bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary cilia control endothelial permeability by regulating expression and location of junction proteins
Authors: Diagbouga Mannekomba R , Morel Sandrine , Cayron Anne F , Haemmerli Julien , Georges Marc , Hierck Beerend P , Allémann Eric , Lemeille Sylvain , Bijlenga Philippe , Kwak Brenda R
Published: May 2021

Aims

Wall shear stress (WSS) determines intracranial aneurysm (IA) development. Polycystic kidney disease (PKD) patients have a high IA incidence and risk of rupture. Dysfunction/absence of primary cilia in PKD endothelial cells (ECs) may impair mechano-transduction of WSS and favour vascular disorders. The molecular links between primary cilia dysfunction and IAs are unknown.

Methods and results

Wild-type and primary cilia-deficient Tg737orpk/orpk arterial ECs were submitted to physiological (30 dynes/cm2) or aneurysmal (2 dynes/cm2) WSS, and unbiased transcriptomics were performed. Tg737orpk/orpk ECs displayed a fivefold increase in the number of WSS-responsive genes compared to wild-type cells. Moreover, we observed a lower trans-endothelial resistance and a higher endothelial permeability, which correlated with disorganized intercellular junctions in Tg737orpk/orpk cells. We identified ZO-1 as a central regulator of primary cilia-dependent endothelial junction integrity. Finally, clinical and histological characteristics of IAs from non-PKD and PKD patients were analysed. IAs in PKD patients were more frequently located in the middle cerebral artery (MCA) territory than in non-PKD patients. IA domes from the MCA of PKD patients appeared thinner with less collagen and reduced endothelial ZO-1 compared with IA domes from non-PKD patients.

Conclusion

Primary cilia dampen the endothelial response to aneurysmal low WSS. In absence of primary cilia, ZO-1 expression levels are reduced, which disorganizes intercellular junctions resulting in increased endothelial permeability. This altered endothelial function may not only contribute to the severity of IA disease observed in PKD patients, but may also serve as a potential diagnostic tool to determine the vulnerability of IAs.
The Criminal Registry in the German Empire: The ‘Cult of Previous Convictions’ and the Offender’s Right to Be Forgotten
Authors: de Groot Timon
Published: May 2021

In 1882 the criminal registry, a bureaucratic tool used to assemble information about the criminal biographies of German citizens, was implemented in all territories of the German Empire. This article demonstrates that the registry, evidence that states were accumulating ever more knowledge about the population, was from the beginning surrounded by critical reflection on its functioning. Worried about the scale of the work involved, in the interests of administrative efficiency bureaucrats wished the use of the registry to be curtailed. Prussian officials stressed that private parties should be denied access to the registry, while scholars pointed out that the registry was not intended to support forensic investigation. Journalists and worried citizens argued that the use of the registry in German courts was responsible for a culture of excessive suspicion. By portraying the emotional effects of the registry on German citizens, critics therefore sought to mobilize empathy for the ‘victims’ of the registry and started to demand a ‘right to be forgotten’. The Expungement Law of 1920 was designed as a solution to many of these problems and can be viewed as the endpoint of an important liberalizing process in German society. Yet, for many contemporaries the law was largely ineffective, for it did not combat social prejudices against citizens with a criminal record.
Quality of Education and Late-Life Cognitive Function in a Population-Based Sample From Puerto Rico
Authors: Barba Cheyanne , Garcia Alberto , Clay Olivio J , Wadley Virginia G , Andel Ross , Dávila Ana Luisa , Crowe Michael
Published: May 2021

Background and Objectives

We examined quality of education, literacy, and years of education in relation to late-life cognitive function and decline in older Puerto Ricans.

Research Design and Methods

Our sample consisted of 3,385 community-dwelling adults aged 60 years and older from the Puerto Rican Elderly: Health Conditions study. Quality of education was based on principal component analysis of variables gathered from Department of Education and Census reports. Literacy (yes/no) and years of education were self-reported. Cognitive function was assessed in participants’ homes at baseline and 4 years later using a previously validated Spanish-language 20-point global screening measure for dementia, the minimental Cabán. Regression models were adjusted for sociodemographic and life course covariates.

Results

Quality of education was positively correlated with both educational attainment and cognitive performance. Independent of years of education, literacy, childhood economic hardship, and adult economic hardship, compared to participants in the lowest quartile of education quality, those in the highest quartile had significantly better baseline cognitive performance (β = 0.09, p < .001). Quality of education did not consistently show an association with change in cognitive function over 4 years. Literacy and greater educational attainment were each independently associated with better cognitive function at baseline and less cognitive decline.

Discussion and Implications

Quality of education, literacy, and years of education, while interrelated, also show independent associations with cognitive functioning in older Puerto Ricans. The downstream factors of literacy and years of education were more closely related to age-related cognitive decline than quality of education.
Opsin Expression Varies with Reproductive State in the Cichlid FishAstatotilapia burtoni
Authors: Butler Julie M , Maruska Karen P
Published: May 2021

Synopsis

Animals use visual communication to convey crucial information about their identity, reproductive status, and sex. Plasticity in the auditory and olfactory systems has been well-documented, however, fewer studies have tested for plasticity in the visual system, a surprising detail since courtship and mate choice are largely dependent on visual signals across taxa. We previously found reproductive state-dependent plasticity in the eye of the highly social cichlid fish Astatotilapia burtoni. Male A. burtoni increase their courtship, including multicomponent visual displays, when around ovulated females, and ovulated females are more responsive to male visual courtship displays than non-ovulated females. Based on this, we hypothesized that ovulation status impacts visual capabilities in A. burtoni females. Using electroretinograms, we found that ovulated females had greater visual sensitivity at wavelengths corresponding to male courtship coloration compared with non-reproductively-receptive females. In addition, ovulated females had higher neural activation in the retina and higher mRNA expression levels of neuromodulatory receptors (e.g., sex-steroids; gonadotropins) in the eye than non-ovulated females. Here, we add to this body of work by testing the hypothesis that cone opsin expression changes with female reproductive state. Ovulated females had higher expression of short wavelength sensitive opsins (sws1, sws2a, sws2b) compared with mouthbrooding females. Further, expression of sws2a, the most abundant opsin in the A. burtoni eye, positively correlated with levels of circulating 11-ketotestosterone and estradiol and estrogen, androgen, and gonadotropin system receptor expression in the eye in females. These data indicate that reproductive state-dependent plasticity also occurs at the level of photoreceptors, not just through modulation of visual signals at downstream retinal layers. Collectively, these data provide crucial evidence linking endocrine modulation of visual plasticity to mate choice behaviors in females.
Discrete Restriction for (x,x3) and Related Topics
Authors: Hughes Kevin , Wooley Trevor D
Published: May 2021

Defining the truncated extension operator $E$ for a sequence $a(n)$ with $n \in{\mathbb{Z}} $ by putting $$\begin{align*} & {E}{a}(\alpha,\beta):=\sum_{|n|\le N}a(n) e(\alpha n^3 + \beta n), \end{align*}$$we obtain the conjectured tenth moment estimate $$\begin{align*} & \| {E} a \|_{L^{10}({\mathbb{T}} ^2)}\lesssim_\epsilon N^{\frac{1}{10}+\epsilon} \|a\|_{\ell^2({\mathbb{Z}} )}. \end{align*}$$We obtain related conclusions when the curve $(x,x^3)$ is replaced by $(\phi _1(x), \phi _2(x))$ for suitably independent polynomials $\phi _1(x),\phi _2(x)$ having integer coefficients.
An investigation of links between metabolic rate and feed efficiency in European sea bass Dicentrarchus labrax
Authors: Rodde Charles , de Verdal Hugues , Vandeputte Marc , Allal François , Nati Julie , Besson Mathieu , Blasco Felipe R , Benzie John A H , McKenzie David J
Published: May 2021

Feed efficiency (FE) is the amount of body weight gain for a given feed intake. Improving FE through selective breeding is key for sustainable finfish aquaculture but its evaluation at individual level is technically challenging. We therefore investigated whether individual routine metabolic rate (RMR) was a predictor of individual FE in the European sea bass Dicentrarchus labrax, a major species in European mariculture. The European sea bass has three genetically distinct populations across its geographical range, namely Atlantic (AT), West Mediterranean (WM), and East Mediterranean (EM). We compared FE and RMR of fish from these three populations at 18 or 24 °C. We held 200 fish (62 AT, 66 WM, and 72 EM) in individual aquaria and fed them from ad libitum down to fasting. FI was assessed for an ad libitum feeding rate and for a fixed restricted ration (1% of metabolic body weight·day−1, with metabolic body weight = body weight0.8). After being refed 12 wk in a common tank, individual RMR was measured over 36 h by intermittent flow respirometry. There was a significant effect of temperature whereby fish at 18 °C had greater mean FE (P < 0.05) and lower RMR (P < 0.001). There was also a significant effect of population, where AT fish had lower FE (P < 0.05) and greater RMR (P < 0.001) than WM and EM, at both temperatures. Despite these differences in temperature and population means, individual FE and RMR were not significantly correlated (P > 0.05). Therefore, although the results provide evidence of an association between metabolic rate and FE, RMR was not a predictor of individual FE, for reasons that require further investigation.
ESCRT components ISTL1 andLIP5 are required for tapetal function and pollen viability
Authors: Goodman Kaija , Paez-Valencia Julio , Pennington Janice , Sonntag Annika , Ding Xinxin , Lee Han Nim , Ahlquist Paul G. , Molina Isabel , Otegui Marisa S.
Published: May 2021

Pollen wall assembly is crucial for pollen development and plant fertility. The durable biopolymer sporopollenin and the constituents of the tryphine coat are delivered to developing pollen grains by the highly coordinated secretory activity of the surrounding tapetal cells. The role of membrane trafficking in this process, however, is largely unknown. In this study, we used Arabidopsis thaliana to characterize the role of two late-acting endosomal sorting complex required for transport (ESCRT) components, ISTL1 and LIP5, in tapetal function. Plants lacking ISTL1 and LIP5 form pollen with aberrant exine patterns, leading to partial pollen lethality. We found that ISTL1 and LIP5 are required for exocytosis of plasma membrane and secreted proteins in the tapetal cells at the free microspore stage, contributing to pollen wall development and tryphine deposition. Whereas the ESCRT machinery is well known for its role in endosomal trafficking, the function of ISTL1 and LIP5 in exocytosis is not a typical ESCRT function. The istl1 lip5 double mutants also show reduced intralumenal vesicle concatenation in multivesicular endosomes in both tapetal cells and developing pollen grains as well as morphological defects in early endosomes/trans-Golgi networks, suggesting that late ESCRT components function in the early endosomal pathway and exocytosis.
Evolution of β-lactamases and enzyme promiscuity
Authors: Fröhlich Christopher , Chen John Z , Gholipour Sevan , Erdogan Ayse N , Tokuriki Nobuhiko
Published: May 2021

β-Lactamases represent one of the most prevalent resistance mechanisms against β-lactam antibiotics. Beyond their clinical importance, they have also become key models in enzymology and evolutionary biochemistry. A global understanding of their evolution and sequence and functional diversity can therefore aid a wide set of different disciplines. Interestingly, β-lactamases have evolved multiple times from distinct evolutionary origins, with ancestries that reach back billions of years. It is therefore no surprise that these enzymes exhibit diverse structural features and enzymatic mechanisms. In this review, we provide a bird’s eye view on the evolution of β-lactamases within the two enzyme superfamilies—i.e. the penicillin-binding protein-like and metallo-β-lactamase superfamily—through phylogenetics. We further discuss potential evolutionary origins of each β-lactamase class by highlighting signs of evolutionary connections in protein functions between β-lactamases and other enzymes, especially cases of enzyme promiscuity.
Preoperative laboratory testing in elderly patients
Authors: Lee Kyung-Cheon , Lee Il-Ok
Published: May 2021

Purpose of review

Preoperative testing in elderly patients is performed to examine the patient's current medical condition in the context of evaluating vulnerabilities and predicting postoperative complications to ensure that all functions recover before surgery. This review focused on preoperative laboratory tests in geriatric patients.

Recent findings

Preoperative complete blood count, electrolyte testing, and blood chemistry can predict postoperative complications. Preoperative elevated morning/evening salivary cortisol secretion ratio, C-reactive protein/albumin ratio (CAR), neutrophil/lymphocyte ratios, and preoperative decreased serum albumin level or 25-hydroxyvitamin D levels can predict postoperative cognitive dysfunction. Elevated brain-type natriuretic peptide or serum alkaline phosphatase levels can be biomarkers of major postoperative adverse cardiac events. Decreased preoperative estimated glomerular filtration rates and serum albumin levels can predict acute kidney injury. Hyponatremia, hypocalcemia, and low albumin/fibrinogen ratio predict postoperative complications. Hypoalbuminemia can predict surgical site infection or postoperative mortality after hip fracture surgery. A high CAR can predict anastomotic site leakage and is a risk factor for one-year mortality after hip surgery.

Preoperative laboratory testing helps predict postoperative adverse complications; thus, a plan of care can be initiated.
Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus
Authors: Burkett Linda S. , Siddique Moiuri , Zeymo Alexander , Brunn Elizabeth A. , Gutman Robert E. , Park Amy J. , Iglesia Cheryl B.
Published: May 2021

OBJECTIVE:

To compare 6-month safety and efficacy outcomes of fractionated CO2 laser (laser) with topical clobetasol propionate (steroid) for treatment of symptomatic vulvar lichen sclerosus.

METHODS:

We conducted a single-center randomized controlled trial that compared fractionated CO2 laser with steroid treatment for patients with biopsy-proven lichen sclerosus. Randomization was stratified by prior clobetasol propionate use. The primary outcome was mean change in Skindex-29 score at 6 months. A total sample size of 52 participants were recruited to detect a mean difference of 16 points on the Skindex-29 (SD±22) with 80% power, based on a one-sided two-sample t test with α=0.05, accounting for 10% attrition. Secondary outcomes included validated subjective and objective measures. Intention-to-treat, per protocol, and regression analysis based on prior steroid exposure were performed.

RESULTS:

From October 2015 to July 2018, 202 women were screened, 52 were randomized, and 51 completed a 6-month follow-up. No significant difference was found in baseline demographics, symptoms, and physician assessment scores. There was greater improvement in the Skindex-29 score in the laser arm at 6-months (10.9 point effect size, 95% CI 3.42–18.41; P=.007). Overall, 89% (23/27) of patients in the laser group rated symptoms as being “better or much better” compared with 62% (13/24) of patients in the steroid group, P=.07. More patients (81%, 21/27) were “satisfied or very satisfied” with laser treatment compared with steroid treatment (41%, 9/24); P=.01. After stratification for previous steroid use, the significant change of Skindex-29 score was only seen in the previously exposed group. There was one adverse event in each group: minor burning and blistering at the laser site and reactivation of genital herpes 1 week after starting steroid.

CONCLUSION:

Fractionated CO2 laser treatment showed significant improvement in subjective symptoms and objective measures compared with clobetasol propionate, without serious safety or adverse events at 6 months.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02573883.
Chorioamnionitis and Risk for Maternal and Neonatal Sepsis
Authors: Beck Celeste , Gallagher Kelly , Taylor Leigh A. , Goldstein Jeffery A. , Mithal Leena B. , Gernand Alison D.
Published: May 2021

OBJECTIVE:

To estimate the risk of maternal and neonatal sepsis associated with chorioamnionitis.

DATA SOURCES:

PubMed, BIOSIS, and ClinicalTrials.gov databases were systematically searched for full-text articles in English from inception until May 11, 2020.

METHODS OF STUDY SELECTION:

We screened 1,251 studies. Randomized controlled trials, case-control, or cohort studies quantifying a relationship between chorioamnionitis and sepsis in mothers (postpartum) or neonates born at greater than 22 weeks of gestation were eligible. Studies were grouped for meta-analyses according to exposures of histologic or clinical chorioamnionitis and outcomes of maternal or neonatal sepsis.

TABULATION, INTEGRATION, AND RESULTS:

One hundred three studies were included, and 55 met criteria for meta-analysis (39 studies of preterm neonates, 10 studies of general populations of preterm and term neonates, and six studies of late preterm and term neonates). Study details and quantitative data were abstracted. Random-effects models were used to generate pooled odds ratios (ORs); most studies only reported unadjusted results. Histologic chorioamnionitis was associated with confirmed and any early-onset neonatal sepsis (unadjusted pooled ORs 4.42 [95% CI 2.68–7.29] and 5.88 [95% CI 3.68–9.41], respectively). Clinical chorioamnionitis was also associated with confirmed and any early-onset neonatal sepsis (unadjusted pooled ORs 6.82 [95% CI 4.93–9.45] and 3.90 [95% CI 2.74–5.55], respectively). Additionally, histologic and clinical chorioamnionitis were each associated with higher odds of late-onset sepsis in preterm neonates. Confirmed sepsis incidence was 7% (early-onset) and 22% (late-onset) for histologic and 6% (early-onset) and 26% (late-onset) for clinical chorioamnionitis-exposed neonates. Three studies evaluated chorioamnionitis and maternal sepsis and were inconclusive.

CONCLUSION:

Both histologic and clinical chorioamnionitis were associated with early- and late-onset sepsis in neonates. Overall, our findings support current guidelines for preventative neonatal care. There was insufficient evidence to determine the association between chorioamnionitis and maternal sepsis.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42020156812.
Performance and Diagnostic Value of Genome-Wide Noninvasive Prenatal Testing in Multiple Gestations
Authors: van Riel Margot , Brison Nathalie , Baetens Machteld , Blaumeiser Bettina , Boemer François , Bourlard Laura , Bulk Saskia , De Leener Anne , Désir Julie , Devriendt Koenraad , Dheedene Annelies , Duquenne Armelle , Fieremans Nathalie , Fieuw Annelies , Gatot Jean-Stéphane , Grisart Bernard , Janssens Sandra , Khudashvili Naïri , Lannoo Lore , Marichal Axel , Meunier Colombine , Palmeira Leonor , Parijs Ilse , Pichon Bruno , Roets Ellen , Sammels Eva , Smits Guillaume , Suenaert Marion , Sznajer Yves , Van den Bogaert Kris , Vancoillie Leen , Vandeputte Lotte , Vantroys Elise , Vermeesch Joris Robert , Janssens Katrien
Published: May 2021

OBJECTIVE:

To evaluate the accuracy and diagnostic value of genome-wide noninvasive prenatal testing (NIPT) for the detection of fetal aneuploidies in multiple gestations, with a focus on dichorionic–diamniotic twin pregnancies.

METHODS:

We performed a retrospective cohort study including data from pregnant women with a twin or higher-order gestation who underwent genome-wide NIPT at one of the eight Belgian genetic centers between November 1, 2013, and March 1, 2020. Chorionicity and amnionicity were determined by ultrasonography. Follow-up invasive testing was carried out in the event of positive NIPT results. Sensitivity and specificity were calculated for the detection of trisomy 21, 18, and 13 in the dichorionic–diamniotic twin cohort.

RESULTS:

Unique NIPT analyses were performed for 4,150 pregnant women with a multiple gestation and an additional 767 with vanishing gestations. The failure rate in multiple gestations excluding vanishing gestations ranged from 0% to 11.7% among the different genetic centers. Overall, the failure rate was 4.8%, which could be reduced to 1.2% after single resampling. There were no common fetal trisomies detected among the 86 monochorionic–monoamniotic and 25 triplet cases. Two monochorionic–diamniotic twins had an NIPT result indicative of a trisomy 21, which was confirmed in both fetuses. Among 2,716 dichorionic–diamniotic twin gestations, a sensitivity of 100% (95% CI 74.12–100%) and a specificity of 100% (95% CI 99.86–100%) was reached for trisomy 21 (n=12). For trisomy 18 (n=3), the respective values were 75% (95% CI 30.06–95.44%) sensitivity and 100% (95% CI 99.86–100%) specificity, and for trisomy 13 (n=2), 100% (95% CI 20.65–100%) sensitivity and 99.96% (95% CI 99.79–99.99%) specificity. In the vanishing gestation group, 28 NIPT results were positive for trisomy 21, 18, or 13, with only five confirmed trisomies.

CONCLUSION:

Genome-wide NIPT performed accurately for detection of aneuploidy in dichorionic–diamniotic twin gestations.
Delivery Mode After Manual Rotation of Occiput Posterior Fetal Positions
Authors: Verhaeghe Caroline , Corroenne Romain , Spiers Andrew , Descamps Philippe , Gascoin Géraldine , Bouet Pierre-Emmanuel , Parot-Schinkel Elsa , Legendre Guillaume
Published: May 2021

OBJECTIVE:

To evaluate whether manual rotation of fetuses in occiput posterior positions at full dilation increases the rate of spontaneous vaginal delivery.

METHODS:

In an open, single-center, randomized controlled trial, patients with a term, singleton gestation, epidural analgesia, and ultrasonogram-confirmed occiput posterior position at the start of the second stage of labor were randomized to either manual rotation or expectant management. Our primary endpoint was the rate of spontaneous vaginal delivery. Secondary endpoints were operative vaginal delivery, cesarean delivery, and maternal and neonatal morbidity. Analyses were based on an intention-to-treat method. A sample size of 107 patients per group (n=214) was planned to detect a 20% increase in the percent of patients with a spontaneous vaginal delivery (assuming 60% without manual rotation vs 80% with manual rotation) with 90% power and alpha of 0.05.

RESULTS:

Between February 2017 and January 2020, 236 patients were randomized to either manual rotation (n=117) or expectant management (n=119). The success rate of the manual rotation maneuver, defined by conversion to an anterior position as confirmed by ultrasonogram, was 68%. The rate of the primary endpoint did not differ between the groups (58.1% in manual rotation group vs 59.7% in expectant management group (risk difference −1.6; 95% CI −14.1 to 11.0). Manual rotation did not decrease the rate of operative vaginal delivery (29.9% in manual rotation group vs 33.6% in expectant management group (risk difference −3.7; 95% CI −16.6 to 8.2) nor the rate of cesarean delivery (12.0% in manual rotation group vs 6.7% in expectant management group (risk difference 5.3; 95% CI −2.2 to 12.6). Maternal and neonatal morbidity was also similar across the two groups.

CONCLUSION:

Manual rotation of occiput posterior positions at the start of second stage of labor does not increase the rate of vaginal delivery without instrumental assistance.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03009435.
Privacy Risks in Prenatal Aneuploidy and Carrier Screening
Authors: Parobek Christian M. , Russo Melissa L. , Lewkowitz Adam K.
Published: May 2021

Modern prenatal genetic screening techniques such as cell-free fetal DNA and expanded carrier screening genotype substantial amounts of maternal and fetoplacental DNA. Although DNA can be deidentified by stripping protected health information from genetic data, anonymized DNA can be reidentified using genetic databases, raising long-term genetic privacy concerns for both mother and fetus. In this commentary, we explore the evolution of prenatal genetic screening and how modern screening techniques may pose unanticipated privacy risks. We highlight knowledge gaps and outline steps to improve patient awareness of and control over their genetic privacy, including specific recommendations for laboratories and prenatal care practitioners who offer screening. We also encourage our colleagues who provide prenatal care to be well informed about the privacy implications of the genetic tests we order and to be vocal advocates for our patients' genetic privacy, both with the laboratories that perform these tests and in the public sphere.
Differentiating Acute Rejection From Preeclampsia After Kidney Transplantation
Authors: Yin Ophelia , Kallapur Aneesh , Coscia Lisa , Constantinescu Serban , Moritz Michael , Afshar Yalda
Published: May 2021

OBJECTIVE:

To evaluate the clinical and laboratory characteristics in pregnancy that differentiate preeclampsia from acute renal allograft rejection and to investigate the maternal, neonatal, and graft sequelae of these diagnoses.

METHODS:

We conducted a retrospective case-controlled registry study of data abstracted from Transplant Pregnancy Registry International deliveries between 1968 and 2019. All adult kidney transplant recipients with singleton pregnancies of at least 20 weeks of gestation were included. Acute rejection was biopsy proven and preeclampsia was diagnosed based on contemporary criteria. Variables were compared using χ2, Fisher exact, and Wilcoxon rank sum tests as appropriate. Multivariable linear regression was used to analyze preterm birth. Kaplan-Meier curves with log-rank test and Cox proportional hazards model were used to compare graft loss over time.

RESULTS:

There were 26 pregnant women with biopsy-confirmed acute rejection who were matched by the year they conceived to 78 pregnant women with preeclampsia. Recipients with acute rejection had elevated peripartum serum creatinine levels (73% vs 14%, P<.001), with median intrapartum creatinine of 3.90 compared with 1.15 mg/dL (P<.001). Conversely, only patients with preeclampsia had a significant increase in proteinuria from baseline. Although there were no significant differences in maternal outcomes, graft loss within 2 years postpartum (42% vs 10%) and long-term graft loss (73% vs 35%) were significantly increased in recipients who experienced acute rejection (P<.001 for both). The frequency of delivery before 32 weeks of gestation was 53% with acute rejection and 20% with preeclampsia. After controlling for hypertension and immunosuppressant use, acute rejection was associated with higher frequency of delivery at less than 32 weeks of gestation (adjusted odds ratio 4.04, 95% CI 1.10–15.2).

CONCLUSION:

In pregnancy, acute rejection is associated with higher creatinine levels, and preeclampsia is associated with increased proteinuria. Acute rejection in pregnancy carries a risk of prematurity and graft loss beyond that of preeclampsia for kidney transplant recipients.

FUNDING SOURCE:

The Transplant Pregnancy Registry International is supported in part by an educational grant from Veloxis Pharmaceuticals.
The Collision of Mental Health, Substance Use Disorder, and Suicide
Authors: Forray Ariadna , Yonkers Kimberly A.
Published: May 2021

Suicide is the 10th leading cause of death, and, in women, nearly half of all suicide deaths occur during their reproductive years. Suicide is associated with psychiatric illness, especially mood and anxiety disorders. Childhood adversities, such as physical, emotional, and sexual abuse, and intimate partner violence increase the risk of suicide. Having more than one psychiatric disorder or comorbid substance use disorder also increases the risk of suicide. Substance use disorders can be the triggering factor for a suicide attempt among those who have a psychiatric condition and suicidal thoughts. Women attempt suicide three times more often than men, although they are less likely to complete suicide. Although the rate of suicide decreases in the perinatal period, pregnant women are more likely to use violent means. Women who complete suicide in the perinatal period are also more likely to be younger, married, and experiencing a depressive episode. For many women, the only encounter with the medical system they have might be in reproductive health care clinics. This means that their obstetrician–gynecologist has a unique opportunity to address women's mental health and enhance suicide prevention. The American College of Obstetricians and Gynecologists recommends screening for depression among perinatal women. Clinicians need to be aware that women with severe perinatal depression are at increased risk of suicide and that women with suicidal thoughts need careful monitoring, evaluation, and treatment.
Surgical Management of Symptomatic Apical Pelvic Organ Prolapse
Authors: Larouche Maryse , Belzile Eric , Geoffrion Roxana
Published: May 2021

OBJECTIVE:

To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP).

DATA SOURCES:

MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002–2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English.

METHODS OF STUDY SELECTION:

From 2,665 records, we included randomized controlled trials and comparative studies of interventions with or without hysterectomy, including abdominal apical reconstruction through open, laparoscopic, or robotic approaches and vaginal apical reconstructions. Repairs using transvaginal mesh, off-the-market products, procedures without apical suspension, and follow-up less than 6 months were excluded.

TABULATION, INTEGRATION, AND RESULTS:

Relative risk (RR) was used to estimate the effect of surgical procedure on each outcome. For each outcome and comparison, a meta-analysis was conducted to pool the RRs when possible. Meta-regression and bias tests were performed when appropriate. The GRADE (Grades for Recommendation, Assessment, Development and Evaluation) system for quality rating and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting were used. Sixty-two articles were included in the review (N=22,792) and 50 studies in the meta-analyses. There was heterogeneity in study quality, techniques used, and outcomes reported. Median follow-up was 1–5 years. Vaginal suspensions showed higher risk of overall and apical anatomic recurrence compared with sacrocolpopexy (RR 1.82, 95% CI 1.22–2.74 and RR 2.70, 95% CI 1.33–5.50) (moderate), whereas minimally invasive sacrocolpopexy showed less overall and posterior anatomic recurrence compared with open sacrocolpopexy (RR 0.59, 95% CI 0.47–0.75 and RR 0.59, 95% CI 0.44–0.80, respectively) (low). Different vaginal approaches, and hysterectomy and suspension compared with hysteropexy had similar anatomic success. Subjective POP recurrence, reintervention for POP recurrence and complications were similar between most procedures.

CONCLUSION:

Despite variations in anatomic outcomes, subjective outcomes and complications were similar for apical POP procedures at 1–5 years. Standardization of outcome reporting and comparative studies with longer follow-up are urgently needed.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42019133869.
Preoperative Decision to Perform Portal Vein Resection Improves Survival in Patients With Resectable Pancreatic Head Cancer Adjacent to Portal Vein
Authors: Terasawa Muga , Mise Yoshihiro , Yoshioka Ryuji , Oba Atsushi , Ono Yoshihiro , Inoue Yosuke , Imamura Hiroshi , Hiromichi Ito , Takahashi Yu , Kawasaki Seiji , Saiura Akio
Published: May 2021

Objective:

We hypothesized that preoperatively planned portal vein resection (PVR), which prevents from approaching tumors, improves survival in patients with resectable pancreatic head cancer adjacent to the portal vein (PhC-PV).

The decision to perform PVR is difficult in patients with resectable PhC-PV.

Methods:

This is a retrospective, bi-institutional study of patients undergoing pancreatoduodenectomy (PD) for resectable PhC-PV from 2009 to 2018. We compared clinical data of patients who underwent PD with preoperatively planned PVR (planned PVR group) and those who underwent conventional PD (cPD) in which decision to perform PVR was made intraoperatively (cPD group).

Results:

Among the study population of 176 patients, 53 patients (30.1%) underwent PD with planned PVR. The remaining 123 patients (69.9%) underwent cPD. Tumor characteristics were similar between the 2 groups. Operation time and major complication rates did not differ between the 2 groups. The local recurrence rate of patients in the planned PVR group (28.3%) was lower than that of the cPD group (44.7%; P = 0.041). Median overall survival (OS) was longer in the planned PVR group than in the cPD group (32 vs 27 months; P = 0.011). Multivariate analysis revealed that having undergone planned PVR was an independent factor for favorable OS (hazard ratio = 1.65; 95% confidence interval = 1.08–2.61; P = 0.021).

Conclusions:

The preoperative decision to perform PVR improves survival by enhancing local control of resectable PhC-PV.
Construct Validity and Item Response Theory Analysis of the PROMIS-29 v2.0 in Recipients of Lumbar Spine Surgery
Authors: Cook Chad E. , Rethorn Zachary D. , Chiarotto Alessandro , Garcia Alessandra N. , Gottfried Oren
Published: May 2021

Study Design.

Observational cohort design involving measurement property assessment.

Objectives.

The aim of this study was to assess construct validity through hypothesis testing and to examine reliability and discrimination of the PROMIS-29 v2.0 using item response theory (IRT) analyses.

Summary of Background Data.

Patient-Reported Outcomes Measurement Information System (PROMIS) 29.0 version 2.0 includes 28 questions for the seven domains of Physical function, Anxiety, Depression, Fatigue, Sleep disturbance, Social role, and Pain interference, and one item related to pain intensity. To date, the tool has not been tested for construct validity for selected concepts, nor has it been evaluated using IRT in a population of spine surgery recipients.

Methods.

Using the Quality Outcomes Dataset lumbar registry, we evaluated the construct validity of the PROMIS-29 v2.0 against pain intensity measures for back and leg, the Oswestry Disability Index, the EQ5D 3L-visual analog scale (quality of life) and proxy measures of activities, mobility and self-care. IRT was used to test PROMIS-29 v2.0 assumptions and fit.

Results.

The sample included 652 surgery recipients (mean age = 60.1, SD = 14.0) who had a high level of baseline disability. Hypothesis testing confirmed direction and magnitude of correlation between the PROMIS and legacy measures in 10 of the 12 hypotheses. IRT identified three misfit items, but otherwise adequate scale reliability and unidimensionality.

Conclusion.

The PROMIS-29 v2.0 measures several different constructs pertinent to a patient's health and recovery during spine surgery. We feel that the PROMIS-29 v2.0 tool is a useful and effective outcome measure for populations who receive spine surgery.

Level of Evidence: 4
Cyclic Tensile Stress to Rat Thoracolumbar Ligamentum Flavum Inducing the Ossification of Ligamentum Flavum
Authors: Zhao Yin , Yuan Bo , Cheng Li , Zhou Shengyuan , Tang Yifan , Zhang Zhichao , Sun Yanqing , Xu Zheng , Li Fengning , Liao Xinyuan , Chen Xiongsheng
Published: May 2021

Study Design.

Western blot, reverse transcription-polymerase chain reaction (RT-PCR), radiological, and histological analyses of the rat ossification of ligamentum flavum (OLF) induced by cyclic tensile stress.

Objective.

The aim of this study was to induce the OLF using cyclic tensile stress to rat thoracolumbar ligamentum flavum, and to investigate the possible molecular mechanism of tension-induced OLF.

Summary of Background Data.

Tensile stress has been considered as an important factor leading to the OLF. So far, however, no OLF induced by tension has been reported.

Methods.

Forty rats were randomly divided into five equal groups. For control groups, the blank and anesthesia groups were not subjected to tension. For experimental groups, the 4-, 8-, and 12-week groups were subjected to cyclic tensile stress of ligamentum flavum after abdominal anesthesia for 4 weeks, 8 weeks, and 12 weeks, respectively, using an original stress apparatus for rats. The radiological and morphological changes of rat spine, as well as the protein and mRNA expressions of CD44, bone morphogenetic protein-2 (BMP-2), integrin β3, collagen protein type I (COL1), osteopontin (OPN), runt-related transcription factor 2 (RUNX-2), and vascular endothelial growth factor (VEGF), were concerned.

Results.

The micro-CT showed OLF in the 4-, 8-, and 12-week group. The axial maximum occupied area of ossifications was 1.42 mm2, 3.35 mm2, and 7.28 mm2, respectively. In histopathology, chondrocytes proliferated in the experimental model; woven bone arose in the 8- and 12-week groups, and was more noticeable in the 12-week group. According to western blot and RT-PCR, the expressions of seven osteogenesis-related molecules were all increased in three experimental groups.

Conclusion.

Cyclic tensile stress to the ligamentum flavum in rats can induce the OLF, and the longer the duration, the more visible the osteogenesis. The upregulation and synergism of osteogenesis-related molecules may contribute to the OLF induced by tensile stress.

Level of Evidence: N/A
Prospective Investigation of Postoperative Complications in Anterior Decompression with Fusion for Severe Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Egawa Satoru , Yoshii Toshitaka , Sakai Kenichiro , Kusano Kazuo , Nakagawa Yukihiro , Hirai Takashi , Kimura Atsushi , Furuya Takeo , Kanchiku Tsukasa , Nagamoto Yukitaka , Takahata Masahiko , Mori Kanji , Katoh Hiroyuki , Nagoshi Narihito , Imagama Shiro , Koda Masao , Kawaguchi Yoshiharu , Takeshita Katsushi , Matsumoto Morio , Yamazaki Masashi , Okawa Atsushi
Published: May 2021

Study Design.

A prospective multicenter study.

Objective.

This study aims to investigate the postoperative complications of anterior decompression with fusion (ADF) for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data.

Surgical treatment for cervical OPLL has a high risk of various complications. ADF is reported to be effective for cervical OPLL, especially for massive OPLL. However, few studies have focused on the surgical complications of ADF.

Methods.

We prospectively included 102 patients undergoing ADF for severe cervical OPLL with average canal occupying ratio of 49.8%. We evaluated systemic and local complications, neurological complications, and risk factors related to the postoperative complications.

Results.

Frequently observed complications included graft/ implant complications (18.6%), neurological complications (11.8%), and cerebrospinal fluid leak (11.8%). Motor palsy involving only the upper extremity was found in nine patients (8.8%), and other motor palsies involving the lower extremities were found in three patients (2.9%). None of the preoperative factors were significantly associated with the occurrence of neurological palsies, whereas the number of operated levels was a significant factor related to the postoperative graft/implant complications (P = 0.003; odds ratio, 2.112). The incidence of graft/implant complications and related reoperation increased as the number of operated levels increased (especially four levels or more). Most motor palsies were observed immediately after surgery. Of the motor palsies in the bilateral upper extremities and palsies involving the lower extremities, 85.7% showed good recovery, whereas only 40% of unilateral upper extremity motor palsies showed good recovery during the follow-up period.

Conclusion.

In ADF for cervical OPLL, the number of operated levels was a significant factor related to the postoperative complication. Specifically, the incidence of graft/implant complications and reoperation rate increased in ADF with four or more levels.

Level of Evidence: 3
Primary and Revision Anterior Cervical Discectomy and Fusion
Authors: Wong Michele , Williams Nicholas , Kacker Ashutosh
Published: May 2021

Study Design.

Retrospective chart review.

Objective.

To determine risk factors for postoperative otolaryngologic complications among patients who undergo primary and revision anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Swallowing and voice dysfunction are frequent postoperative complaints after ACDF surgery with a published incidence varying between 1.2% and 60%. A thorough understanding of the incidence and risk factors for these complications is needed.

Methods.

Electronic medical records of adults who underwent ACDF with predicted difficult surgical site exposure performed by two-surgeon approach between 2008 and 2018 were reviewed. Patients were categorized by primary or revision ACDF status and by the number of levels addressed during the operation. Associations with postoperative otolaryngologic symptoms were assessed using simple and multivariable logistic regression.

Results.

Participants included 718 adults with an average age of 55.8 years and 45% female sex. One hundred seventy-five patients (27%) underwent revision ACDF; ACDF status was unidentifiable for 74 patients. Seventy-nine cases (12%) involved one spinal level. New postoperative otolaryngologic symptoms among those who underwent primary and revision ACDF were 12.6% and 10.9% respectively. No evidence was found of an association between postoperative otolaryngologic symptoms and revision ACDF (OR, 0.84 [95% CI, 0.48–1.49]; P 
= 0.55), but evidence was found of an association with prior thyroidectomy (aOR, 3.8 [95% CI, 1.53–8.94], P 
= 0.0003). Significant evidence was found of increased odds for new postoperative dysphagia with increasing number of surgical levels (aOR, 1.5 [95% CI, 1.09–2.07]; P = 0.01).

Conclusion.

Prior thyroidectomy and number of spinal levels addressed during ACDF were identified as risk factors for postoperative otolaryngologic complications including dysphagia. Revision ACDF was not associated with increased odds of postoperative otolaryngologic symptoms or dysphagia.

Level of Evidence: 4
PROMIS Scores Should Not be Used in Isolation to Measure Outcomes in Lumbar Stenosis Patients
Authors: Phan Amy , Liu Andrew Y. , Sulovari Aron , Maqsoodi Noorullah , Everett Clifford Richard , Mesfin Addisu
Published: May 2021

Study Design.

Retrospective cross-sectional analysis.

Objective.

The aim of this study was to establish the strength of relationship between the Patient-reported Outcomes Measurement Information System (PROMIS) Adult Depression (AD), Physical Function (PF), and Pain Interference (PI) with the Swiss Spinal Stenosis Questionnaire (SSSQ) in assessing lumbar spinal stenosis (LSS).

Summary of Background Data.

In 2009, there were >35,000 surgeries for LSS, which amounted to $1.65 billion in health care cost. By 2021, there will be >2.4 million people in the United States with symptomatic LSS. There is an increasing emphasis on patient-reported outcomes (PROs) to define value in medicine. Therefore, it would be beneficial to compare PROMIS, a universal PRO, against the SSSQ, the “criterion standard” for assessing LSS.

Methods.

Eighty-two patients with LSS completing the PROMIS and SSSQ were enrolled. Per existing institutional protocol, PROMIS AD, PF, and PI were completed at every clinic visit. Linear regression analysis was then performed to evaluate how well the SSSQ and PROMIS scores correlated to each other.

Results.

When linear regression was performed for pre-treatment values, the R
2 value for the SSSQ PF versus PROMIS PF was 0.14 (P = 0.0008), whereas the R
2 value for the SSSQ symptom severity versus PROMIS PI was 0.03 (P = 0.13). The R
2 value for the combined SSSQ physical function and symptom severity versus PROMIS AD was 0.07 (P = 0.02). When post-treatment SSSQ satisfaction scores were correlated to postoperative PROMIS AD, PI, and PF scores, the R
2 values for a good linear fit were 0.13, 0.25, and 0.18 respectively (P values: 0.01, 0.003, and 0.003).

Conclusion.

Pre-treatment PROMIS scores do not adequately capture the disease-specific impact of spinal stenosis, but postoperative PROMIS scores better reflect outcomes after surgery for LSS. PROMIS scores should not be used in isolation to assess outcomes in patients with LSS.

Level of Evidence: 4
Vertebral Augmentation of Cancer-Related Spinal Compression Fractures
Authors: Mattie Ryan , Brar Nick , Tram Jennifer T. , McCormick Zachary L. , Beall Douglas P. , Fox Andrew , Saltychev Mikhail
Published: May 2021

Study Design.

Systematic review and meta-analysis.

Objective.

To compare the magnitude and duration of pain relief with vertebral augmentation to any other therapy for the treatment of cancer-related vertebral compression fractures through meta-analysis of randomized controlled trials.

Summary of Background Data.

Derived from search on PubMed, EMBASE, CINAHL, Scopus, Central, Scopus, and Web of Science databases in May 2020. Studies selected were limited to randomized controlled trials comparing vertebral augmentation, either Balloon Kyphoplasty or Percutaneous Vertebroplasty (PVP) with or without additional therapy to any other intervention or placebo/sham.

Methods.

The methodological quality of each included study was assessed according to the Cochrane Collaboration's domain-based framework. Random effects model, Q test, and I2 statistics were implemented.

Results.

Of 180 records identified, 7 were considered relevant, and included 476 participants. The risk of bias was considered “Low” in all studies. In five of the studies, vertebral augmentation alone (either PVP or Balloon Kyphoplasty) comprised one group, while comparative treatments included nonsurgical management, Kiva implantation, PVP and radiofrequency therapy, PVP and chemotherapy, PVP and intrasomatic injection of steroid, and PVP with 125I seeds. Two studies compared PVP with an additional therapy against the standard of care. With regard to changes in pain severity, the effect sizes varied from 0.0 (95% –1.7 to 1.7) to –5.1 (95% –5.3 to –4.9). Most studies demonstrated a positive and statistically significant effect associated with PVP. Four of the seven studies demonstrated a clinically significant effect as well. Other than cement leakage, with an event rate of 0.24 (95% CI 0.11–0.44) or 24% (95% CI 11%–44%), there were no major adverse events consistently observed across multiple studies.

Conclusions.

The included randomized controlled trials demonstrated an overall positive and statistically significant effect of vertebral augmentation surgeries, such as vertebroplasty and kyphoplasty, for the treatment of cancer-related vertebral compression fractures, especially when compared with nonsurgical management, radiofrequency ablation, or chemotherapy alone.

Level of Evidence: 1