bluuebunny/crossref_metadata_2025 huggingface dataset:
PSIV-6 Differential gene expression of fibro/adipogenic progenitors between Wagyu and Brahman cattle: A possible contribution to their different meat quality
Authors: Li Chaoyang , Liu Qianglin , Welborn Matt , Wang Leshan , Li Yuxia , Deng Buhao , McMillin Kenneth , Fu Xing
Published: October 2021

The amount of intramuscular fat directly influences the meat quality. However, significant differences in the ability to accumulate intramuscular fat are present among different beef cattle breeds. While Wagyu, a cattle breed that originated from Japan, is renowned for abundant intramuscular fat, Brahman cattle generally have very little intramuscular fat accumulation and produce tougher meat. We identified that bovine intramuscular fat is derived from a group of bipotent progenitor cells named fibro/adipogenic progenitors (FAPs) which also give rise to fibroblasts. Thus, the variation in intramuscular fat development between Wagyu and Brahman is likely attributed to the difference in FAPs between these two breeds. In order to understand the gene expression difference between FAPs of the two breeds, single-cell RNA-seq was performed using total single-nucleated cells isolated from the longissimus muscle of young purebred Wagyu, purebred Brahman, and Wagyu-Brahman cross cattle. FAPs constitute the largest single-nucleated cell population in both Wagyu and Brahman skeletal muscle. Multiple subpopulations of FAPs with different gene expression profiles were identified, suggesting that FAP is a heterogeneous population. A unique FAP cluster expressing lower levels of fibrillar collagen and extracellular remodeling enzyme genes but higher levels of select proadipogenic genes was identified exclusively in Wagyu skeletal muscle, which likely contributes to the robust intramuscular adipogenic efficiency of Wagyu FAPs. In conclusion, the difference in the cellular composition and gene expression of FAPs between Wagyu and Brahman cattle likely contribute to their distinct meat quality.
PSV-16 Validation of an algorithm to assess feedbunk replacement events in beef cattle using an electronic feeding system
Authors: O’Reilly Keara , Carstens Gordon , Foris Borbala , Daigle Courtney L
Published: October 2021

Visual observations of social behavior and dominance relationships in cattle have been used to examine associations with productivity and well-being. This method is time consuming limiting the number of animals that can be evaluated. The objective of this study was to validate an algorithm to quantify feedbunk replacement events using data from an electronic feeding system. Crossbred beef steers (n = 20) fed a grower diet were housed in 1 of 2 pens each equipped with 3 electronic feedbunks (GrowSafe Systems) and video recorders. A trained video observer recorded all feedbunk replacement events and other agonistic activities at the feedbunk over a 4-d period (24 h/d). The electronic feeding system recorded the start and end timestamps of bunk visit (BV) events for each animal. An algorithm was developed to determine BV events deemed to be replacement events, defined as a BV event when an actor animal displaced a reactor animal from the feedbunk and occupied the same feeder within a specified period of time (replacement criterion). We calculated the recall and precision corresponding to replacement criterions from 1 to 60 s, and the optimum replacement criterion was determined to be between 18 and 20 s. The recall, precision and F-score of the algorithm using this replacement criterion were high (on average > 0.75). Furthermore, a replacement competition index was computed as a proxy for competitive feedbunk behavior, calculated as the number of actor-initiated replacement events divided by the total number of replacement events for each steer. Using Spearmans rank correlation we found high correlations (r > 0.7; P < 0.05) between the electronic and observed indices. These preliminary results demonstrate the potential of the GrowSafe system to quantify feedbunk replacement events for confined beef cattle, providing opportunities to evaluate associations between competitive feedbunk behavior and economically relevant traits.
Proteolytic Activation of Bacillus thuringiensis Cry3Aa Toxin in the Red Palm Weevil (Coleoptera: Curculionidae)
Authors: Guo Yajie , Sun Yunzhu , Liao Qiliao , Carballar-Lejarazú Rebeca , Sheng Liangjing , Wang Shaozhen , Zhou Jianshuang , Zhang Feiping , Wu Songqing
Published: October 2021

The red palm weevil (RPW), Rhynchophorus ferrugineus (Oliver) is an important pest of palms that causes significant damage by boring into and feeding within palm stem tissues. Here, we studied the proteolytic process of Cry3Aa in the RPW to understand the mechanism of Cry toxicity. The bioassays showed that Cry3Aa toxin is weakly toxic to the RPW. Proteolytic activation assays indicated the Cry3Aa protein is digested into smaller fragments than the 55-kDa activated fragments under different conditions. In particular, at higher mass ratios of gut protease and Cry3Aa protein (5:1, 2:1, and 1:1, respectively), and at 36.9°C for 16 h in a solution of pH 8.6, the Cry3Aa protoxin is over-digested by the gut proteases of weevil larvae. Moreover, the zymogram analysis of the gut proteases revealed the RPW larvae harbors intestinal digestive enzymes mainly composed of serine proteases. This study describes the proteolytic activation process of Cry3Aa in the midgut of RPW larvae.
Professionalism—its effect on interpersonal relationships in high-tech global virtual teams
Authors: Zaidman Nurit
Published: October 2021

Drawing on accounts presented—and the metaphors incorporated therein—in interviews with 129 workers, this study considers the effect of professionalism on relationships between Indian and Israeli global team members working in the high-tech industry. This study shows how the discourse of professionalism (together with additional, professionally oriented organizational mechanisms), as manifested in high-tech organizations, dictates not only employee–organization relations but also relationships between peers working in global virtual teams (GVTs). The study further illuminates how this particular construction of professionalism can engender a paradox in interpersonal relationships for professionals working in GVTs; and its subtle negative impact, from an ethical perspective, on interpersonal relationships between them. It also shows, however, that perceptions of friendship do emerge despite these limiting conditions.
Seronegative granulomatosis with polyangiitis presenting as an acute skull base osteomyelitis with multiple cranial neuropathies
Authors: Lotfallah Andrew , Shahidi Shayan , Odelberg Sven Wilhelm , Darr Adnan , Mathews John
Published: October 2021

Granulomatosis with polyangiitis (GPA, formerly Wegener’s) is a rare form of vasculitis, commonly affecting the upper and lower respiratory tract with simultaneous glomerulonephritis. Ear, nose and throat (ENT) manifestations account for the majority of presentations. The presence of antineutrophil cytoplasmic antibody is a recognized hallmark of GPA, but clinicians should remain cautious of false negative results. We describe a rare case of GPA presenting with concurrent middle ear disease and multiple lower cranial nerve palsies. Clinical judgment was affected by repeated negative autoimmune screens, and a definitive diagnosis was only achieved following renal biopsy. Reported cases of GPA presenting with mastoiditis or cranial nerve involvement are typically seropositive, with seronegative GPA following a less aggressive process. This case highlights the importance of clinical suspicion in the face of treatment resistant ENT pathology, and the need for early histopathological analysis. Early diagnosis and treatment are crucial in limiting disease progression.
RBM6 splicing factor promotes homologous recombination repair of double-strand breaks and modulates sensitivity to chemotherapeutic drugs
Authors: Machour Feras E , Abu-Zhayia Enas R , Awwad Samah W , Bidany-Mizrahi Tirza , Meinke Stefan , Bishara Laila A , Heyd Florian , Aqeilan Rami I , Ayoub Nabieh
Published: October 2021

RNA-binding proteins regulate mRNA processing and translation and are often aberrantly expressed in cancer. The RNA-binding motif protein 6, RBM6, is a known alternative splicing factor that harbors tumor suppressor activity and is frequently mutated in human cancer. Here, we identify RBM6 as a novel regulator of homologous recombination (HR) repair of DNA double-strand breaks (DSBs). Mechanistically, we show that RBM6 regulates alternative splicing-coupled nonstop-decay of a positive HR regulator, Fe65/APBB1. RBM6 knockdown leads to a severe reduction in Fe65 protein levels and consequently impairs HR of DSBs. Accordingly, RBM6-deficient cancer cells are vulnerable to ATM and PARP inhibition and show remarkable sensitivity to cisplatin. Concordantly, cisplatin administration inhibits the growth of breast tumor devoid of RBM6 in mouse xenograft model. Furthermore, we observe that RBM6 protein is significantly lost in metastatic breast tumors compared with primary tumors, thus suggesting RBM6 as a potential therapeutic target of advanced breast cancer. Collectively, our results elucidate the link between the multifaceted roles of RBM6 in regulating alternative splicing and HR of DSBs that may contribute to tumorigenesis, and pave the way for new avenues of therapy for RBM6-deficient tumors.
BrainBase: a curated knowledgebase for brain diseases
Authors: Liu Lin , Zhang Yang , Niu Guangyi , Li Qianpeng , Li Zhao , Zhu Tongtong , Feng Changrui , Liu Xiaonan , Zhang Yuansheng , Xu Tianyi , Chen Ruru , Teng Xufei , Zhang Rongqin , Zou Dong , Ma Lina , Zhang Zhang
Published: October 2021

Brain is the central organ of the nervous system and any brain disease can seriously affect human health. Here we present BrainBase (https://ngdc.cncb.ac.cn/brainbase), a curated knowledgebase for brain diseases that aims to provide a whole picture of brain diseases and associated genes. Specifically, based on manual curation of 2768 published articles along with information retrieval from several public databases, BrainBase features comprehensive collection of 7175 disease–gene associations spanning a total of 123 brain diseases and linking with 5662 genes, 16 591 drug–target interactions covering 2118 drugs/chemicals and 623 genes, and five types of specific genes in light of expression specificity in brain tissue/regions/cerebrospinal fluid/cells. In addition, considering the severity of glioma among brain tumors, the current version of BrainBase incorporates 21 multi-omics datasets, presents molecular profiles across various samples/conditions and identifies four groups of glioma featured genes with potential clinical significance. Collectively, BrainBase integrates not only valuable curated disease–gene associations and drug–target interactions but also molecular profiles through multi-omics data analysis, accordingly bearing great promise to serve as a valuable knowledgebase for brain diseases.
Bubble-templated synthesis of nanocatalyst Co/C as NADH oxidase mimic
Authors: Chen Jinxing , Zheng Xiliang , Zhang Jiaxin , Ma Qian , Zhao Zhiwei , Huang Liang , Wu Weiwei , Wang Ying , Wang Jin , Dong Shaojun
Published: October 2021

Designing highly active nanozymes for various enzymatic reactions remains a challenge in practical applications and fundamental research. In this work, by studying the catalytic functions of natural NADH oxidase (NOX), we devised and synthesized a porous carbon-supported cobalt catalyst (Co/C) to mimic NOX. The Co/C can catalyze dehydrogenation of NADH and transfers electrons to O2 to produce H2O2. Density functional theory calculations reveal that the Co/C can catalyze O2 reduction to H2O2 or H2O considerably. The Co/C can also mediate electron transfer from NADH to heme protein cytochrome c, thereby exhibiting cytochrome c reductase-like activity. The Co/C nanoparticles can deplete NADH in cancer cells, induce increase of the reactive oxygen species, lead to impairment of oxidative phosphorylation and decrease in mitochondrial membrane potential, and cause ATP production to be damaged. This ‘domino effect’ facilitates the cell to approach apoptosis.
Chronic Hepatitis B Infection Among Preexposure Prophylaxis Users Enrolled in a Population-Based Program in British Columbia, Canada
Authors: Thompson Kyle A , Blank Gabriel , Toy Junine , Moore David M , Lachowsky Nathan , Bacani Nicanor , Zhang Wendy , Sereda Paul , Lima Viviane D , Barrios Rolando , Montaner Julio S G , Hull Mark W
Published: October 2021

Initiation of human immunodeficiency virus preexposure prophylaxis (PrEP) medications will also treat hepatitis B infection (HBV). The prevalence of chronic HBV was 0.86% (n=41/4760) among enrollees in a provincial PrEP program in British Columbia, Canada. Overall, 46.3% lacked follow-up HBV DNA monitoring, underscoring the need for HBV-related education for PrEP prescribers.
Noisy Autonomy: The Ethics of Audible and Silent Noise
Authors: Shaw David
Published: October 2021

In this paper, I summarize the medical evidence regarding the auditory and non-auditory effects of noise and analyse the ethics of noise and personal autonomy in the social environment using a variety of case studies. Key to this discussion is the fact that, contrary to the traditional definition of noise, sound can be noise without being annoying, as the evidence shows that some sounds can harm without being perceived. Ultimately, I develop a theory of ‘noisy autonomy’ with which to guide us in discussing the public health ethics of noise and other sounds.
A glossary of plant cell structures: Current insights and future questions
Authors: Kang Byung-Ho , Anderson Charles T , Arimura Shin-ichi , Bayer Emmanuelle , Bezanilla Magdalena , Botella Miguel A , Brandizzi Federica , Burch-Smith Tessa M , Chapman Kent D , Dünser Kai , Gu Yangnan , Jaillais Yvon , Kirchhoff Helmut , Otegui Marisa S , Rosado Abel , Tang Yu , Kleine-Vehn Jürgen , Wang Pengwei , Zolman Bethany Karlin
Published: October 2021

In this glossary of plant cell structures, we asked experts to summarize a present-day view of plant organelles and structures, including a discussion of outstanding questions. In the following short reviews, the authors discuss the complexities of the plant cell endomembrane system, exciting connections between organelles, novel insights into peroxisome structure and function, dynamics of mitochondria, and the mysteries that need to be unlocked from the plant cell wall. These discussions are focused through a lens of new microscopy techniques. Advanced imaging has uncovered unexpected shapes, dynamics, and intricate membrane formations. With a continued focus in the next decade, these imaging modalities coupled with functional studies are sure to begin to unravel mysteries of the plant cell.
Political Parties and Decentralization in Pakistan
Authors: Ali Sameen A Mohsin , Mufti Mariam
Published: October 2021

Why do politicians vote to decentralize power and resources? Drawing on structuralist and voluntarist approaches, we investigate why national party elites in Pakistan voted to devolve power to the provinces under the 18th Amendment to the 1973 Constitution but are hesitant to devolve meaningful fiscal and administrative power to the local level. We argue that the explanation for this disjuncture lies in Pakistan’s history of military experiments with local government, its candidate-centered party system, and the re-election incentives of politicians at the national, provincial and local levels. Using interviews with local government representatives, politicians, and bureaucrats, and archival research through National Assembly, Senate debates and newspapers, we show that devolution to the provinces was a means of holding a fragile federation together. However, Pakistan’s political parties, unable to elicit credible commitment from their legislators, feared that devolving power further could result in party defections, the rise of regional leaders, and inevitably, party fragmentation.
Health lifestyles during adolescence: clustering of health behaviours and social determinants in Italian adolescents
Authors: Velasco V , Gragnano A , Ghelfi M ,   Gruppo Regionale HBSC Lombardia 2014, Vecchio L P
Published: October 2021

Background

Health behaviours in adolescence have a high impact on both current and future health. The literature claims a focus on social determinants and shows that these behaviours are associated. The concept of ‘health lifestyles’ should be considered to account for co-occurring health behaviours and determinants interactions. The aim of this study is to increase our understanding of adolescents’ health lifestyles and to (i) cluster adolescents according to a comprehensive number of health behaviours and (ii) describe these groups according to sociodemographic characteristics, perceptions of life contexts (family, school, peers or neighbourhood) and perceived physical and psychosocial health conditions.

Methods

In Italy, 906 15-year-old students participated in the cross-national Health Behaviour of School-aged Children study. Clusters were identified by applying the KAMILA clustering method and compared using analysis of variance and chi-squared tests.

Results: Four clusters were identified: ‘substance consumers’, ‘media lovers’, ‘active students’ and ‘passive students’. Each cluster exhibited different characteristics related to health behaviours and social determinants.

Conclusions

Interesting associations between health behaviours were identified, which showed the relevance of considering the adolescents’ overall lifestyles. The description of each cluster permitted the identification of risks and protective factors, which may be important for designing effective health promotion activities.
Defining renal remission in an international cohort of 248 children and adolescents with lupus nephritis
Authors: De Mutiis Chiara , Wenderfer Scott E , Orjuela Alvaro , Bagga Arvind , Basu Biswanath , Sar Tanmoy , Aggarwal Amita , Jain Avinash , Yap Hui-Kim , Ito Shuichi , Ohnishi Ai , Iwata Naomi , Kasapcopur Ozgur , Laurent Audrey , Mastrangelo Antonio , Ogura Masao , Shima Yuko , Rianthavorn Pornpimol , Silva Clovis A , Trindade Vitor , Dormi Ada , Tullus Kjell
Published: October 2021

Objective

We studied the rate of remission of LN in an international cohort of 248 children and adolescents with biopsy-proven LN. Five different definitions from scientific studies and the definitions recommended by the ACR and Kidney Disease: Improving Global Outcomes were used.

Methods

Anonymized clinical data in patients with biopsy-proven LN class ≥III (International Society of Nephrology/Royal Pathology Society) diagnosed and treated in the last 10 years in 23 international centres from 10 countries were collected. We compared the rate of patients in complete and partial remission applying the different definitions.

Results

The mean age at diagnosis was 11 years and 4 months, and 177 were females. The number of patients in complete and partial remission varied a great deal between the different definitions. At 24 months, between 50% and 78.8% of the patients were in full remission as defined by the different criteria. The number of patients in partial remission was low, between 2.3% and 25%. No difference in achieved remission was found between boys and girls or between children and adolescents (P > 0.05). Patients with East Asian ethnicity reached remission more often than other ethnicities (P = 0.03–0.0008). Patients treated in high-income countries showed a higher percentage of complete remission at 12 and 24 months (P = 0.002–0.000001).

Conclusion

The rate of children and adolescents with LN achieving remission varied hugely with the definition used. Our results give important information for long-awaited treatment studies in children and young people.
Reliability of the Clozapine:N-Desmethylclozapine (CLZ:NDMC) Ratio
Authors: Solomon Shirlee Daniela , Powell Valerie , Sanches Marcos , Borlido Carol , Burton Leah , De Luca Vincenzo , Rajji Tarek , Remington Gary
Published: October 2021

Clozapine represents the only agent approved for treatment resistant schizophrenia (TRS). Clear dosing guidelines have been difficult to delineate, and therapeutic drug monitoring (TDM) has become a common method to guide clinical use. In this context, attention has also focused on the ratio between clozapine (CLZ) and its metabolite, N-desmethylclozapine (NDMC). The CLZ:NDMC ratio has been implicated in cognition, an important clinical domain in schizophrenia, and various clinico-demographic factors are thought to impact it. To date, the reliability of the CLZ:NDMC ratio has not been established, and the present study aimed to (i) calculate the intraclass correlation coefficient (ICC) for the CLZ:NDMC ratio to assess reliability, and (ii) investigate the effect of selected clinico-demographic factors. The sample consisted of 100 patients diagnosed with schizophrenia or schizoaffective disorder being treated with clozapine, stabilized on their current dose, and able to provide at least 2 TDM samples. The calculated ICC for the CLZ:NDMC ratio was 0.65, while sex and co-administration of a mood stabilizer, specifically divalproex sodium, were found to significantly impact the ratio. In conclusion, the CLZ:NDMC ratio is moderately reliable, and can be influenced by clinical variables that warrant further investigation. Key limitations of the present investigation include inability to collect data on relevant variables such as smoking and ethnicity, as well as categorical exclusion of known inhibitors/inducers of clozapine metabolism. At the same time, these limitations underscore the challenges in utilizing such measures in clinical practice.
Mechanical Pain Sensitivity in Postamputation Pain
Authors: Beisheim-Ryan Emma H. , Pohlig Ryan T. , Hicks Gregory E. , Horne John R. , Medina Jared , Sions Jaclyn M.
Published: October 2021

Objectives:

Postamputation, clinical markers of pain-related peripheral and central nervous system hypersensitivity remain understudied. This study aimed to identify whether adults with postamputation pain demonstrate greater pain sensitivity in primary (ie, amputated region) and secondary (ie, nonamputated region) sites, as compared with pain-free peers and controls with intact limbs.

Methods:

Ninety-four participants postunilateral, transtibial amputation (59 with pain, 35 pain-free) and 39 controls underwent pain-pressure threshold (PPT) testing at 10 sites. Pain-pressure thresholds were normalized to sex-specific control data using Z score conversions. Normalized primary-site and secondary-site PPTs were compared between groups using multivariate analysis of variance (P<0.050).

Results:

Compared with pain-free peers, adults with postamputation pain demonstrated reduced normalized PPTs across primary and secondary sites (mean difference=0.61-0.74, P=0.001 to 0.007). Compared with controls, adults with postamputation pain demonstrated reduced normalized PPTs (mean difference=0.52, P=0.026) only at primary sites.

Discussion:

Adults with postamputation pain demonstrate greater amputated region pain sensitivity as compared with pain-free peers or controls with intact limbs, indicating peripheral sensitization persists even after limb healing. Secondary-site pain sensitivity was similar between controls and adults with postamputation pain, suggesting central nervous system hypersensitivity may not be ubiquitous with postamputation pain. Studies are needed to investigate mechanisms underlying pain sensitivity differences between adults with and without postamputation pain.
Complementary and Integrative Approaches in Obstetrics and Gynecology
Authors: Barbieri Anna , Fenske Suzanne
Published: October 2021

Integrative medicine is a holistic approach to health care that acknowledges multiple dimensions of health, including its physical, emotional, and spiritual aspects. It approaches health not just as absence of disease but as a state of optimal vitality, and utilizes all appropriate evidence-based modalities, including lifestyle interventions, complementary treatments, and conventional allopathic methods, in one paradigm. Utilization of non-conventional therapies by women and interest in integrative care is very high. Much disinformation exists and many women engage in non-conventional therapies without medical advice, sometimes benefiting from them, but also possibly delaying needed care or placing themselves at risk. Research and clinical interest in non-conventional methods also is rising within the medical community, with increased recognition of the value of an integrative health model for individuals and communities. Obstetrician–gynecologists are in a unique position to support their patients in holistic health optimization by choosing beneficial integrative strategies while identifying potentially harmful practices.
Mobile Hysteroscopy With the Use of a Smartphone as a Cost-Effective, Diagnostic Technique
Authors: Kathopoulis Nikolaos , Chatzipapas Ioannis
Published: October 2021

BACKGROUND:

Smartphone technology can be adapted to promote cable-free, wireless, and cost-effective diagnostic mobile office hysteroscopy.

INSTRUMENT:

We developed a new cable-free setup by coupling a rigid 30°, 2-mm-diameter hysteroscope to a smartphone using a commercially available adapter and using a portable and rechargeable light-emitting diode cold light source. The new setup cost is considerably lower compared with that of a typical endoscopic tower.

EXPERIENCE:

We performed both standard hysteroscopy and hysteroscopy using the new portable setup in 40 patients for a variety of benign gynecologic indications. The operating time was compared between the two methods, as was the pain perceived by the patients. Videos from the two setups were blindly reviewed and scored by experts regarding image resolution, brightness, color, and overall image quality. The new technique was acceptable for diagnosis in 97.5% of the videos.

CONCLUSION:

We report a promising initial experience using a smartphone to provide a convenient, cable-free, low-cost, office hysteroscopy system.
Outcomes in Twins Compared With Singletons Subsequent to Preterm Prelabor Rupture of Membranes
Authors: Fishel Bartal Michal , Ugwu Lynda G. , Grobman William A. , Bailit Jennifer L. , Reddy Uma M. , Wapner Ronald J. , Varner Michael W. , Thorp John M. , Caritis Steve N. , Prasad Mona , Tita Alan T. N. , Saade George R. , Rouse Dwight J. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: October 2021

OBJECTIVE:

To compare maternal and neonatal outcomes after preterm prelabor rupture of membranes (PROM) from 23 to 34 weeks of gestation in twin compared with singleton gestations.

METHODS:

We conducted a secondary analysis of an obstetric cohort of 115,502 individuals and their singleton or twin neonates born in 25 hospitals nationwide (2008–2011). Those with preterm PROM from 23 0/7 through 33 6/7 weeks of gestation were included; neonates with major fetal anomalies were excluded. The coprimary outcomes for this analysis were composite maternal morbidity (chorioamnionitis, blood transfusion, postpartum endometritis, wound infection, sepsis, venous thromboembolism, intensive care unit admission, or death) and composite major neonatal morbidity (persistent pulmonary hypertension, intraventricular hemorrhage grade III or IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II or III, bronchopulmonary dysplasia, stillbirth subsequent to admission, or neonatal death before discharge). Logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs) with 95% CIs for twin compared with singleton gestations.

RESULTS:

Of 1,531 (1.3%) individuals who met eligibility criteria for this analysis, 218 (14.2%) had twin gestations. The median gestational age at preterm PROM was similar between those with twins and singletons (31.2 weeks [interquartile range 27.4–32.9] vs 30.6 weeks [interquartile range 26.9–32.7], P=.23); however, those with twin gestations had a shorter median latency period (2.0 days [interquartile range 1.0–5.0] vs 3.0 days [interquartile range 2.0–8.0], P<.001). After adjustment for potential confounders, odds of experiencing composite maternal morbidity (17.9% vs 19.3%, adjusted OR 0.97, 95% CI 0.66–1.42) or composite neonatal morbidity (20.4% vs 20.5%, OR 0.97, 95% CI 0.72–1.31) did not differ between groups.

CONCLUSION:

In a large, diverse cohort, the likelihood of composite maternal or neonatal morbidity per fetus after preterm PROM was similar for twin and singleton gestations.
Testosterone Therapy in Women
Authors: Dunsmoor-Su Rebecca , Fuller Ashley , Voedisch Amy
Published: October 2021

The physiology of testosterone as a normal female hormone in reproductive years and beyond is poorly taught and understood. This has led to unregulated and dangerous prescribing practices by physicians and other health care professionals. There are data for safe use, and as women's health care practitioners, we owe it to our patients to follow these guidelines and practices, as well as advocate for more research and safer, regulated products to prescribe.
Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes
Authors: Miller Emily S. , Fleming Oriana , Ekpe Etoroabasi E. , Grobman William A. , Heard-Garris Nia
Published: October 2021

OBJECTIVE:

To examine the association between adverse childhood experiences and adverse pregnancy outcomes.

METHODS:

This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses.

RESULTS:

Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06–2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38–2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99–1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05–1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth.

CONCLUSION:

One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.
Transfusion Preparedness in the Labor and Delivery Unit
Authors: Benson Ashley E. , Metcalf Ryan A. , Cail Kelly , Rollins Mark D. , Warrick Christine M. , Falkner Dane , Clark Erin A.S. , Nelson Richard E. , Einerson Brett D.
Published: October 2021

OBJECTIVE:

To evaluate patient safety, resource utilization, and transfusion-related cost after a policy change from universal type and screen to selective type and screen on admission to labor and delivery.

METHODS:

Between October 2017 and September 2019, we performed a single-center implementation study focusing on risk-based type and screen instead of universal type and screen. Implementation of our policy was October 2018 and compared 1 year preimplementation with 1 year postimplementation. Patients were risk-stratified in alignment with California Maternal Quality Care Collaborative recommendations. Under the new policy, the blood bank holds a blood sample for processing (hold clot) on patients at low- and medium-risk of hemorrhage. Type and screen and crossmatch are obtained on high-risk patients or with a prior positive antibody screen. We collected patient outcomes, safety and cost data, and compliance and resource utilization metrics. Cost included direct costs of transfusion-related testing in the labor and delivery unit during the study period, from a health system perspective.

RESULTS:

In 1 year postimplementation, there were no differences in emergency-release transfusion events (4 vs 3, P>.99). There were fewer emergency-release red blood cell (RBC) units transfused (9 vs 24, P=.002) and O-negative RBC units transfused (8 vs 18, P=.016) postimplementation compared with preimplementation. Hysterectomies (0.05% vs 0.1%, P=.44) and intensive care unit admissions (0.45% vs 0.51%, P=.43) were not different postimplementation compared with preimplementation. Postimplementation, mean monthly type and screen-related costs (ABO typing, antibody screen, and antibody workup costs) were lower, $9,753 compared with $20,676 in the preimplementation year, P<.001.

CONCLUSION:

Implementation of selective type and screen policy in the labor and delivery unit was associated with projected annual savings of $181,000 in an institution with 4,000 deliveries per year, without evidence of increased maternal morbidity.
Postpartum Outcomes With Systematic Treatment and Management of Postpartum Hypertension
Authors: Suresh Sunitha C. , Duncan Colleen , Kaur Harjot , Mueller Ariel , Tung Avery , Perdigao Joana L. , Khosla Kavia , Dhir Rohin , Stewart Karie , Wallace Kedra , Ahn Roy , Rana Sarosh
Published: October 2021

OBJECTIVE:

To test the ability of a hospital-wide, bundled quality-improvement initiative to improve postpartum maternal blood pressure control and adherence to postpartum follow-up among patients with hypertensive disorders of pregnancy.

METHODS:

This quality-improvement initiative consisted of a bundle of clinical interventions including health care professional and patient education, a dedicated nurse educator, and protocols for postpartum hypertensive disorders of pregnancy care in the inpatient, outpatient and readmission setting. We implemented this initiative in patients with hypertensive disorders of pregnancy starting in January 2019 at the University of Chicago. The study period was divided into four periods, which correspond to preintervention, distinct bundle roll outs, and postintervention. Our primary outcome was postpartum hypertension visit adherence. Secondary outcomes included blood pressure values and antihypertensive medication use in the immediate postpartum and outpatient postpartum time periods. We then stratified our outcomes by race to assess whether the effect size differed.

RESULTS:

A total of 926 patients who delivered between September 2018 and November 2019 were included. Postpartum hypertension visit adherence improved from preintervention period compared with the full implementation period (33.5% vs 59.4%, P<.001). Blood pressure in the first 24 hours postpartum decreased from preintervention compared with full implementation (preintervention median [interquartile range] systolic blood pressure 149 mm Hg [138, 159] vs 137 [131, 146] in postimplementation; P<.001). After implementation, fewer patients experienced a blood pressure of 140/90 mm Hg or higher at the first postpartum blood pressure check, when compared with preintervention (39.1% vs 18.5%, P=.004). The effect size did not differ by race.

CONCLUSION:

A bundled quality-improvement initiative for patients with hypertensive disorders of pregnancy was associated with improved postpartum visit adherence and blood pressure control in the postpartum period.
Reduced Semantic Context and Signal-to-Noise Ratio Increase Listening Effort As Measured Using Functional Near-Infrared Spectroscopy
Authors: Rovetti Joseph , Goy Huiwen , Zara Michael , Russo Frank A.
Published: October 2021

Objectives:

Understanding speech-in-noise can be highly effortful. Decreasing the signal-to-noise ratio (SNR) of speech increases listening effort, but it is relatively unclear if decreasing the level of semantic context does as well. The current study used functional near-infrared spectroscopy to evaluate two primary hypotheses: (1) listening effort (operationalized as oxygenation of the left lateral PFC) increases as the SNR decreases and (2) listening effort increases as context decreases.

Design:

Twenty-eight younger adults with normal hearing completed the Revised Speech Perception in Noise Test, in which they listened to sentences and reported the final word. These sentences either had an easy SNR (+4 dB) or a hard SNR (−2 dB), and were either low in semantic context (e.g., “Tom could have thought about the sport”) or high in context (e.g., “She had to vacuum the rug”). PFC oxygenation was measured throughout using functional near-infrared spectroscopy.

Results:

Accuracy on the Revised Speech Perception in Noise Test was worse when the SNR was hard than when it was easy, and worse for sentences low in semantic context than high in context. Similarly, oxygenation across the entire PFC (including the left lateral PFC) was greater when the SNR was hard, and left lateral PFC oxygenation was greater when context was low.

Conclusions:

These results suggest that activation of the left lateral PFC (interpreted here as reflecting listening effort) increases to compensate for acoustic and linguistic challenges. This may reflect the increased engagement of domain-general and domain-specific processes subserved by the dorsolateral prefrontal cortex (e.g., cognitive control) and inferior frontal gyrus (e.g., predicting the sensory consequences of articulatory gestures), respectively.
Breech Presentation in Twins as a Risk Factor for Developmental Dysplasia of the Hip
Authors: Oh Eun Ji , Min Jae Jung , Kwon Soon-Sun , Kim Seong Been , Choi Chang Won , Jung Young Hwa , Oh Kyung Joon , Park Jee Yoon , Park Moon Seok
Published: October 2021

Introduction:

Identifying risk factors associated with developmental dysplasia of the hip (DDH) is essential for early diagnosis and treatment. Breech presentation is a major DDH risk factor, possibly because of crowding of the fetus within the uterus. In multifetal pregnancy, fetuses are generally smaller than singletons, which may obscure the effect of breech presentation on fetal hips. Only a few studies have investigated the occurrence of DDH in multifetal pregnancies. In this study, we aimed to evaluate whether the breech presentation is a major risk factor of DDH in twin pregnancies.

Methods:

This retrospective study included 491 consecutive live births (after 23+0 weeks gestation) delivered through cesarean section with at least 1 baby with noncephalic presentation in single or twin pregnancies from April 2013 to October 2018. We analyzed the incidence of DDH and its associated factors, including sex, breech, and multifetal pregnancy, with a generalized linear mixed model.

Results:

The incidence of DDH was 12.5% in singleton with breech presentation, 9.8% in twin-breech presentation, and 0.7% in twin-cephalic presentation. Multivariate analysis showed that singleton-breech presentation (P=0.003), twin-breech presentation (P=0.003), and female sex (P=0.008) were independent risk factors for DDH.

Conclusion:

Breech presentation is an independent risk factor for DDH in twin pregnancies, although twin pregnancy itself is not an independent risk factor for DDH.
Frequency and Implications of Concurrent Complications Following Adult Spinal Deformity Corrective Surgery
Authors: Bortz Cole , Pierce Katherine E. , Brown Avery , Alas Haddy , Passfall Lara , Krol Oscar , Kummer Nicholas A. , Wang Erik , O’Connell Brooke , Wang Charles , Vasquez-Montes Dennis , Diebo Bassel G. , Neuman Brian J. , Gerling Michael C. , Passias Peter G.
Published: October 2021

Study Design.

Retrospective review.

Objective.

Identify co-occurring perioperative complications and associated predictors in a population of patients undergoing surgery for adult spinal deformity (ASD).

Summary of Background Data.

Few studies have investigated the development of multiple, co-occurring complications following ASD-corrective surgery. Preoperative risk stratification may benefit from identification of factors associated with multiple, co-occurring complications.

Methods.

Elective ASD patients in National Surgical Quality Improvement Program (NSQIP) 2005 to 2016 were isolated; rates of co-occurring complications and affected body systems were assessed via cross tabulation. Random forest analysis identified top patient and surgical factors associated with complication co-occurrence, using conditional inference trees to identify significant cutoff points. Binary logistic regression indicated effect size of top influential factors associated with complication co-occurrence at each factor's respective cutoff point.

Results.

Included: 6486 ASD patients. The overall perioperative complication rate was 34.8%; 28.5% of patients experienced one complication, 4.5% experienced two, and 1.8% experienced 3+. Overall, 11% of complication co-occurrences were pulmonary/cardiovascular, 9% pulmonary/renal, and 4% integumentary/renal. By complication type, the most common co-occurrences were transfusion/urinary tract infection (UTI) (24.3%) and transfusion/pneumonia (17.7%). Surgical factors of operative time ≥400 minutes and fusion ≥9 levels were the strongest factors associated with the incidence of co-occurring complications, followed by patient-specific variables like American Society of Anesthesiologists (ASA) physical status classification grade ≥2 and age ≥65 years. Regression analysis further showed associations between increasing complication number and longer length of stay (LOS), (R
2 = 0.202, P < 0.001), non-home discharge (R
2 = 0.111, P = 0.001), and readmission (R
2 = 0.010, P < 0.001).

Conclusion.

For surgical ASD patients, the overall rate of co-occurring perioperative complications was 6.3%. Body systems most commonly affected by complication co-occurrences were pulmonary and cardiovascular, and common co-occurrences included transfusion/UTI (24.3%) and transfusion/pneumonia (17.7%). Increasing number of perioperative complications was associated with greater LOS, non-home discharge, and readmission, highlighting the importance of identifying risk factors for complication co-occurrences.

Level of Evidence: 3
The Relationship of Kinesiophobia with Pain and Quality of Life in Idiopathic Scoliosis
Authors: Figueras Clara , Matamalas Antonia , Pizones Javier , Moreno-Manzanaro Lucia , Betegón Jesús , Bagó Juan
Published: October 2021

Study Design.

Prospective, multi-centric, cross-sectional study.

Objective.

To analyze the construct validity of the Tampa Scale of Kinesiophobia (TSK) in a cohort of patients with adolescent idiopathic scoliosis (AIS).

Summary of the Background Data.

Back pain is not uncommon in AIS. The fear of movement (kinesiophobia) in response to pain is related to back pain. TSK psychometric properties in AIS patients have not been properly analyzed.

Methods.

Patients with AIS and no prior spine surgery were prospectively included. They fulfilled the Spanish version of the TSK-11 questionnaire, a pain intensity numerical rating scale (NRS), refined SRS-22 (SRS-22r), the Hospital Anxiety and Depression Scale (HADS), and item 7 of the Core Outcome Measurement Index (COMI). The sample was split into two groups for the statistical analysis: adolescents and young adults. Cronbach alpha was used to assess internal consistency. Discriminant and concurrent validity were obtained by computing Pearson correlation coefficients between the TSK score and several criterion measures.

Results.

A total of 275 patients were included—198 adolescents (mean age of 14.6 yrs) and 77 young adults (mean age of 26.9 yrs). The Cobb of largest curve means were 44.9° and 48.9°, respectively. In the adolescent group, the TSK mean (±SD) was 21.5 (±5.93), with a floor effect of 2.5%. In the adult group, the TSK mean was 24.2 (±6.63), with a floor effect of 3.9%. The ceiling effect was 0% in both groups. Cronbach alphas for the adolescent and adult groups were 0.76 and 0.79, respectively. No correlation was found in any group between the TSK score and the curve magnitude or pattern (Lenke classification). The TSK was significantly correlated with HAD depression and SRS-22r in both groups. However, these correlations were weaker in adolescents. In adults, the TSK also significantly correlates with NRS and work/school absenteeism.

Conclusion.

The Spanish version of TSK-11 is a reliable and valid instrument to analyze kinesiophobia in AIS. However, the weak correlation between kinesiophobia and pain intensity, disability, and emotional condition in adolescents requires further study.

Level of Evidence: 4
Rehabilitation Following Nerve Transfer Surgery
Authors: Larocerie-Salgado Juliana , Chinchalkar Shrikant , Ross Douglas C. , Gillis Joshua , Doherty Christopher D. , Miller Thomas A.
Published: October 2021

Nerve transfer surgery is an important new addition to the treatment paradigm following nerve trauma. The following rehabilitation plan has been developed over the past 15 years, in an interdisciplinary, tertiary peripheral nerve program at the “Roth|McFarlane Hand and Upper Limb Centre.” This center evaluates more than 400 patients with complex nerve injuries annually and has been routinely using nerve transfers since 2005. The described rehabilitation program includes input from patients, therapists, physiatrists, and surgeons and has evolved based on experience and updated science. The plan is comprised of phases which are practical, reproducible and will serve as a framework to allow other peripheral nerve programs to adapt and improve the “Roth|McFarlane Hand and Upper Limb Centre” paradigm to enhance patient outcomes.