bluuebunny/crossref_metadata_2025 huggingface dataset:
South Slavic Lands
Authors: Milanović Ljubomir
Published: November 2021

The reception of Byzantine art among the South Slavs began with their conversion to Christianity in the ninth century. Bulgaria and Serbia were the largest medieval states, covering most of the territory of the Balkan Peninsula. With the development and strengthening of political power of these kingdoms, more influences from Byzantium penetrated the state administration and society. Art production mostly relied on the patronage of local rulers, nobles, or prelates, who were able to bring the best artists from Byzantine centers or those trained in Byzantine workshops. This resulted in the intermingling of Byzantine traditions and skills and local patrons’ desires for creating artistic programs and objects with political and national content.
Spolia in Byzantine Art and Architecture
Authors: Kiilerich Bente
Published: November 2021

This article discusses the use of spolia in Byzantium from the fourth to the fifteenth centuries. The varied practices of reuse are analyzed by presenting examples from sacred and secular environments, ranging from monuments in Constantinople (serpent column, obelisk) and Nicopolis (ambo) to architectural fragments and sculpted reliefs in fortifications (Nicaea) and churches (Skripou, Merbaka, Little Metropolis Athens). Some twenty possible motivations for reuse are proposed. The problems of establishing precise meanings and the changing meanings over time are addressed. Finally, the article suggests some future directions for research, including object biography and an aesthetics of spolia.
“There’s a Rainbow on the River”: The Affordances of Boy Soprano Bobby Breen in 1930s Hollywood
Authors: McCracken Allison
Published: November 2021

This chapter discusses the cultural and industrial significance of boy soprano and child star Bobby Breen, who starred in a series of popular musical films in 1930s Hollywood. It argues that Breen’s status as a presexual child allowed his queer-coded voice and persona to escape the condemnation of gender-nonconforming adult male singers that was prevalent at the time, opening up spaces for queer reception, resistance, and celebration. An interdisciplinary, intersectional framework is applied to identify Breen’s particular affordances, offering a broad and inclusive application of the word “queer” to demonstrate how Breen’s boy soprano activated multiple kinds of social difference. Breen’s narratives place his characters in direct opposition to white, middle-class, masculinist, heteronormative men and the institutions they represent, giving representation and agency to otherwise marginalized groups as central narrative actors, industry professionals and audience members, including gender-variant and queer people, women, working-class white ethnics, and Black and other communities of color.
Making a Scene: Queercore Cinema
Authors: Nault Curran
Published: November 2021

This chapter recuperates the oft-overlooked queer punk cinematic corpus of queercore, and delineates its constituting elements: deviant content and do-it-yourself (DIY) practice, coalescing in an insistence on queercore’s capital D subcultural Difference. In doing so, this chapter engages three films by queercore instigator G. B. Jones as centerpieces around which a constellation of other instructive instances appear: The Troublemakers (1990), The Lollipop Generation (2008), and The Yo-Yo Gang (1992). Irreverent, experimental, and unapologetic, queercore cinema first emerged in the 1980s, as academics and activists were beginning to articulate notions of the “radical queer,” and it forges a neglected link between the mischievous films of the 1960s and 1970s gay underground and the provocative, arty experimentations of 1990s New Queer Cinema.
Arias for an Untold Want: The Queer Desire of the Diva Film
Authors: McElroy Dolores
Published: November 2021

This chapter defines the diva as a specific cultural type that has been shaped by long-held ideas about the female voice, but has moved beyond the narrow category of the female singer, and grown to encompass many non-singing women and characters who are understood as a “public success” but a “private failure.” Using the operatic history of the term “diva,” the chapter defines the type not by its reception in queer circles, but by its foundation in a “doubly feminine” relation of desire. Via close readings of the films Rapsodia Satanica (1917), Funny Girl (1968), and Queen Christina (1933), it explores the queer valences of female “narcissism,” and argues that a transhistorical “diva genre” of film is defined by a queer feminine “doubling,” which manifests in scenes featuring the spectacularized longing of the female lead.
Venture Capital, Angel Capital, and Other Finance, IPOs, and Acquisitions
Authors: Lin Lin
Published: November 2021

This chapter focuses on the development of non-bank financial institutions, particularly venture capital (VC), angel capital, private equity, and foreign funds, and their role in funding entrepreneurial ventures in China. It discusses the development of the venture capital market and the evolution of domestic and foreign funds in China. It examines the exits of VC-backed companies through initial public offerings (IPOs) and mergers and acquisitions and explores the connection between the stock market and VC market in China. It also evaluates recent institutional improvements and regulatory reforms for facilitating access to finance for small enterprises in China, especially the recent reforms to the stock market.
Innovation Elements in Traditional Chinese Culture
Authors: Chen Jin , Wu Qingqian
Published: November 2021

The conflict between traditional Chinese culture and Western cultures has long been one between an archaic, outdated culture and a modern, new culture. Traditional Chinese culture is deemed synonymous with backwardness, decrepitude, and decadence and doomed with the passage of time, particularly since social Darwinism swept across the late Qing Dynasty and captured the spiritual world of Chinese intellectuals. Despite differences in culture types, both traditional Chinese culture and Western culture contribute to innovative buildup. It is of great significance to deeply explore the innovative factors in traditional Chinese culture and to explore both the modernization road and innovation modes with Chinese characteristics. This chapter analyzes and explores the innovative factors and values in Chinese traditional culture from the aspects of traditional modes of thinking, traditional ideas and beliefs, traditional organizations and institutions, and traditional implementations and technologies.
Global Supply Chains as Drivers of Innovation in China
Authors: Murphree Michael , Breznitz Dan
Published: November 2021

China’s manufacturing and innovation capabilities are directly related. Availability of complementary resources in rapid prototyping, test production, and components and the ability to deploy innovations at scale increasingly lead high-technology firms, including startups, to consider China as a developmental base across sectors from big data to cloud computing, smart grid, renewable energy, and alternative energy vehicles. Entry into global value chains (GVCs) has led to vast transfers of knowledge, creating human resource capabilities that continuously facilitate the upgrading of Chinese firms. China’s most advanced industries were all those characterized by active participation in GVCs. China’s entry into GVCs has differed significantly from the experiences of other emerging economies, arguably affording China greater innovation benefits. This is directly related to China’s institutional environment of “structured uncertainty.” Structured uncertainty shaped the pattern and impact of entry into GVCs, dictating which regions entered GVCs, when, and how, with long-term knowledge transfer effects.
China’s Financial Innovation
Authors: Zhang Liqing
Published: November 2021

Substantial innovations have happened in China’s financial sector over the past four decades, ranging from the significant increase of institutions, changes of market structure, and development of products to the improvement of regulatory frameworks. These changes and innovations reflect China’s transition from a centrally planned economy to a modern market economy; persistent demand of various financial services derived from the government, corporations, and individuals in a period of rapid economic growth; and alternatively occurring regulation and deregulation by the authorities. The unprecedentedly advanced progress of technology, especially the emergence of modern information revolutions, makes all these changes and innovations possible. Financial innovation has made profound impacts on China’s economic efficiency, financial stability, and social equality, among them some quite positive and some relatively negative.
Green Innovation in China
Authors: Huang Ping , Lema Rasmus
Published: November 2021

China’s rapid economic growth combined with its large population has created substantial environmental pressures, not least the need for efficient and sustainable energy provision. This chapter addresses the problem of transition to sustainable energy sources. It shows how the Chinese response to the sustainability challenge has depended on both “hard” (technological) and “soft” (institutional) innovations. The chapter also shows how the sustainability challenge has presented a window of opportunity for industrial development and competitiveness in the green economy. Finally, it discusses the wider global implication of China’s mounting innovation capacities in green technologies.
Optimal Embedded Leverage for Portfolios of Commodity Trading Advisors
Authors: Tjurhufvud Christian Lundström , Peltomäki Jarkko
Published: November 2021

The chapter evaluates the profit when investing in portfolios of Commodity Trading Advisors (CTA) with optimal embedded leverage. The authors’ results support their expectation that it is possible to improve the long-term profitability of diversified CTA portfolios by obtaining optimal embedded leverage, but the improvement in profitability varies across CTA indexes. In addition, the crisis alpha feature of CTAs are considered and it is shown that diversified portfolios of CTAs can achieve a much larger crisis alpha by using optimal leverage factors. Optimal embedded leverage can also a useful tool in managing and evaluating the leverage of trend-following strategies and CTA portfolios.
Outsourcing Compliance Functions and Fraud Detection
Authors: Shapiro David M.
Published: November 2021

This chapter addresses the compliance function for hedge funds and considers areas where violations can occur. It surveys regulation in place in the US and internationally, looking in particular at the Securities and Exchange Commission and the Commodity Futures Trading Commission, and highlights key issues. Primarily, the chapter focuses on the outsourced nature of many of the agents responsible for providing assurance of the honesty of hedge fund operations, including trading, and reporting, registration, and discussing how compliance is made effective. The chapter concludes by considering the risks that require further research.
Indirect Regulation of Hedge Funds
Authors: Kaal Wulf A.
Published: November 2021

This chapter evaluates the prevalent regulatory approaches for hedge funds. Among these are direct regulation, indirect regulation, so-called prudential hedge fund regulation, and eventually co-coordinated international cooperation. The chapter shows that indirect regulation of the hedge fund industry attains most regulatory objectives while providing the industry with sufficient freedom to operate. The chapter concludes with an examination of the benefits of indirect regulation of the hedge fund industry.
Hedge Fund Flows
Authors: Baquero Guillermo , Verbeek Marno
Published: November 2021

Hedge fund flows characterize the average opinion of hedge fund investors about managerial skill, expected performance, financial and operational risk. However, liquidity restrictions hamper the ability of investors to rapidly switch from one fund to another. In addition, capacity constraints at the fund or style level may imply that future returns decrease when more money is allocated to a given hedge fund. In this chapter, we provide a detailed overview of what are the drivers, and limitations, of hedge fund flows, how flows are related to measures of past performance, and to what extent flows are able to predict subsequent performance. We also discuss some implications of these relationships, for example in terms of incentives to fund managers.
Pregnancy outcomes in relation to disease activity and anti-rheumatic treatment strategies in women with rheumatoid arthritis: a matched cohort study from Sweden and Denmark
Authors: Hellgren Karin , Secher Anne Emilie , Glintborg Bente , Rom Ane Lilleøre , Gudbjornsson Bjorn , Michelsen Brigitte , Granath Fredrik , Hetland Merete Lund
Published: November 2021

Objectives

To explore the association of maternal RA to pregnancy outcomes, especially preterm birth (PTB) and small for gestational age (SGA), in relation to disease activity and anti-rheumatic treatment before and during pregnancy.

Methods

By linking prospective clinical rheumatology registers (CRR) in Sweden (the Swedish Rheumatology Quality Register, SRQ) and Denmark (the Danish clinical quality register, DANBIO) with medical birth registers, we identified 1739 RA-pregnancies and 17 390 control-pregnancies (matched 1:10 on maternal age, birth year, parity) with delivery 2006–18. Disease activity (DAS28, CRP, HAQ score) and anti-rheumatic treatment 9 months before and during pregnancy were identified through CRR and prescribed drug registers. Using logistic regression, we estimated adjusted odds ratios (aOR) with 95% CI for PTB and SGA overall and stratified by disease activity and anti-rheumatic treatment before and during pregnancy, adjusting for maternal characteristics.

Results

We found increased aOR of PTB [1.92 (1.56–2.35)] and SGA [1.93 (1.45–2.57)] in RA-pregnancies vs control-pregnancies. For RA-pregnancies with DAS28-CRP ≥4.1 vs <3.2 during pregnancy, aOR was 3.38 (1.52–7.55) for PTB and 3.90 (1.46–10.4) for SGA. Use of oral CS (yes/no) during pregnancy resulted in an aOR of 2.11 (0.94–4.74) for PTB. The corresponding figure for biologics was 1.38 (0.66–2.89). Combination therapy, including biologics before pregnancy, was a marker of increased risk of both PTB and SGA.

Conclusion

During pregnancy, disease activity rather than treatment seems to be the most important risk factor for PTB and SGA in RA. Women with RA should be carefully monitored during pregnancy, especially if they have moderate to high disease activity or/and are treated with extensive anti-rheumatic treatment.
Perivascular and endomysial macrophages expressing VEGF and CXCL12 promote angiogenesis in anti-HMGCR immune-mediated necrotizing myopathy
Authors: Lia Anna , Annese Tiziana , Fornaro Marco , Giannini Margherita , D’Abbicco Dario , Errede Mariella , Lorusso Loredana , Amati Angela , Tampoia Marilina , Trojano Maria , Virgintino Daniela , Ribatti Domenico , Serlenga Luigi , Iannone Florenzo , Girolamo Francesco
Published: November 2021

Objectives

To study the phenotype of macrophage infiltrates and their role in angiogenesis in different idiopathic inflammatory myopathies (IIMs).

Methods

The density and distribution of the subpopulations of macrophages subsets (M1, inducible nitric oxide+, CD11c+; M2, arginase-1+), endomysial capillaries (CD31+, FLK1+), degenerating (C5b-9+) and regenerating (NCAM+) myofibres were investigated by immunohistochemistry in human muscle samples of diagnostic biopsies from a large cohort of untreated patients (n: 81) suffering from anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR)+ immune mediated necrotizing myopathy (IMNM), anti-signal recognition particle (anti-SRP)+ IMNM, seronegative IMNM, DM, PM, PM with mitochondrial pathology, sporadic IBM, scleromyositis, and anti-synthetase syndrome. The samples were compared with mitochondrial myopathy and control muscle samples.

Results

Compared with the other IIMs and controls, endomysial capillary density (CD) was higher in anti-HMGCR+ IMNM, where M1 and M2 macrophages, detected by confocal microscopy, infiltrated perivascular endomysium and expressed angiogenic molecules such as VEGF-A and CXCL12. These angiogenic macrophages were preferentially associated with CD31+ FLK1+ microvessels in anti-HMGCR+ IMNM. The VEGF-A+ M2 macrophage density was significantly correlated with CD (rS: 0.98; P: 0.0004). Western blot analyses revealed increased expression levels of VEGF-A, FLK1, HIF-1α and CXCL12 in anti-HMGCR+ IMNM. CD and expression levels of these angiogenic molecules were not increased in anti-SRP+ and seronegative IMNM, offering additional, useful information for differential diagnosis among these IIM subtypes.

Conclusion

Our findings suggest that in IIMs, infiltrating macrophages and microvascular cells interactions play a pivotal role in coordinating myogenesis and angiogenesis. This reciprocal crosstalk seems to distinguish anti-HMGCR associated IMNM.
Fixed-term work contracts and anti-immigration attitudes. A novel test of ethnic competition theory
Authors: Ersanilli Evelyn , Präg Patrick
Published: November 2021

Whether labor market competition is shaping anti-immigration attitudes is a contentious issue. We conduct a novel test of ethnic competition theory by comparing the attitudes toward immigration of workers with fixed-term contracts to those with permanent jobs in Europe. Fixed-term contract workers are particularly at risk of competition as they have to compete for jobs in the foreseeable future. In the first step of our investigation, we analyze cross-sectional data (European Social Survey, 2002–18) from 18 Western European countries. We find that—contrary to our expectation—fixed-term workers are less anti-immigration. The effect is substantively small. In the second step, we use a fixed-effects design with longitudinal data from the German Socio-Economic Panel (GSOEP, 1999–2015) to rule out time-constant unobserved heterogeneity. We find that transitioning from a fixed to a permanent contract does not affect anti-immigration attitudes. Our combined results thus add to the growing body of studies that do not find evidence for labor market competition as an explanation of anti-immigrant attitudes.
Overexpression of MdASMT9, an N-acetylserotonin methyltransferase gene, increases melatonin biosynthesis and improves water-use efficiency in transgenic apple
Authors: Zhou Kun , Li Yangtiansu , Hu Lingyu , Zhang Jingyun , Yue Hong , Yang Shulin , Liu Yuan , Gong Xiaoqing , Ma Fengwang
Published: November 2021

Improving apple water-use efficiency (WUE) is increasingly desirable in the face of global climate change. Melatonin is a pleiotropic molecule that functions in plant development and stress tolerance. In apple, exogenous application of melatonin has been largely investigated, but melatonin biosynthesis and its physiological roles remain elusive. In the plant biosynthetic pathway of melatonin, the last and key step is that N-acetylserotonin methyltransferase (ASMT) converts N-acetylserotonin into melatonin. Here, we identified an apple ASMT gene, MdASMT9, using homology-based cloning and in vitro enzyme assays. Overexpression of MdASMT9 significantly increased melatonin accumulation in transgenic apple lines. Moreover, an enhanced WUE was observed in the MdASMT9-overexpressing apple lines. Under well-watered conditions, this increase in WUE was attributed to an enhancement of photosynthetic rate and stomatal aperture via a reduction in abscisic acid biosynthesis. By contrast, under long-term moderate water deficit conditions, regulations in photoprotective mechanisms, stomatal behavior, osmotic adjustment and antioxidant activity enhanced the WUE in transgenic apple lines. Taken together, our findings shed light on the positive effect of MdASMT9 on improving WUE of apple by modulating melatonin biosynthesis.
The Contrast of Color: Why the Black Community Continues to Suffer Health Disparities
Authors: Gillispie-Bell V.
Published: November 2021

(Obstet Gynecol. 2021;137:220–224)

In the Current Commentary section of a 2021 edition of Obstetrics & Gynecology, Dr Veronica Gillispie-Bell, a Black, female obstetrician and gynecologist, asserts that health disparities among the Black community are due to implicit bias of health care providers and structural racism in the health care system.
Biomarkers and the Prediction of Adverse Outcomes in Preeclampsia: A Systematic Review and Meta-Analysis
Authors: Lim S. , Li W. , Kemper J. , Nguyen A. , Mol B.W. , Reddy M.
Published: November 2021

(Obstet Gynecol. 2021;137:72–81)

Progress has occurred recently to predict and diagnose preeclampsia in pregnant women. Angiogenic and antiangiogenic biomarkers such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were recently examined. In addition these factors have been implemented clinically as predictive measurements of preeclampsia. This study aims to review and analyze sFlt-1, PlGF, and the sFLt-1/PlGF ratio and their ability to predict time to delivery and adverse outcomes in patients with preeclampsia.
Accuracy of Postpartum Hemorrhage Coding in the Swedish Pregnancy Register
Authors: Ladfors L.V. , Muraca G.M. , Butwick A. , Edgren G. , Stephansson O.
Published: November 2021

(Acta Obstet Gynecol Scand. 2021;100:322–330)

Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality worldwide. Evaluating trends related to PPH depends on the accuracy of diagnostic codes, namely the International Classification of Diseases, 10th revision codes (ICD-10). The accuracy of these codes has not been widely reported and is relevant to research and quality improvement endeavors. The aim of this study was to assess the accuracy of ICD-10 codes for PPH in Sweden.
Association Between Extremely Preterm Cesarean Delivery and Maternal Depressive and Anxious Symptoms: A National Population-based Cohort Study
Authors: Blanc J. , Resseguier N. , Lorthe E. , Goffinet F. , Sentilhes L. , Auquier P. , Tosello B. , d’Ercole C.
Published: November 2021

(BJOG. 2021;128:594–602)

During the postpartum period, women are at high risk of developing depression and anxiety. Risk factors that may contribute to the development of these conditions are preterm birth and cesarean delivery (CD). In this context, extremely preterm deliveries, usually associated with emergency CD, is an important area of study. The aim of this study was to examine whether there was an association between CD at <26 weeks’ gestation and maternal depression and anxiety. The authors hypothesized that cesarean delivery before 26 weeks’ gestation compared to delivery between 26 and 34 weeks would be associated with severe depression or anxiety.
Creating a Model to Predict Time Intervals From Induction of Labor to Induction of Anesthesia and Delivery to Coordinate Workload
Authors: Warner L.L. , Hunter Guevara L.R. , Barrett B.J. , Arendt K.W. , Peterson A.A. , Sviggum H.P. , Duncan C.M. , Thompson A.C. , Hanson A.C. , Schulte P.J. , Martin D.P. , Sharpe E.E.
Published: November 2021

(Int J Obstet Anesth. 2021;45:115–123)

Recent evidence and guidelines supports offering induction of labor (IOL) to low-risk nulliparous women at 39 weeks’ gestation to reduce risk of cesarean delivery (CD) or adverse neonatal outcomes. Surgical patient outcomes can be impacted by timing of surgery and this may translate to risk of maternal and neonatal outcomes depending on timing of delivery and care team staffing levels and availability. This study aimed to create a model to predict timing from IOL to request for anesthesia and subsequent delivery in order to optimize anesthesia and obstetric team workload during the most well-staffed hours.
Topical Intranasal Lidocaine is not a Sphenopalatine Ganglion Block
Authors: Narouze S.
Published: November 2021

(Reg Anesth Pain Med. 2021:46. PMID: 33323391)

There is a complex network of nerves within the pterygopalatine fossa. The largest peripheral parasympathetic ganglion, located within the pterygopalatine fossa, is the sphenopalatine ganglion (SPG) which plays an important role in managing primary and secondary headache disorders. Recent interest exists in applying local anesthetics (LA) as an SPG block to manage headaches, especially postdural puncture headache management. This discourse reviews why intranasal LA application is not an acceptable and effective route for SPG block.
Long-term Psychological and Physical Outcomes of Women After Postdural Puncture Headache: A Retrospective, Cohort Study
Authors: Orbach-Zinger S. , Eidelman L.A. , Livne M.Y. , Matkovski O. , Mangoubi E. , Borovich A. , Wazwaz S.A. , Ioscovich A. , Zekry Z.H.B. , Ariche K. , Weiniger C.F.
Published: November 2021

(Eur J Anaesthesiol. 2021;38:130–137)

Accidental dural puncture (ADP) occurs in 0.4% to 6% of patients who receive neuraxial analgesia, and a significant number of ADP patients develop postdural puncture headache (PDPH). PDPH is associated with impaired maternal-neonatal bonding, longer hospital stay, limited ambulation and maternal morbidity. While previous studies have investigated long-term physical outcomes associated with PDPH, limited data exists on the associations between PDPH and long-term psychological outcomes, like postpartum depression (PPD) and postpartum posttraumatic stress disorder (PTSD). This study compared the frequency of these outcomes in women with PDPH with a control group of women without PDPH.
Postpartum Hemorrhage
Authors: Bienstock J.L. , Eke A.C. , Hueppchen N.A.
Published: November 2021

(N Engl J Med. 2021;384:1635–1645. doi: 10.1056/NEJMra1513247. PMID: 33913640)

Research and literature on postpartum hemorrhage (PPH) is critical because it is the highest cause of global maternal morbidity and mortality. In the United States PPH accounts for 11% of maternal deaths. Data shows from 1993 to 2014, PPH (blood loss >1000 mL following vaginal or cesarean delivery) severe enough to require a blood transfusion increased by 500% (8/10,000 deliveries in 1993; 40/10,000 deliveries in 2014). Despite the need for research on PPH, data is difficult to accurately analyze and management guidelines vary greatly across the world. This review aims to discuss causes, identification, prediction, prevention, and management of PPH.
Perioperative Management of Patients With Suspected or Confirmed COVID-19: Review and Recommendations for Perioperative Management From a Retrospective Cohort Study
Authors: Zheng H. , Hébert H.L. , Chatziperi A. , Meng W. , Smith B.H. , Yan J. , Zhou Z. , Zhang X. , Luo A. , Wang L. , Zhu W. , Hu J. , Colvin L.A.
Published: November 2021

(Br J Anaesth. 2020;125:895–911. doi: 10.1016/j.bja.2020.08.049. PMID: 33121750; PMCID: PMC7473146)

Since Coronavirus disease 2019 (COVID-19) became a worldwide pandemic, health care guidelines have pivoted to protect health care workers (HCWs) and patients. There is little known, however, regarding best perioperative management practices for patients with COVID-19 and how techniques impact patient outcomes and transmission rates. A rapid review was done early on, but a more thorough, high-quality, and evidence-based analysis was needed. This study aims to do 2 things: (1) take case reports and studies of patients with confirmed or suspected COVID-19 who underwent surgery and conduct a rapid review on the data (eg, morbidity, mortality, use of intensive care, hospital length of stay, pain support, and respiratory) as well as COVID-19 transmission rates to HCWs and (2) analyze various perioperative techniques and outcomes for cesarean sections (C-sections) during the COVID-19 pandemic in Tongji Hospital, Wuhan.
Outpatient Penicillin Allergy Testing in Pregnant Women Who Report an Allergy
Authors: Desravines N. , Waldron J. , Venkatesh K.K. , Kwan M. , Boggess K.A.
Published: November 2021

(Obstet Gynecol. 2021;137:56–61)

Up to 74% of women are given antibiotics for various indications during pregnancy. Patients who report an allergy to penicillin are given other broad-spectrum antibiotics, which can increase the risk for antibiotic resistance and mortality. The American College of Obstetricians and Gynecologists recommends the testing of pregnant women who report having a penicillin allergy. However, little is known about allergy testing in pregnancy. The aim of this study is to examine the feasibility, acceptance and safety of outpatient testing for women with penicillin allergy in pregnancy.
Cesarean Delivery After Nonmedically Indicated Induction of Labor: A Population-based Study Using Different Definitions of Expectant Management
Authors: Zenzmaier C. , Pfeifer B. , Leitner H. , König-Bachmann M.
Published: November 2021

(Acta Obstet Gynecol Scand. 2021;100:220–228)

Induction of labor (IOL) has been associated with an increased risk of cesarean delivery (CD), when compared with spontaneous onset of labor. But when compared with expectant management, randomized controlled trials (RCTs) and observational studies have found that nonmedically indicated or “elective” IOL is associated with fewer CD. Expectant management is typically defined as all births at a later gestation, usually >41 weeks, regardless of mode of delivery. However, this definition may bias clinicians to favor IOL earlier or at full term when considering the risk of expectant management in the short term, or until the next appointment when IOL may be reconsidered. The aim of this study was to evaluate the risk of CD after elective IOL using the 2 definitions of expectant management.
Incidence of Postpartum Hypertension Within 2 Years of a Pregnancy Complicated by Preeclampsia: A Systematic Review and Meta-Analysis
Authors: Giorgione  , Ridder A. , Kalafat E. , Khalil A. , Thilaganathan B.
Published: November 2021

(BJOG. 2021;128:495–503. doi: 10.1111/1471-0528.16545. [Epub October 21, 2020]. PMID: 32981216)

Women who experience hypertensive disorders during pregnancy (HDP) are at increased risk of long-term and potentially short-term adverse cardiovascular outcomes, especially women with recurrent HDP. Identifying the rate, magnitude, and timing of hypertension following HDP may help determine strategies to mitigate the effects of HDP and improve maternal outcomes. This study aimed to systematically review and analyze literature that reported hypertension within the first 2 years following HDP compared with uncomplicated pregnancy.
A Systematic Review of the Association Between Postpartum Depression and Neuraxial Labor Analgesia
Authors: Orbach-Zinger S. , Heesen M. , Grigoriadis S. , Heesen P. , Halpern S.
Published: November 2021

(Int J Obstet Anesth. 2021;45:142–149)

Postpartum depression (PPD) has a reported prevalence of 6.5% to 12.9% and is associated with negative effects on maternal and neonatal physical and psychological health. Many factors contribute to the risk of PPD, including marital satisfaction, history of depression, genetic factors, hormonal factors, and labor pain. Previous meta-analyses found no evidence that neuraxial analgesia is associated with low rates of PPD, but new information has been reported since these studies were published. This systematic review aimed to investigate whether the use of neuraxial labor analgesia has any effect on the incidence of PPD.
Relationship of sleep duration and annual changes in sleep duration with the incidence of gastrointestinal cancers: a prospective cohort study
Authors: Chen Yu-Heng , Lyu Zhang-Yan , Wang Gang , Feng Xiao-Shuang , Xie Shuang-Hua , Chen Shuo-Hua , Yin Jian , Ren Jian-Song , Mi Zi-Han , Wang Shen , Wu Shou-Ling , Li Ni , Dai Min
Published: November 2021

Background:

Prospective analyses have yet to identify a consistent relationship between sleep duration and the incidence of gastrointestinal (GI) cancers. The effect of changes in sleep duration on GI cancer incidence has scarcely been studied. Therefore, we aimed to examine the association between baseline sleep duration and annual changes in sleep duration and GI cancer risk in a large population-based cohort study.

Methods:

A total of 123,495 participants with baseline information and 83,511 participants with annual changes in sleep duration information were prospectively observed from 2006 to 2015 for cancer incidence. Cox proportional-hazards models were used to calculate hazard ratios (HRs) and their confidence intervals (CIs) for GI cancers according to sleep duration and annual changes in sleep duration.

Results:

In baseline sleep duration analyses, short sleep duration (≤5 h) was significantly associated with a lower risk of GI cancer in females (HR: 0.31, 95% CI: 0.10–0.90), and a linear relationship between baseline sleep duration and GI cancer was observed (P = 0.010), especially in males and in the >50-year-old group. In the annual changes in sleep duration analyses, with stable category (0 to −15 min/year) as the control group, decreased sleep duration (≤−15 min/year) was significantly associated with the development of GI cancer (HR: 1.29; 95% CI: 1.04–1.61), especially in the >50-year-old group (HR: 1.32; 95% CI: 1.01–1.71), and increased sleep duration (>0 min/year) was significantly associated with GI cancer in females (HR: 2.89; 95% CI: 1.14–7.30).

Conclusions:

Both sleep duration and annual changes in sleep duration were associated with the incidence of GI cancer.
Impact of Different Adipose Depots on Cardiovascular Disease
Authors: Diaz-Canestro Candela , Xu Aimin
Published: November 2021

Adipose tissue (AT)-derived factors contribute to the regulation of cardiovascular homeostasis, thereby playing an important role in cardiovascular health and disease. In obesity, AT expands and becomes dysfunctional, shifting its secretory profile toward a proinflammatory state associated with deleterious effects on the cardiovascular system. AT in distinct locations (ie, adipose depots) differs in crucial phenotypic variables, including inflammatory and secretory profile, cellular composition, lipolytic activity, and gene expression. Such heterogeneity among different adipose depots may explain contrasting cardiometabolic risks associated with different obesity phenotypes. In this respect, central obesity, defined as the accumulation of AT in the abdominal region, leads to higher risk of cardiometabolic alterations compared with the accumulation of AT in the gluteofemoral region (ie, peripheral obesity). The aim of this review was to provide an updated summary of clinical and experimental evidence supporting the differential roles of different adipose depots in cardiovascular disease and to discuss the molecular basis underlying the differences of adipose depots in the regulation of cardiovascular function.
Lipo Definition in Thighs: Volumizing and Defining the Vastus Muscles by Fat Transfer
Authors: Cipriani Raúl Martín Manzaneda , Adrianzen Gerardo A. , Zulueta Jaroslav , Sarango Braulio
Published: November 2021

Background:

Volumizing muscles in the thighs by fat grafting to complement body contouring surgeries has not been adequately investigated. Our objective was to describe a technique (VDVFAT) that defines and volumizes thigh muscles by lipotransfer in the vastus medialis and vastus lateralis muscles.

Methods:

VDVFAT was performed in 52 patients by the same surgeon at a private clinic in Lima, Peru, between 2018 and 2019. All patients were aged between 18 and 60 years, had no cutaneous flaccidity of the thighs, had a body mass index less than 28, and had Goldman surgical risk below Class II.

Results:

A total of 45 women aged 19–41 years (mean: 29.2 years) and seven men aged 24–41 years (mean: 33 years) were included. A mean of 173.36 cm3 of intramuscular fat was grafted to the vastus lateralis, resulting in increased muscle thickness of 21.09 mm, which is equivalent to 88.31% of the initial size of the muscle (P < 0.0001). An intramuscular fat mass of 123.53 cm3 was grafted into the vastus medialis, resulting in increased muscle thickness of 30 mm, which is equivalent to 87.02% of the initial size of the muscle (P < 0.0001).

Conclusions:

Volumizing and defining the vastus muscles by fat transfer is a safe and reproducible method for defining and volumizing muscles. However, further studies are necessary to determine the durability of fat grafts.
Predictive Factors of Keloid Formation in Congenital Foot Syndactyly
Authors: Oh Sang Ho , Woo Sang Hyun
Published: November 2021

Background:

Keloid formation after syndactyly division is a stressful situation for patients. In our experience, digital enlargement may be involved in keloid formation following syndactyly divisions. Therefore, we aimed to identify predictive factors and reference values for keloid formation.

Methods:

In this retrospective study, 11 keloid patients (seven children, four adults) and 11 nonkeloid patients after syndactyly division (control group) with the same sex, age, webspace division site, and operation were enrolled between 2008 and 2020. Using preoperative x-ray images, we compared bony width, length, area, and protruding index relative to the great toe between keloid and control groups. Additionally, reference values for keloid formation were obtained using receiver operating characteristic curves. Statistical analysis was performed using Spearman’s correlation test.

Results:

When compared with the same digit in the normal foot, distal phalanx (P3) bony base width, area, and protruding index on keloid foot were significantly different between keloid group and control group. The reference values for keloid formation after syndactyly release were 1.34 for the P3 area ratio and 1.61 for the P3 triangular area ratio (using the horizontal length of the P3 base and P3 vertical length). The reliability of reference values for the P3 area ratio and P3 triangular area ratio was excellent for all patients.

Conclusions:

If digital enlargement in distal phalanx is present when compared with adjacent toe in patients who had undergone primary foot syndactyly divisions, risk of keloid development should be communicated preoperatively, and preventive strategies for keloid development and close observations are required.
Sacral Pressure Ulcer in Leriche Syndrome: A Case Report
Authors: Ishikawa Shoichi , Takaoka Satomi , Arai Kiyohito , Ichioka Shigeru
Published: November 2021

We experienced a case of a sacral pressure ulcer complicated with Leriche syndrome, an aortoiliac artery occlusion that has not been previously reported. In this case, the abdominal aorta below the bifurcation of the renal arteries into the bilateral common iliac arteries was occluded, and wound healing was delayed. Therefore, endovascular treatment was used for managing this condition, and wound healing was accelerated. Then, reconstructive surgery with a local flap was performed, and wound healing was achieved. In the case of delayed healing of buttock pressure ulcers, it is important to evaluate the blood flow in the iliac artery as well as the infection and nutritional status of the wound. In addition, after endovascular treatment, blood flow in the local flap is a matter of concern. If the wound healing is good, and imaging confirms that there is no restenosis at the endovascular treatment site and the perforator of the flap, reconstructive surgery can be performed safely.
Femtosecond Laser and Mechanical Dissection for ICRS and MyoRing Implantation: A Meta-Analysis
Authors: Struckmeier Ann-Kristin , Hamon Loïc , Flockerzi Elias , Munteanu Cristian , Seitz Berthold , Daas Loay
Published: November 2021

Purpose:

The aims of this meta-analysis were to evaluate the results of intracorneal ring segments (ICRSs) and MyoRing in the management of corneal ectasia and to compare the clinical outcomes and complication rates between mechanical and femtosecond (FS) laser-assisted surgery.

Methods:

An online electronic search was performed for pre–post studies published until April 2020. Uncorrected distance visual acuity, corrected distance visual acuity, sphere, cylinder, spherical equivalent, steep, flat, and mean keratometry values were considered as outcomes. Weighted mean difference with 95% confidence interval was used as a pooled estimation of intervention efficacy.

Results:

Of 1484 potentially related studies, 115 studies were finally included in the meta-analysis. Findings of this meta-analysis demonstrated considerable improvement in visual, refractive, and keratometric outcomes in all ICRS models and MyoRing. Intrastromal tunnel creation with both methods yielded similar results. Complication rates were without exception higher when mechanical dissection was used.

Conclusions:

ICRS and MyoRing are appropriate treatment options for patients with corneal ectasia. Both techniques for tunnel creation are efficacious in achieving good visual, keratometric, and refractive results. Mechanical intrastromal tunnel creation is associated with much higher complication rates when compared with FS laser-assisted technique.
Postnatal Cytomegalovirus Infection of Preterm and Very-low-birth-weight Infants Through Maternal Breast Milk: Does It Matter?
Authors: Bimboese Patricia , Kadambari Seilesh , Tabrizi Sepehr N. , Garland Suzanne M. , Tigg Alison , Lau Rosalind , Morley Colin J. , Curtis Nigel
Published: November 2021

Background:

Postnatal infection with cytomegalovirus (CMV) in very-preterm and very-low-birth-weight infants, transmitted through breast milk (BM), is potentially associated with adverse outcomes. This study aimed to investigate the incidence and clinical significance of postnatal CMV infection in a tertiary neonatal intensive care unit.

Methods:

Infants of CMV-seropositive mothers born in a neonatal intensive care unit in Melbourne, Australia, were observed for 14 weeks from birth in a prospective cohort study. Maternal BM and infant urine were tested weekly for CMV by culture and polymerase chain reaction, respectively. Clinical and laboratory data were collected and analyzed in relation to the infants’ CMV infection status.

Results:

Data from 65 infants of 56 CMV-seropositive mothers were available for analysis. Of these mothers, 88% (49/56) shed CMV in their BM. Of the 58 infants exposed to CMV-positive BM, 27 (47%) became urine polymerase chain reaction CMV-positive. There was no significant difference in gestational age, birth weight, incidence of bronchopulmonary dysplasia, or necrotizing enterocolitis between the CMV-positive and CMV-negative groups. However, CMV-positive infants had a longer length of hospital stay and more episodes of prolonged neutropenia. Of the CMV-positive infants, 30% (8/27) remained asymptomatic, 48% (13/27) had symptoms categorized as mild and 22% (6/27) as severe.

Conclusions:

About half of preterm and very-low-birth-weight infants exposed to CMV-positive BM become infected, and a fifth develop significant clinical symptoms. Future studies should address the maternal and neonatal factors that determine the risk of mother-to-infant CMV transmission, as well as those leading to clinical deterioration and long-term sequelae.
Mixed Vaginitis Due to Bacterial Vaginosis and Candidiasis
Authors: Benyas Dana , Sobel Jack D.
Published: November 2021

Objective

The aim of the study was to review recent clinic cases with mixed vaginitis due to bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) with reference to demographics, clinical presentation, diagnosis, and treatment.

Materials and Methods

This is a retrospective chart review of patients defined with mixed vaginitis due to BV and VVC in academic vaginitis clinic over 3 years (2018–2021).

Results

Thirty-eight women, mean age 32.6 years, met mixed vaginitis definition criteria. Diagnosis was invariably suspected clinically and rapidly confirmed using standard point of care diagnostic tests. Most patients (>90%) had a history of long-standing recurrent vaginitis both BV and VVC. Condom use was infrequent at 30% and 100% of yeast isolates were Candida albicans. Dual antimicrobial therapy achieved short term therapeutic success in 66.7% with failure in part due to fluconazole resistant C. albicans strains.

Conclusions

Mixed vaginitis is not uncommon and serves as a significant therapeutic challenge requiring initial dual antimicrobial therapy and additional consideration for long-term antimicrobial therapy.
Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients
Authors: Fumagalli Jacopo , Panigada Mauro , Klompas Michael , Berra Lorenzo
Published: November 2021

Purpose of review

We conducted a systematic literature review to summarize the available evidence regarding the incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because of acute respiratory distress syndrome secondary to SARS-CoV-2 infection (C-ARDS).

Recent findings

Sixteen studies (6484 patients) were identified. Bacterial coinfection was uncommon at baseline (<15%) but a high proportion of patients developed positive bacterial cultures thereafter leading to a VAP diagnosis (range 21–64%, weighted average 50%). Diagnostic criteria varied between studies but most signs of VAP have substantial overlap with the signs of C-ARDS making it difficult to differentiate between bacterial colonization versus superinfection. Most episodes of VAP were associated with Gram-negative bacteria. Occasional cases were also attributed to herpes virus reactivations and pulmonary aspergillosis. Potential factors driving high VAP incidence rates include immunoparalysis, prolonged ventilation, exposure to immunosuppressants, understaffing, lapses in prevention processes, and overdiagnosis.

Covid-19 patients who require mechanical ventilation for ARDS have a high risk (>50%) of developing VAP, most commonly because of Gram-negative bacteria. Further work is needed to elucidate the disease-specific risk factors for VAP, strategies for prevention, and how best to differentiate between bacterial colonization versus superinfection.
Orthopedic concerns of a child with short stature
Authors: Liau Zi Qiang Glen , Wang Yuhang , Lin Hong-Yi , Cheong Chin Kai , Gupta Shobhit , Hui James Hoi Po
Published: November 2021

Purpose of review

Pediatric short stature poses severe concerns to the patient, parents, and physicians. Management for pediatric short stature is still widely debated due to heterogenous etiological factors and treatment options. This review will address the approach to pediatric short stature, commonly within the subset of skeletal dysplasia resulting in disproportionate short stature. The following will be discussed: the etiology, clinical, and radiological evaluations, and management for pediatric short stature.

Recent findings

Early recognition of short stature and appropriate referrals is shown to benefit the patient and reduce parental concern. A multidisciplinary team, comprising an orthopedic surgeon, is fundamental to provide holistic care and ensure overall good quality of life. Advancements in clinical diagnostic tools and diversified treatment modalities today provides optimism in managing pediatric short stature.

Skeletal dysplasia can be treated with good prognosis if diagnosed and managed early. Thorough clinical, radiological, laboratory, and even genetic investigations are important to differentiate and manage various types of skeletal dysplasia. Our review will provide a comprehensive and up-to-date approach to skeletal dysplasia for pediatric orthopedic surgeons, and indications for physicians to refer patients with suspected short stature to pediatric orthopedic surgeons.