana , Chacko Mary Purna , Kirubakaran Richard , Mascarenhas Mariano , Kamath Mohan S.
Published: October 2022

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2022;271:235–244)

Chromosomal aberrations occur at a frequency of approximately 1 in 150 to 200 live births and are one of the most important causes of congenital anomalies and miscarriages. The introduction of chromosomal microarray (CMA) in the 1990s advanced the detection of chromosomal aberrations to include small copy number variants that previously were not detectable when only karyotype was used.
Mix and Mesh: An Electronic Database of FPMRS Mesh Products Through 2020
Authors: Woodburn Katherine L. , Cardenas-Trowers Olivia O. , Fitzgerald Jocelyn J.
Published: October 2022

(Abstracted from Female Pelvic Med Reconstr Surg 2022;28:e154–e156)

In the United States, traditionally used treatment methods for pelvic organ prolapse (POP) and stress urinary incontinence include various types of synthetic mesh. Because the first transvaginal mesh product arrived on the market, over 1 million mesh products have been implanted.
Potential Role of the Corpus Luteum in Maternal Cardiovascular Adaptation to Pregnancy and Preeclampsia Risk
Authors: Conrad Kirk P. , von Versen-Höynck Frauke , Baker Valerie L.
Published: October 2022

(Abstracted from Am J Obstet Gynecol 2022;226:683–699)

Preeclampsia (PE) affects 4.6% (95% confidence interval [CI], 2.7–8.2) of all pregnancies worldwide and often necessitates iatrogenic premature delivery, increasing the likelihood of neonatal morbidity and low birthweight. Mothers and their children who survive PE are at increased risk of developing adverse cardiovascular events later in life, although the mechanism behind this and many of the PE disease manifestations remains unclear.
Live-Birth Outcomes Among Women With Infertility and Anti-Müllerian Hormone Levels of 0.3 ng/mL or Lower
Authors: Romanski Phillip A. , Gelvin Brady , Bortoletto Pietro , Rosenwaks Zev , Kang Hey-Joo
Published: October 2022

OBJECTIVE:

To estimate the live-birth rate per in vitro fertilization (IVF) cycle and after cumulative infertility treatment among patients with anti-müllerian hormone (AMH) levels of 0.3 ng/mL or lower.

METHODS:

We conducted a retrospective cohort study at a single academic center of patients with infertility and AMH levels of 0.3 ng/mL or lower who initiated one or more IVF cycles (2013–2019). Exclusion criteria included prior chemotherapy, hormonal contraceptive use within 3 months of AMH level measurement, and severe male factor infertility. Patients were stratified by Society for Assisted Reproductive Technology (SART) age group. The primary outcome was live-birth rate per IVF cycle. Live-birth outcomes were compared with the 2018 SART National Summary Report for live births per single intended oocyte retrieval, with proportion difference (PD) and 95% CI reported.

RESULTS:

A total of 978 patients were included. The median (interquartile range) number of cycles initiated was 2 (1–3). With the first initiated cycle, the live-birth rate for those with AMH levels of 0.3 ng/mL or lower was significantly lower in each age category compared with the SART live-birth rate per single initiated cycle (younger than 35 years: 26.2% vs 55.6%, PD 29.4%, 95% CI 20.9–37.9%; 35–37 years: 15.9% vs 40.8%, PD 24.9%, 95% CI 19.0–30.9%; 38–40 years: 12.6% vs 26.8%, PD 14.3%, 95% CI 10.2–18.3%; 41–42 years: 4.7% vs 13.4%, PD 8.7%, 95% CI 5.9–11.6%; older than 42 years: 1.2% vs 4.1%, PD 2.9%, 95% CI 1.5–4.3%). In patients aged 35–37, 38–40, 41–42, and older than 42 years, the cumulative live-birth rate after up to three initiated cycles was comparable with the SART live-birth rate per single initiated cycle but remained significantly lower in patients younger than age 35 years (PD 16.8%, 95% CI 7.3–26.2%). After all treatments were included (cumulative IVF, ovulation induction, and unassisted cycles), live-birth rates were similar to SART live-birth rates per single initiated cycle in all age groups.

CONCLUSION:

Compared with national outcomes, patients with AMH levels of 0.3 ng/mL or lower had a significantly lower chance of live birth after their first initiated cycle. However, the cumulative live-birth rate after up to three initiated cycles was comparable with national live-birth outcomes per single initiated cycle in patients aged 35 years or older. In patients younger than age 35 years, only when all IVF and non-IVF treatment cycles were included did the cumulative live-birth rate become comparable with the national rate per single IVF cycle.
Dismantling Structural Barriers
Authors: McClurg Asha Belle , Arora Kavita Shah , Schiff Lauren D. , Carey Erin T. , Neal-Perry Genevieve Scott
Published: October 2022

Disparities in health by race, ethnicity, and socioeconomic status within obstetrics and gynecology are well described and prompt evaluation for structural barriers. Academic medicine has a historical role in caring for marginalized populations, with medical trainees often serving as first-line clinicians for outpatient care. The ubiquitous approach of concentrating care of marginalized patients within resident and trainee clinics raises ethical questions regarding equity and sends a clear message of value that is internalized by learners and patients. A path forward is elimination of the structural inequities caused by maintenance of clinics stratified by training level, thereby creating an integrated patient pool for trainees and attending physicians alike. In this model, demographic and insurance information is blinded and patient triage is guided by clinical acuity and patient preference alone. To address structural inequities in our health care delivery system, we implemented changes in our department. Our goals were to improve access and patient experience and to send a unified message to our patients, learners, and faculty—our clinical staff, across all training levels, are committed to giving the highest standard of care to all people, regardless of insurance status or ability to pay. Academic medical centers must look internally for structural barriers that contribute to health care disparities within obstetrics and gynecology as we aim to make progress toward equity.
Patterns in Contraceptive Use Among Women of Mexican Origin in the United States and in Mexico
Authors: Coleman-Minahan Kate , Boniface Emily R. , Fuentes-Rivera Evelyn , Saavedra-Avendaño Biani , Riosmena Fernando , Darney Blair G.
Published: October 2022

OBJECTIVE:

To examine current contraceptive use by parity among four ethnicity and nativity groups: non-Latina White women in the United States, Mexican-American women in the United States, foreign-born women of Mexican origin in the United States, and Mexican women in Mexico.

METHODS:

We combined nationally representative data from sexually active women, aged 15–44 years, and not seeking pregnancy from the U.S. National Survey of Family Growth and the Mexican National Survey of Demographic Dynamics. This is a secondary binational analysis. Using multivariable logistic regression, we estimated the prevalence of moderately or most effective contraceptive method use (compared with least effective or no contraceptive method) by ethnicity and nativity and tested the interaction between ethnicity and nativity and parity.

RESULTS:

Compared with non-Latina White women, women of Mexican origin had lower odds of using a moderately or most effective contraceptive method (adjusted odds ratio [aOR] [95% CI] Mexican-American women: 0.69 [0.54–0.87]; foreign-born women: 0.67 [0.48–0.95]; Mexican women in Mexico: 0.59 [0.40–0.87]). Among parous women, the adjusted probability of using a moderately or most effective contraceptive method was approximately 65% among all four groups. Contraceptive method use did not differ by parity among non-Latina White women. However, parous Mexican-American women were 1.5 times more likely to use moderately or most effective contraceptive methods than nulliparous Mexican-American women (adjusted probability 66.1% vs 42.7%). Parous foreign-born women were 1.8 times more likely to use most or moderately effective contraceptive methods than their nulliparous counterparts (64.5% vs 36.0%), and parous Mexican women in Mexico were three times more likely to use moderately or most effective contraceptive methods (65.2% vs 21.5%).

CONCLUSION:

Findings suggest that access to effective contraception is limited outside the context of childbearing for women of Mexican origin in the United States and, to an even larger extent, in Mexico.
Perinatal Outcomes of Pregnancies of Unknown Location With Human Chorionic Gonadotropin Concentration Above the Discriminatory Zone
Authors: Dawodu Olanrewaju , Wu Jessica , Gallop Robert , Barnhart Kurt T.
Published: October 2022

In this retrospective cohort study, we investigated the relationship between delayed presentation of first-trimester ultrasonographic landmarks of intrauterine pregnancy and perinatal outcomes. Patients presenting as pregnancies of unknown location who ultimately had intrauterine pregnancies were included and divided into two groups, determined by visualization of intrauterine landmarks at hCG <2000 or ≥ 2000. From 487 total patients, there was no significant difference in incidence of favorable perinatal outcome (73.3% vs 73.7%, RR=1.01, 95% CI 0.98-1.10). Of 439 live births, mean birthweight was statistically significantly lower by 115 g in the latter group. No significant difference was found for other neonatal or maternal outcomes. Our findings suggest no relationship between delayed presentation of intrauterine landmarks and poor perinatal outcomes, but a potential association with lower birthweight, though this may have limited clinical significance.
Medically Attended Influenza During Pregnancy in the 2019–2020 and 2020–2021 Influenza Seasons
Authors: Irving Stephanie A. , Shuster Elizabeth , Henderson Jillian T. , Li De-Kun , Ferber Jeannette , Odouli Roxana , Munoz Flor M. , Nicholson Erin , Hadden Louise , Juergens Mary , Newes-Adeyi Gabriella , Reichle Lawrence , Arriola Carmen Sofia , Dawood Fatimah S. , Daugherty Michael , Wielgosz Kristina , Naleway Allison L.
Published: October 2022

Influenza testing and case-confirmation rates in pregnant populations have not been reported during the coronavirus disease 2019 (COVID-19) pandemic. Using electronic medical record data from a cohort of nearly 20,000 pregnancies in the United States, this retrospective cohort study examines the frequency of acute respiratory or febrile illness encounters, influenza testing, and influenza positivity during the 2020–2021 influenza season, which occurred during the COVID-19 pandemic, compared with the 2019–2020 influenza season, which largely did not. The ratios of influenza tests to acute respiratory or febrile illness visits were similar in the 2019–2020 and 2020–2021 influenza seasons (approximately 1:8 and 1:9, respectively) but were low and varied by study site. Although influenza testing in pregnant patients continued in the 2020–2021 season, when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) circulation was widespread in the United States, no cases of influenza were identified in our study cohort.
Association of Physician Densities and Gynecologic Cancer Outcomes in the United States
Authors: Smick Alexandra H. , Holbert Michael , Neff Robert
Published: October 2022

OBJECTIVE:

To evaluate whether there is an association between county-level obstetrician–gynecologist (ob-gyn) and primary care physician (PCP) densities and gynecologic cancer outcomes in the United States.

METHODS:

A retrospective cohort study of gynecologic cancers (uterine, ovarian, and cervical) in the Surveillance, Epidemiology, and End Results (SEER) database was performed from 2005 to 2018. County-level demographics were abstracted from the SEER database, population density from the United States Census Bureau, and physician density (ob-gyns and PCPs/100,000 females) from the Area Health Resources File. Backward stepwise regression models were used.

RESULTS:

Final analysis included 113,938 patients for stage at diagnosis analysis and 98,573 patients for 5-year survival analysis. Uterine, ovarian, and cervical cancers represented 60.0%, 25.0%, and 15.0% of patients, respectively. Most counties (57%) were nonmetropolitan and had a mean ob-gyn density of 8 per 100,000 females and a mean PCP density of 89 per 100,000 females. Multivariate analysis showed that increasing PCP density was associated with earlier stage at diagnosis (95% CI −6.27 to −0.05; P<.05) and increased 5-year survival rates in cervical cancer (95% CI 0.03–0.09; P<.05). Obstetrician–gynecologist density was not found to affect stage or survival outcomes for uterine or ovarian cancer. Analysis of sociodemographic factors for cervical cancer showed that median household income was negatively correlated with stage (P=.01) and that the percentage of those with bachelor’s degrees and metropolitan status were positively correlated with 5-year survival rates (P<.01). For uterine cancer, the percentage of Black females was positively correlated with stage (P<.01) and negatively correlated with 5-year survival rates (P<.01).

CONCLUSION:

Increasing PCP density, but not ob-gyn density, is associated with earlier stage at diagnosis and improved 5-year survival rates in cervical cancer. County-level sociodemographic factors, including population diversity, metropolitan status, educational attainment, and household income, were also correlated with outcomes across all cancer types. Targeting PCP supply and education in lower density counties may improve population-based care for cervical cancer.
Preimplantation Genetic Testing for Aneuploidy With Comprehensive Chromosome Screening in Patients Undergoing In Vitro Fertilization
Authors: Cheng Xin , Zhang Yu , Deng Haidong , Feng Yuning , Chong Weelic , Hai Yang , Hao Pengfei , He Jialing , Li Tiangui , Peng Liyuan , Wang Peng , Xiao Yangchun , Fang Fang
Published: October 2022

OBJECTIVE:

To review the effect of comprehensive chromosome screening–based preimplantation genetic testing for aneuploidy (PGT-A) in women undergoing in vitro fertilization (IVF) treatment, we conducted this meta-analysis to compare pregnancy outcomes of women who did and did not undergo such testing.

DATA SOURCES:

We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception until February 28, 2022, for randomized controlled trials focusing on PGT-A treatment without any language restrictions.

METHODS OF STUDY SELECTION:

Randomized controlled trials involving women undergoing IVF with or without PGT-A and comprehensive chromosome testing. Pooled relative risks (RRs) with 95% CIs were calculated for the primary outcome using a random-effects model with the Mantel-Haenszel method.

RESULTS:

A total of nine trials with 3,334 participants were included. Overall, PGT-A was not associated with an increased live-birth rate (RR 1.13, 95% CI 0.96–1.34, I2=79%). However, PGT-A raised the live-birth rate in women of advanced maternal age (RR 1.34, 95% CI 1.02–1.77, I2=50%) but not in women of nonadvanced age (RR 0.94, 95% CI 0.89–0.99, I2=0%).

CONCLUSION:

Preimplantation genetic testing for aneuploidy increases the live-birth rate in women of advanced maternal age.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42022311540.
Incarcerated Gravid Uterus Liberated by Placement of a Vaginal Balloon
Authors: Abelman Sarah H. , Jayakumaran Jenani S. , Sigdel Manisha , Baxter Jason K.
Published: October 2022

BACKGROUND:

Incarceration of the gravid uterus is an infrequent obstetric complication that can cause severe complications.

CASE:

A 37-year-old woman, G3P2002, at 14 weeks of gestation presented with vomiting, back pain, and urinary retention. She was noted to be in acute renal failure, with a creatinine level of 9.24 mg/dL, and results of her physical examination were concerning for uterine incarceration. Passive maneuvers and manual pressure failed to resolve the incarceration. Under spinal anesthesia, a Bakri balloon was inflated in the posterior vagina, elevating the fundus and relieving the incarcerated uterus.

CONCLUSION:

An intravaginal balloon may aid in the alleviation of uterine incarceration.
Long-Acting Reversible Contraception
Authors: Baker Courtney C. , Creinin Mitchell D.
Published: October 2022

Long-acting reversible contraceptive (LARC) methods are effective options for pregnancy prevention. Currently available products in the United States include an etonogestrel implant, a copper intrauterine device (IUD), and several levonorgestrel IUDs. With increasing prevalence and duration of use, our understanding of efficacy, risks, and benefits has evolved. In addition to a brief discussion on nomenclature and LARC use within a framework of bodily autonomy and reproductive justice, this review covers clinical challenges with placement and removal, evidence-based duration of use, and how to mitigate side effects. Although all obstetrician–gynecologists as well as primary care clinicians can safely provide LARCs, complex family planning specialists are an expert referral source for challenging cases and evidence-based care as contraceptive technology continues to develop.
Patterns of Risky Health Behaviors and Associations With Chronic Diseases Among Young Adult Nursing Students: A Latent Class Analysis
Authors: DONG Chaoqun , CHEN Hua , YANG Yeqin , LI Yi , SUN Yumei , SUN Hongyu
Published: October 2022

Background

Little is known about how health behaviors cluster to form meaningful patterns that influence health outcomes in young adult nursing students.

Purpose

The purpose of this study was to identify the unique health behavior patterns among young adult nursing students in China and examine the associations between health behaviors and chronic diseases.

Methods

Using an electronic app, the achievements of an exercise target, sedentary behavior, smoking and drinking, and dietary patterns were assessed in 1,480 nursing student participants aged 18–24 years from two medical universities in Eastern China.

Results

A four-class model was developed using latent class analysis that included the “failure to achieve exercise target, alcohol-drinking, and insufficient fruit and vegetable group” (Group 1, n = 187, 12.6%), the “alcohol-drinking and sedentary behavior group” (Group 2, n = 290, 19.6%), the “sedentary behavior only group” (Group 3, n = 721, 48.7%), and the “failure to achieve exercise target only group” (Group 4, n = 282, 19.1%). Logistic regressions indicated that nursing students in Group 2 (odds ratio [OR] = 0.42), Group 3 (OR = 0.51), and Group 4 (OR = 0.30) were less likely to have chronic diseases than those in Group 1 after adjusting for sociodemographic variables.

Conclusions

The health behaviors were clustered in different patterns among young adult nursing students. Tailoring interventions to specific groups is suggested to improve health outcomes.
Examining the Needs-Based Time Use of Chinese Nursing Assistants: A Time–Motion Study
Authors: WANG Xinxia , SHEN Jun , CHEN Qiu
Published: October 2022

Background

In light of the worldwide shortage of nurses and to maximize the effectiveness of the nursing care available, it is important to investigate the components of the care regularly provided by nursing assistants (NAs) to older adults. Well-organized allocation of NA care activities is directly linked to the quality of care provided to nursing home (NH) residents and their quality of life. However, relevant knowledge about the actual time allocation of NAs in this context is lacking, as previous related studies have focused only on the duration necessary for NAs to complete nursing activities.

Purpose

This study was designed to investigate the time allocation of NAs in completing job tasks necessary to meet the needs of residents in nursing care units at an NH in China.

Methods

A time–motion method and nonparticipatory observations were used to collect data. Two postgraduate students observed 15 NAs' time expenditure and nursing content simultaneously during day shifts for 3 weeks as the NAs provided care to residents in four different nursing care levels. Data on nursing time and activity frequency were collected using a worklist based on the Zuluaga–Raysmith model.

Results

The 119.6 hours of observation included 8,907 discrete observed activities. In terms of the care provided to meet the needs of residents, the most time-consuming activities were physical health care (26.8%) and communication care (18.3%), followed by mental, emotional, social, and spiritual health care (14.1%) and protection and security care (12.6%). The higher the level of care, the higher the proportion of somatic nursing time and nursing activity frequency. However, the time and frequency of psychological and spiritual care showed an opposite trend.

Conclusions

Because of their lack of formal nursing training and skills, NAs pay more attention to meeting the physiological needs of residents while ignoring their mental needs. Moreover, their effectiveness in providing spiritual care tends to be quite low. Furthermore, the NA nursing activity classification system based on the Zuluaga–Raysmith model developed in this study is applicable for designing nursing work tasks, organizing NH units, and improving the quality of life of residents, as this model accurately reflects the essence of NA work.
Effect of 0.12% Chlorhexidine Oral Rinse on Preventing Hospital-Acquired Pneumonia in Nonventilator Inpatients
Authors: CHEN Yen-Chin , KU En-Ni , TSAI Pei-Fang , NG Cheng-Man , WANG Jiun-Ling , LIN Che-Wei , KO Nai-Ying , CHANG Ying-Ju
Published: October 2022

Background

Nonventilator hospital-associated pneumonia (NV-HAP) is a nosocomial infection with a multifactorial etiology that is particularly prevalent in individuals with poor oral health.

Purpose

This study was designed to determine the effect of a 0.12% chlorhexidine gluconate oral rinse intervention on oral health and on reducing NV-HAP in inpatients.

Methods

A randomized, double-blind, and triple-arm clinical trial was conducted on a sample of 103 patients aged ≥ 50 years. Using the blocking sample method, patients were randomly assigned into three groups. These included Group A, using an oral rinse solution of 0.12% chlorhexidine; Group B, using Listerine; and Group C, using a standard saline oral rinse. In addition to routine hospital-associated pneumonia preventative nursing care, the participants used the oral rinse solutions twice a day with a period of at least 9 hours between each use. Oral health, the degree of bacterial exposure, and the clinical pneumonia index scale were evaluated in each of the groups at baseline (first day), on Intervention Days 3 and 7, and at discharge. The clearance rate was calculated by dividing the number of bacteria cleared by the total frequency of oral bacteria in the collected culture × 100%.

Results

Each arm of the study was composed of 34–35 participants, with an average hospitalization duration of 7.5 days. There was no incidence of NV-HAP or any changes in clinical pulmonary infection score among the three groups. Group A achieved a more significant improvement in oral health assessment tool scores between baseline and discharge than either Group B or C (p = .03), particularly in the tongue, gums, and tissues; saliva; and oral cleanliness subscales. In addition, Group A reported higher clearance rates for Staphylococcus (100.00% vs. 66.67% vs. 66.67%, respectively), Escherichia coli (100.00% vs. 60.00% vs. 66.67%, respectively), and Pseudomonas aeruginosa (75.00% vs. 46.30% vs. 25.00%, respectively) than Groups B and C.

Conclusions/Implications for Practice

Although the results do not provide evidence supporting the use of a 0.12% chlorhexidine oral rinse as better in terms of preventing NV-HAP in middle-aged and elderly inpatients, nursing supervision was found to have an overall positive effect on oral health. The use of oral rinse with 0.12% chlorhexidine for nonventilated patients with poor oral health may be recommended.
Hand Function After an Electrical Accident—A Case-Control Study
Authors: Rådman Lisa , Wold Andrew , Norman Kerstin , Olausson Håkan , Thordstein Magnus
Published: October 2022

Objective

Electrical accidents cause both acute and long-term injuries. The care of acute injuries is somewhat standardized, but currently recommendations or assessment tools are not available for assessing the long-term effects of an accident on hand function.

Methods

A case-control study of 24 healthy controls and 24 cases, 1 to 5 years after an electrical accident and with self-reported neurosensory symptoms, was performed using three hand-function tests: the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Purdue Pegboard test, and the Shape and Texture Identification test.

Results

Compared with the control group, patients received statistically significantly lower scores for the Disabilities of the Arm, Shoulder, and Hand outcome measure and the Purdue Pegboard and for one finger on the Shape and Texture Identification test.

Conclusion

Hand function is affected after an electrical accident in individuals with self-reported neurosensory symptoms.
Voluntary Field Recall of Advanced Bionics HiRes Cochlear Implants: A Single-Institution Experience
Authors: McHugh Christopher I. , Swedenborg Britta K. , Chen Jenny X. , Jung David H. , Mankarious Leila A. , Quesnel Alicia M. , Cohen Michael S. , Arenberg Julie G. , Franck Kevin H. , Santos Felipe
Published: October 2022

Objectives

In 2020, Advanced Bionics (AB) announced a recall of two cochlear implant (CI) models, the “HiRes Ultra” and “HiRes Ultra 3D”, because of reports of hearing degradation. The present study examines clinical parameters and patient features in cases of device failure and evaluates outcomes after reimplantation.

Materials and Methods

A series of 52 patients implanted with the recalled devices experienced suspected device failure and subsequently underwent revision CI placement at a tertiary academic medical center between December 2019 and November 2021.

Results

Consonant–nucleus–consonant scores and individual phonemes increased significantly between patients' preoperative evaluation and primary cochlear implantation. Performance declined significantly before revision and recovered after revision CI placement. Similarly, pure-tone average thresholds improved between preoperative and primary CI, fell before revision surgery, and were corrected with revision implantation. As a group, patients reached their peak hearing performance significantly faster after revision CI (mean ± standard deviation, 53.4 ± 51.8 d) compared with their primary CI (mean ± standard deviation, 260.6 ± 245.9 d). Electrical field imaging performed by AB and device impedance measurements were found to be abnormal in the basally positioned electrodes (electrodes 9–16).

Conclusion

Hearing performance degradation is significant in AB Ultra device failures and seems to be linked to the basal-most electrodes in the array. Revision outcomes have been robust, necessitating continued monitoring of affected patients and support for reimplantation procedures.

Level of Evidence

IV.
A Randomized Clinical Trial Comparing the Efficacy and Safety of 2% Versus 4% Chlorohexidine Gluconate for Surgical Preparation of the Vagina
Authors: Patnam Radhika , Askew Amy L. , Alby Kevin , Hill Bravada M. , Willis-Gray Marcella G. , Wu Jennifer M. , Geller Elizabeth J.
Published: October 2022

(Abstracted from Female Pelvic Med Reconstr Surg 2022;28:400–407)

Surgical site infection monitoring has the goal of reducing postoperative complications and is a common metric for evaluating hospital safety. Because proper antiseptic preparation at a surgical site can significantly reduce infections, the Centers for Disease Control and Prevention recommends after an alcohol-based prep of skin incisions with antisepsis.
Implementation of a Pediatric Neurocritical Care Program for Children With Status Epilepticus: Adherence to Continuous Electroencephalogram Monitoring
Authors: Herman Isabella , Nguyen Thao , Chan See Wai , Erklauer Jennifer , Riviello James J. , Lai Yi-Chen
Published: October 2022

OBJECTIVES:

To describe adherence to continuous electroencephalogram (cEEG) monitoring as part of a pediatric neurocritical care (PNCC) program for status epilepticus (SE).

DESIGN:

Retrospective review of pre- and postintervention cohorts.

SETTING:

A pediatric referral hospital.

PATIENTS:

Children admitted to the PICU for SE.

INTERVENTIONS:

We restructured the care delivery model to include a pediatric neurointensive care unit (neuro-ICU) and expanded the cEEG capacity. We created a criteria-based cEEG pathway. We provided education to all providers including the nursing staff.

MEASUREMENTS AND MAIN RESULTS:

The main outcomes were: 1) the percentages of children meeting American Clinical Neurophysiology Society (ACNS) criteria who underwent cEEG monitoring and 2) the time interval between PICU arrival and cEEG initiation. PICU admissions with the diagnosis of SE from May 2017 to December 2017 served as the baseline, which was compared with the same periods in 2018 to 2020 (PNCC era).

There were 60 admissions in the pre-PNCC period (2017), 111 in 2018, 118 in 2019, and 108 in 2020. The percentages of admissions from each period that met ACNS criteria for cEEG monitoring were between 84% and 97%. In the pre-PNCC era, 22 of 52 (42%) admissions meeting ACNS criteria underwent cEEG monitoring. In the PNCC era, greater than or equal to 80% of the qualified admissions underwent cEEG monitoring (74/93 [80%] in 2018, 94/115 [82%] in 2019, and 87/101 [86%] in 2020). Compared with the pre-PNCC era, the neuro-ICU had a shorter interval between PICU arrival and cEEG initiation (216 min [141–1,444 min] vs 138 min [103–211 min]).

CONCLUSIONS:

The implementation of a PNCC program with initiatives in care delivery, allocation of resources, and education was associated with increased adherence to best care practices for the management of SE.
The power of integrating data: advancing pain research using meta-analysis
Authors: Fundaun Joel , Thomas Elizabeth T. , Schmid Annina B. , Baskozos Georgios
Published: October 2022

Publications related to pain research have increased significantly in recent years. The abundance of new evidence creates challenges staying up to date with the latest information. A comprehensive understanding of the literature is important for both clinicians and investigators involved in pain research. One commonly used method to combine and analyse data in health care research is meta-analysis. The primary aim of a meta-analysis is to quantitatively synthesise the results of multiple studies focused on the same research question. Meta-analysis is a powerful tool that can be used to advance pain research. However, there are inherent challenges when combining data from multiple sources. There are also numerous models and statistical considerations when undertaking a meta-analysis. This review aims to discuss the planning and preparation for completing a meta-analysis, review commonly used meta-analysis models, and evaluate the clinical implications of meta-analysis in pain research.
Preliminary study: quantification of chronic pain from physiological data
Authors: Cheng Zhuowei , Ly Franklin , Santander Tyler , Turki Elyes , Zhao Yun , Yoo Jamie , Lonergan Kian , Gray Jordan , Li Christopher H. , Yang Henry , Miller Michael , Hansma Paul , Petzold Linda
Published: October 2022

Introduction:

It is unknown if physiological changes associated with chronic pain could be measured with inexpensive physiological sensors. Recently, acute pain and laboratory-induced pain have been quantified with physiological sensors.

Objectives:

To investigate the extent to which chronic pain can be quantified with physiological sensors.

Methods:

Data were collected from chronic pain sufferers who subjectively rated their pain on a 0 to 10 visual analogue scale, using our recently developed pain meter. Physiological variables, including pulse, temperature, and motion signals, were measured at head, neck, wrist, and finger with multiple sensors. To quantify pain, features were first extracted from 10-second windows. Linear models with recursive feature elimination were fit for each subject. A random forest regression model was used for pain score prediction for the population-level model.

Results:

Predictive performance was assessed using leave-one-recording-out cross-validation and nonparametric permutation testing. For individual-level models, 5 of 12 subjects yielded intraclass correlation coefficients between actual and predicted pain scores of 0.46 to 0.75. For the population-level model, the random forest method yielded an intraclass correlation coefficient of 0.58. Bland–Altman analysis shows that our model tends to overestimate the lower end of the pain scores and underestimate the higher end.

Conclusion:

This is the first demonstration that physiological data can be correlated with chronic pain, both for individuals and populations. Further research and more extensive data will be required to assess whether this approach could be used as a “chronic pain meter” to assess the level of chronic pain in patients.
The Association of Age With Depression, Anxiety, and Posttraumatic Stress Symptoms During the COVID-19 Pandemic in Spain: The Role of Loneliness and Prepandemic Mental Disorder
Authors: Gabarrell-Pascuet Aina , Koyanagi Ai , Felez-Nobrega Mireia , Cristóbal-Narváez Paula , Mortier Philippe , Vilagut Gemma , Olaya Beatriz , Alonso Jordi , Haro Josep Maria , Domènech-Abella Joan
Published: October 2022

Objective

Older adults may be at lower risk of common mental disorders than younger adults during the coronavirus disease 2019 (COVID-19) pandemic. Previous research has shown shown differences by age in psychosocial well-being during the pandemic and have highlighted the moderating effect of prepandemic mental disorders on that association. In this line, we examined the association of age with self-reported symptoms of loneliness, depression, anxiety, and posttraumatic stress, as well as potential roles of loneliness symptoms and prepandemic mental disorders on the association between age and mental disorder symptoms.

Methods

Cross-sectional data of 2000 adults in Spain interviewed by telephone during the COVID-19 pandemic (February–March 2021) were analyzed. Depression, anxiety, and posttraumatic stress were measured with the eight-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder Scale, and the four-item checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), respectively. Loneliness was measured with the three-item University of California at Los Angeles Loneliness Scale. Several regression models were constructed to assess factors related to loneliness and mental disorders.

Results

According to cutoff points used, 12.4% of participants revealed depression, 11.9% revealed anxiety, and 11.6% revealed posttraumatic stress. Age was negatively related to mental disorder symptoms and loneliness. Loneliness was associated with higher levels of mental disorder symptoms. This association was stronger in younger adults without prepandemic mental disorders and in older adults with them. The association between age and loneliness was stronger in those with prepandemic mental disorders. Loneliness mediated the association of age with mental disorder symptoms.

Conclusions

Interventions focused on loneliness could alleviate the impact of the COVID-19 pandemic on mental health.
Malt1-dependent cleavage of Tensin-3 controls B-cell adhesion and lymphomagenesis
Authors: Juilland Mélanie , Alouche Nagham , Ubezzi Ivana , Gonzalez Montserrat , Erdmann Tabea , Lenz Georg , Luther Sanjiv A. , Thome Margot
Published: October 2022

The protease Malt1 controls the development and function of lymphocytes and promotes lymphomagenesis by cleaving a limited set of cellular substrates, many of which regulate gene transcription. Here, we report the identification of the integrin-binding scaffold protein Tensin-3 as a Malt1 substrate in activated B cells. B cells expressing a non-cleavable form of Tensin-3 (TNS3-nc) showed normal NF-κB and JNK transcriptional responses but increased and prolonged integrin-dependent adhesion upon activation. Moreover, mice expressing a non-cleavable form of Tensin-3 displayed reduced antibody production in response to immunization with a T-cell dependent antigen. We also explored the role of Tensin-3 in diffuse large B cell lymphomas and mantle cell lymphomas characterized by constitutive Malt1 activity, which showed strong constitutive Tensin-3 cleavage and a correlating reduction in total Tensin-3 levels. Silencing of Tensin-3 expression in Malt1-driven lymphoma models did not affect cellular proliferation but enhanced the dissemination of xenografted lymphoma cells. Thus, Malt1-dependent Tensin-3 cleavage limits integrin-dependent B-cell adhesion and promotes humoral immune responses and metastatic spreading of B cell lymphomas in a transcription-independent manner.
Temporal Extracellular Vesicle Protein Changes following Intraarticular Treatment with Integrin α10β1-selected Mesenchymal Stem Cells in Equine Osteoarthritis
Authors: Clarke Emily J , Johnson Emily , Gutierrez Eva Caamano , Andersen Camilla , Berg Lise C , Jenkins Rosalind E , Lindegaard Casper , Uvebrant Kristina , Lundgren-Åkerlund Evy , Turlo Agnieszka , James Victoria , Jacobsen Stine , Peffers Mandy J
Published: October 2022

Equine osteoarthritis is a heterogeneous, degenerative disease of the musculoskeletal system with multifactorial causation, characterised by a joint metabolic imbalance. Extracellular vesicles are nanoparticles involved in intracellular communication. Mesenchymal stem cell (MSC) therapy is a form of regenerative medicine that utilises their properties to repair damaged tissues. Despite its wide use in veterinary practice, the exact mechanism of action of MSCs is not fully understood. The aim of this study was to determine the synovial fluid extracellular vesicle protein cargo following integrin α10β1-selected mesenchymal stem cell treatment in an experimental model of equine osteoarthritis with longitudinal sampling. Adipose tissue derived, integrin α10-MSCs were injected into the osteoarthritis afflicted joint after 18 days post surgery. Sixty-nine synovial fluid samples were collected via aseptic arthrocentesis at day 0, 18, 21, 28, 35, and 70. Synovial fluid was hyaluronidase treated and extracellular vesicles isolated using differential ultracentrifugation. Extracellular vesicles were characterised using the Exoview human tetraspanin chip. Extracellular vesicle concentration, surface marker identification, fluorescent microscopy and tetraspanin colocalization analysis was undertaken, in conjunction with nanoparticle tracking analysis. For proteomics, extracellular vesicle pellets were suspended in urea lysis buffer. Samples were reduced, alkylated and digested on SP3 beads with trypsin/LysC. A data independent acquisition mode was utilised for nano liquid chromatography tandem mass spectrometry analysis on a Triple TOF 6600 mass spectrometer. A total of 442 proteins were identified across all samples, with 48 proteins differentially expressed (FDR≤ 0.05) between control and osteoarthritis treated with MSCs.. The most significant pathways following functional enrichment analysis of the differentially abundant protein dataset were serine endopeptidase activity (p=0.023), complement activation (classical pathway) (p=0.023), and collagen containing extracellular matrix (p=0.034). To date this is the first study to quantify the global extracellular vesicle proteome in synovial fluid following MSC treatment of osteoarthritis. Changes in the proteome of the synovial fluid-derived EVs following MSC injection suggest EVs may play a role in mediating the effect of cell therapy through altered joint homeostasis and an improved phenotype.
Recycling limits the lifetime of actin turnover
Authors: Colin Alexandra , Kotila Tommi , Guérin Christophe , Orhant-Prioux Magali , Vianay Benoit , Mogilner Alex , Lappalainen Pekka , Théry Manuel , Blanchoin Laurent
Published: October 2022

Intracellular organization is largely mediated by the actin turnover. Cellular actin networks consume matter and energy to sustain their dynamics, while maintaining their appearance. This behavior, called ‘dynamic steady state’, enables cells to sense and adapt to their environment. However, how structural stability can be maintained during the constant turnover of a limited actin monomer pool is poorly understood. To answer this question, we developed an experimental system using actin bead motility in a compartment with a limited amount of monomer. We used the speed and the size of the actin comet tails to evaluate the system’s monomer consumption and its lifetime. We established the relative contribution of actin assembly, disassembly and recycling for a bead movement over tens of hours. Recycling mediated by cyclase-associated proteins is the key step in allowing the reuse of monomers for multiple assembly cycles. Energy supply and protein aging are also factors that limit the lifetime of actin turnover. This work reveals the balancing mechanism for long-term network assembly with a limited amount of building blocks.
Combining RADseq and contact zone analysis to decipher cryptic diversification in reptiles: insights from Acanthodactylus erythrurus (Reptilia: Lacertidae)
Authors: Doniol-Valcroze Paul , Rancilhac Loïs , Brito José Carlos , Miralles Aurélien , Geniez Philippe , Benoit Laure , Loiseau Anne , Leblois Raphaël , Dufresnes Christophe , Crochet Pierre-André
Published: October 2022

Linnaean and Wallacean shortfalls (Uncertainties on species taxonomy and distribution, respectively) are major factors hampering efficient conservation planning in the current context of biodiversity erosion. These shortfalls concern even widespread and abundant species in relatively well-studied regions such as the Mediterranean biodiversity hotspot which still hosts a large fraction of unrecognised biodiversity, notably in small vertebrates. Species delimitations have long been based on phylogenetic analyses of a small number of standard markers, but accurate lineage identification in this context can be obscured by incomplete lineage sorting, introgression or isolation by distance. Recently, integrative approaches coupling various sets of characters or analyses of contact zones aiming at estimating reproductive isolation (RI) have been advocated instead. Analyses of introgression patterns in contact zone with genomic data represent a powerful way to confirm the existence of independent lineages and estimate the strength of their RI at the same time. The Spiny-footed Lizard Acanthodactylus erythrurus (Schinz, 1833) is widespread in the Iberian Peninsula and the Maghreb and exhibits a large amount of genetic diversity, although the precise number and distribution of its genetic lineages remain poorly understood. We applied a RADseq approach to obtain a genome wide SNPs dataset on a contact zone in central Morocco between the previously described Rif and Middle-Atlas lineages. We show that these two lineages exhibit strong RI across this contact zone, as shown by the limited amount and restricted spatial extant of gene flow. We interpret these results as evidence for species-level divergence of these two lineages. Our study confirms the usefulness of RADseq approaches applied on contact zones for cryptic diversity studies and therefore to resolve Linnaean and Wallacean shortfalls.
Evolution of spatial and temporalcis-regulatory divergence between marine and freshwater sticklebacks
Authors: Mack Katya L. , Square Tyler A. , Zhao Bin , Miller Craig T. , Fraser Hunter B.
Published: October 2022

Cis-regulatory changes are thought to play a major role in adaptation. Threespine sticklebacks have repeatedly colonized freshwater habitats in the Northern Hemisphere, where they have evolved a suite of phenotypes that distinguish them from marine populations, including changes in physiology, behavior, and morphology. To understand the role of gene regulatory evolution in adaptive divergence, here we investigatecis-regulatory changes in gene expression between marine and freshwater ecotypes through allele-specific expression (ASE) in F1 hybrids. Surveying seven ecologically relevant tissues, including three sampled across two developmental stages, we identifiedcis-regulatory divergence affecting a third of genes, nearly half of which were tissue-specific. Next, we compared allele-specific expression in dental tissues at two timepoints to characterizecis-regulatory changes during development between marine and freshwater fish. Applying a genome-wide test for selection oncis-regulatory changes, we find evidence for lineage-specific selection on several processes, including the Wnt signaling pathway in dental tissues. Finally, we show that genes with ASE, particularly those that are tissue-specific, are enriched in genomic regions associated with marine-freshwater divergence, supporting an important role forcis-regulatory differences in adaptive evolution of sticklebacks. Altogether, our results provide insight into thecis-regulatory landscape of divergence between stickleback ecotypes and supports a fundamental role forcis-regulatory changes in rapid adaptation to new environments.