bluuebunny/crossref_metadata_2025 huggingface dataset:
The potential for mitigation of methane emissions in ruminants through the application of metagenomics, metabolomics, and other -OMICS technologies
Authors: Asselstine Victoria , Lam Stephanie , Miglior Filippo , Brito Luiz F , Sweett Hannah , Guan Leluo , Waters Sinead M , Plastow Graham , Cánovas Angela
Published: September 2021

Ruminant supply chains contribute 5.7 gigatons of CO2-eq per annum, which represents approximately 80% of the livestock sector emissions. One of the largest sources of emission in the ruminant sector is methane (CH4), accounting for approximately 40% of the sectors total emissions. With climate change being a growing concern, emphasis is being put on reducing greenhouse gas emissions, including those from ruminant production. Various genetic and environmental factors influence cattle CH4 production, such as breed, genetic makeup, diet, management practices, and physiological status of the host. The influence of genetic variability on CH4 yield in ruminants indicates that genomic selection for reduced CH4 emissions is possible. Although the microbiology of CH4 production has been studied, further research is needed to identify key differences in the host and microbiome genomes and how they interact with one another. The advancement of “-omics” technologies, such as metabolomics and metagenomics, may provide valuable information in this regard. Improved understanding of genetic mechanisms associated with CH4 production and the interaction between the microbiome profile and host genetics will increase the rate of genetic progress for reduced CH4 emissions. Through a systems biology approach, various “-omics” technologies can be combined to unravel genomic regions and genetic markers associated with CH4 production, which can then be used in selective breeding programs. This comprehensive review discusses current challenges in applying genomic selection for reduced CH4 emissions, and the potential for “-omics” technologies, especially metabolomics and metagenomics, to minimize such challenges. The integration and evaluation of different levels of biological information using a systems biology approach is also discussed, which can assist in understanding the underlying genetic mechanisms and biology of CH4 production traits in ruminants and aid in reducing agriculture’s overall environmental footprint.
Structure of the Acinetobacter baumannii PmrA receiver domain and insights into clinical mutants affecting DNA binding and promoting colistin resistance
Authors: Palethorpe Samantha , Milton Morgan E , Pesci Everett C , Cavanagh John
Published: September 2021

Acinetobacter baumannii is an insidious emerging nosocomial pathogen that has developed resistance to all available antimicrobials, including the last resort antibiotic, colistin. Colistin resistance often occurs due to mutations in the PmrAB two-component regulatory system. To better understand the regulatory mechanisms contributing to colistin resistance, we have biochemically characterized the A. baumannii PmrA response regulator. Initial DNA-binding analysis shows that A. baumannii PmrA bound to the Klebsiella pneumoniae PmrA box motif. This prompted analysis of the putative A. baumannii PmrAB regulon that indicated that the A. baumannii PmrA consensus box is 5′-HTTAAD N5 HTTAAD. Additionally, we provide the first structural information for the A. baumannii PmrA N-terminal domain through X-ray crystallography and we present a full-length model using molecular modelling. From these studies, we were able to infer the effects of two critical PmrA mutations, PmrA::I13M and PmrA::P102R, both of which confer increased colistin resistance. Based on these data, we suggest structural and dynamic reasons for how these mutations can affect PmrA function and hence encourage resistive traits. Understanding these mechanisms will aid in the development of new targeted antimicrobial therapies.
Late Eocene Two-Pyroxene Trachydacites from the Southern Qiangtang Terrane, Central Tibetan Plateau: High-Temperature Melting of Overthickened and Dehydrated Lower Crust
Authors: Zeng Yun-Chuan , Xu Ji-Feng , Li Ming-Jian , Chen Jian-Lin , Wang Bao-Di , Huang Feng , Ren Shu-Hui
Published: September 2021

Orthopyroxene-bearing granitic rock (e.g. charnockite) is relatively rare but provides an excellent opportunity to probe the thermal and tectonic evolution of deep orogenic crust because of its distinct mineral assemblage. Here we present petrological, mineralogical, elemental, and Sr–Nd–Hf–O isotopic data for late Eocene (ca. 36 Ma; zircon U–Pb ages) volcanic rocks exposed in the Ejiu region in the southern Qiangtang Terrane to investigate how the central Tibetan crust evolved to its modern thickness and thermal state. The Ejiu volcanic rocks (EVRs) are trachydacites with anhydrous mineral assemblages (i.e. two pyroxenes, sanidine, plagioclase, and ilmenite, without amphibole and biotite) and geochemical characteristics (e.g. high P2O5 and TiO2) that resemble those of charnockite-type magmatic rocks. Mineral and whole-rock thermometry and hygrometry suggests that the parent magma crystallized under hot (~1000°C) and dry (H2O < 2 wt.%) condition. Besides, the EVRs display adakitic affinities according to their high SiO2 and Al2O3 contents, high Sr/Y, La/Yb, and Gd/Yb ratios, and low Y and Yb contents, without marked negative Eu anomalies. The calculated melts in equilibrium with pyroxenes also display adakitic compositions (e.g. high Sr/Y and La/Yb ratios), indicating that the adakitic compositions of the EVRs did not result from late-stage magmatic evolution. In addition, the melts of the EVRs were saturated in TiO2, as inferred from the high TiO2 contents of these rocks and the presence of ilmenite. An integrated analysis of the geochemical, petrological, and mineralogical data suggests that the EVRs were neither evolutional products nor partial melts of hydrous mafic materials at normal crustal pressures, but were formed by fusion of an eclogitized mafic protolith with residue containing garnet and rutile but lacking amphibole and plagioclase. The whole-rock Sr–Nd and zircon Hf isotope compositions of the EVRs [(87Sr/86Sr)i = 0.7053 to 0.7066; εNd(t) = −1.40 to −0.99; zircon εHf(t) = +1.08 to +5.31] indicate that the parental protolith was relatively juvenile in nature, but also contained some supracrustal materials given the high zircon δ18O values [zircon δ18O = +8.21‰ to +11.00‰]. The above arguments lead us to propose that of partial melting of a previously dehydrated—but chemically undepleted—mafic lower continental crust at high pressure (>1.5 GPa) and high temperature (>1000°C) generated the EVRs. Based on a synthesis of independent geological and geophysical data, we further suggest that the southern Qiangtang Terrane crust of the central Tibetan Plateau was thick, dry, and elevated during the Late Cretaceous to early Eocene time, and that it became abnormally hot owing to the ascending asthenosphere after lithospheric foundering during the middle Eocene.
Existence of core excited 8Be* =α+α* cluster structure inα+αscattering
Authors: Hirabayashi Yoshiharu , Ohkubo Shigeo
Published: September 2021

We show the existence of the $\alpha+\alpha^*$ cluster structure at the highly excited energy around $E_x=20$ MeV in $^{8}$Be for the first time in the coupled-channel calculations. An extended double-folding model derived using a realistic precise cluster wave function with a well-developed $N+3N$ cluster structure for the first excited state of $^4$He was employed. The calculation reproduces the experimental phase shifts in $\alpha + \alpha$ scattering up to $E_{\rm c.m.}=21$ MeV well. The result shows that the well-developed core-excited $\alpha+\alpha^*$ structure appears as resonances for $L=0$ and $2$ near the $\alpha+\alpha^*$ threshold which correspond to the experimental states at $E_x=20.20$ MeV and $E_x=22.24$ MeV in $^8$Be.
Excluding beneficiaries: a decision not to be taken lightly
Authors: Goldstein Claire , McKenzie André
Published: September 2021

The power to exclude beneficiaries is a little different from other powers given to trustees which must all be exercised in the best interests of the beneficiaries. In the case of exclusion, however, it will not in general, for obvious reasons, be in the interests of the person being excluded (except where there is a fiscal advantage to that person in the exclusion). Instead it may be exercised in the interests of the remaining beneficiaries, will be distinctly averse to the interests of the beneficiary being excluded and once the beneficiary has been excluded he can take no further interest under the settlement (although, of course, the precise scope of the exclusion will depend upon the terms of the power). The trustee is therefore under an obligation to properly consider the position of the person being excluded and as with all powers conveyed on a trustee, the power must be exercised carefully and not capriciously or in bad faith.
Production of Agrocinopine A by Ipomoea batatas Agrocinopine Synthase in Transgenic Tobacco and Its Effect on the Rhizosphere Microbial Community
Authors: Tanaka Aiko , Ryder Maarten H. , Suzuki Takamasa , Uesaka Kazuma , Yamaguchi Nobuo , Amimoto Tomoko , Otani Motoyasu , Nakayachi Osamu , Arakawa Kenji , Tanaka Nobukazu , Takemoto Daigo
Published: September 2021

Agrobacterium tumefaciens is a bacterial pathogen that causes crown gall disease on a wide range of eudicot plants by genetic transformation. Besides T-DNA integrated by natural transformation of plant vegetative tissues by pathogenic Agrobacterium spp., previous reports have indicated that T-DNA sequences originating from an ancestral Agrobacterium sp. are present in the genomes of all cultivated sweet potato (Ipomoea batatas) varieties analyzed. Expression of an Agrobacterium-derived agrocinopine synthase (ACS) gene was detected in leaf and root tissues of sweet potato, suggesting that the plant can produce agrocinopine, a sugar-phosphodiester opine considered to be utilized by some strains of Agrobacterium spp. in crown gall. To validate the product synthesized by Ipomoea batatas ACS (IbACS), we introduced IbACS into tobacco under a constitutive promoter. High-voltage paper electrophoresis followed by alkaline silver nitrate staining detected the production of an agrocinopine-like substance in IbACS1-expressing tobacco, and further mass spectrometry and nuclear magnetic resonance analyses of the product confirmed that IbACS can produce agrocinopine A from natural plant substrates. The partially purified compound was biologically active in an agrocinopine A bioassay. A 16S ribosomal RNA amplicon sequencing and meta-transcriptome analysis revealed that the rhizosphere microbial community of tobacco was affected by the expression of IbACS. A new species of Leifsonia (actinobacteria) was isolated as an enriched bacterium in the rhizosphere of IbACS1-expressing tobacco. This Leifsonia sp. can catabolize agrocinopine A produced in tobacco, indicating that the production of agrocinopine A attracts rhizosphere bacteria that can utilize this sugar-phosphodiester. These results suggest a potential role of IbACS conserved among sweet potato cultivars in manipulating their microbial community.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Validation of the Short-Form Reproductive Coercion Scale With Appalachian Women
Authors: Swan Laura E. T. , Hales Travis , Ely Gretchen E. , Auerbach Samantha L. , Agbemenu Kafuli
Published: September 2021

(Abstracted from Contraception 2021;104:265–270)

Reproductive coercion is a collection of behaviors intended to maintain power and control in a relationship, typically perpetuated by an intimate partner by interfering with autonomous reproductive decision making. Pregnancy coercion is a form of reproductive coercion wherein threats and pressuring behaviors are exhibited to promote pregnancy.
Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation: A Systematic Review and Meta-analysis
Authors: Raghuraman Nandini , Temming Lorene A. , Doering Michelle M. , Stoll Carolyn R. , Palanisamy Arvind , Stout Molly J. , Colditz Graham A. , Cahill Alison G. , Tuuli Methodius G.
Published: September 2021

(Abstracted from JAMA Pediatr 2021;175:368–376)

In the United States, 2 of 3 pregnant women receive oxygen supplementation at some point during labor. It is provided to increase placental oxygen transfer and prevent neonatal acidemia when fetal heart rate (FHR) tracings suggest fetal hypoxia.
Ursodeoxycholic Acid in Intrahepatic Cholestasis of Pregnancy: A Systematic Review and Individual Participant Data Meta-analysis
Authors: Ovadia Caroline , Sajous Jenna , Seed Paul T. , Patel Kajol , Williamson Nicholas J. , Attilakos George , Azzaroli Francesco , Bacq Yannick , Batsry Linoy , Broom Kelsey , Brun-Furrer Romana , Bull Laura , Chambers Jenny , Cui Yue , Ding Min , Dixon Peter H. , Estiú Maria C. , Gardiner Fergus W. , Geenes Victoria , Grymowicz Monika , Günaydin Berrin , Hague William M. , Haslinger Christian , Hu Yayi , Indraccolo Ugo , Juusela Alexander , Kane Stefan C. , Kebapcilar Ayse , Kebapcilar Levent , Kohari Katherine , Kondrackienė Jūratė , Koster Maria P. H. , Lee Richard H. , Liu Xiaohua , Locatelli Anna , Macias Rocio I. R. , Madazli Riza , Majewska Agata , Maksym Kasia , Marathe Jessica A. , Morton Adam , Oudijk Martijn A. , Öztekin Deniz , Peek Michael J. , Shennan Andrew H. , Tribe Rachel M. , Tripodi Valeria , Özterlemez Naciye Türk , Vasavan Tharni , Wong L. F. Audris , Yinon Yoav , Zhang Qianwen , Zloto Keren , Marschall Hanns-Ulrich , Thornton Jim , Chappell Lucy C. , Williamson Catherine
Published: September 2021

(Abstracted from Lancet Gastroenterol Hepatol 2021;6:547–558)

Ursodeoxycholic acid (UA) is a common treatment for intrahepatic cholestasis of pregnancy (ICP), and its use is supported by the Society for Maternal-Fetal Medicine. However, evidence of the benefit of UA to fetal and neonatal outcomes in this patient population is unclear.
Tranexamic Acid for the Prevention of Blood Loss After Cesarean Delivery
Authors: Sentilhes Loic , Sénat Marie V. , Le Lous Maela , Winer Norbert , Rozenberg Patrick , Kayem Gilles , Verspyck Eric , Fuchs Florent , Azria Elie , Gallot Denis , Korb Diane , Desbrière Raoul , Le Ray Camille , Chauleur Celine , de Marcillac Fanny , Perrotin Franck , Parant Olivier , Salomon Laurent J. , Gauchotte Emilie , Bretelle Florence , Sananès Nicolas , Bohec Caroline , Mottet Nicolas , Legendre Guillaume , Letouzey Vincent , Haddad Bassam , Vardon Delphine , Madar Hugo , Mattuizzi Aurelien , Daniel Valerie , Regueme Sophie , Roussillon Caroline , Benard Antoine , Georget Aurore , Darsonval Astrid , Deneux-Tharaux Catherine ,   for the Groupe de Recherche en Obstétrique et Gynécologie
Published: September 2021

(Abstracted from N Engl J Med 2021;384:1623–1634)

Uterotonic agents are recommended to prevent postpartum hemorrhage (PPH). Tranexamic acid (TXA) has emerged as another medical approach to prevent blood loss after delivery.
Ovarian Cancer Population Screening and Mortality After Long-Term Follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): A Randomised Controlled Trial
Authors: Menon Usha , Gentry-Maharaj Aleksandra , Burnell Matthew , Singh Naveena , Ryan Andy , Karpinskyj Chloe , Carlino Giulia , Taylor Julie , Massingham Susan K. , Raikou Maria , Kalsi Jatinderpal K. , Woolas Robert , Manchanda Ranjit , Arora Rupali , Casey Laura , Dawnay Anne , Dobbs Stephen , Leeson Simon , Mould Tim , Seif Mourad W. , Sharma Aarti , Williamson Karin , Liu Yiling , Fallowfield Lesley , McGuire Alistair J. , Campbell Stuart , Skates Steven J. , Jacobs Ian J. , Parmar Mahesh
Published: September 2021

(Abstracted from Lancet 2021;397:2182–2193)

Ovarian cancer is most commonly diagnosed at an advanced stage (3 or 4) and remains the deadliest gynecologic malignancy. When diagnosed at stage 1, a survival rate of greater than 90% has been demonstrated, compared with a 5-year survival rate of 27% and 13% for stage 3 and stage 4 disease, respectively.
Protocol for a pilot feasibility, safety and efficacy study of artificially introducing an air-pleura interface for detection of pleural nodules by computed tomography: the AIR study
Authors: Sidhu Calvin , Fysh Edward T. , Roy Bapti , Kuok Yi Jin , Muruganandan Sanjeevan , Lan Norris S.H. , Mevavala Bhaumik V. , Read Catherine , Tan Ai Ling , Thomas Rajesh , Lee Y. C. Gary
Published: September 2021

Background:

Pleural effusions are common and can arise from many causes including primary or metastatic malignancies. Computed tomography (CT) is part of the routine workup for pleural effusions especially if pleural fluid analysis fails to show an underlying cause. CT can help detect pleural abnormalities such as thickening or nodules and allow imaging guided percutaneous biopsies. Otherwise surgical procedures are often required to obtain histological specimens but have inherent risks. The presence of air in the pleural cavity (eg with trapped lung) has been shown in a case series to enhance CT detection of pleural abnormalities.

The AIR study is a prospective, pilot, proof-of-concept study to assess the feasibility and safety of instilling air intrapleurally to create an air-pleura interface during CT imaging, and the efficacy of this artificial pneumothorax in aiding CT detection of pleural abnormalities.

Methods:

This study will recruit 40 patients with suspected or proven malignant pleural effusions that have a chest tube (including indwelling pleural catheter) in-situ and no pre-existing radiological evidence of advanced pleural abnormalities. A standard CT scan with pleural phase contrast enhancement will be performed. Air will be instilled via the chest tube to introduce an artificial air-pleura interface and a second (non-contrast) CT chest scan will be performed in the prone position. The air will be immediately aspirated after the procedure. The aims of this study are to determine 1) the feasibility and safety of introducing an air-pleura interface using a pre-defined protocol and 2) its effectiveness in detecting additional pleural abnormalities.

Discussion:

The AIR study is the first study to evaluate the feasibility, safety and efficacy of creating an artificial air-pleura interface to enhance detection of pleural abnormalities by CT. Improvements in detection may inform imaging-guided tissue sampling, avoid more invasive tissue acquisition procedures, and add to the assessment of pleural disease burden.
Effects of angiotensin-receptor neprilysin inhibitor on exercise capacity, quality of life, and cardiac function in heart failure with preserved ejection fraction
Authors: Fukuta Hidekatsu , Hagiwara Hiromi , Kamiya Takeshi
Published: September 2021

Background:

Nearly half of patients with heart failure have preserved ejection fraction (EF) and the mortality and morbidity of patients with heart failure with preserved EF (HFpEF) are high. Patients with HFpEF are often elderly and their primary chronic symptom is severe exercise intolerance that results in a reduced quality of life (QOL). Thus, improvement of exercise capacity presents another important clinical outcome in HFpEF patients. Left ventricular diastolic dysfunction is associated with the pathophysiology of HFpEF and it contributes importantly to exercise intolerance in HFpEF patients. The angiotensin-receptor neprilysin inhibitor (ARNI) sacubitril/valsartan was shown to be associated with better survival in HFpEF patients. However, there is insufficient evidence as to the effects of ARNI on exercise capacity and cardiac function in these patients. Accordingly, the purpose of this meta-analysis is to evaluate the effects of ARNI on exercise capacity and QOL as well as cardiac function in HFpEF patients.

Methods:

This meta-analysis will include randomized controlled trials examining the effects of ARNI on exercise capacity, health-related QOL, or cardiac function in HFpEF patients. Information of studies will be collected from PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov. The primary outcome will be exercise capacity (6-minute walking distance). The secondary outcomes will be health-related QOL and left ventricular structure and function.

Discussion:

This meta-analysis will evaluate the effects of ARNI on exercise capacity, QOL, and cardiac function in HFpEF patients, providing evidence regarding the clinical use of ARNI in these patients.

Systematic review registration:

INPLASY202170076
Endoscopic sub-mucosal resection of gastric antrum stromal tumour
Authors: Roy Susmit Prosun , Benjamin Aditya Thomas , Talbot Michael
Published: September 2021

Rationale:

Gastrointestinal stromal tumour (GIST) is the most common mesenchymal tumour of the gastrointestinal tract with 10% to 30% being malignant. Resection of GIST lesions require wide local excision to achieve negative margins.

Patient concerns:

A 68-year-old woman presented with acute on chronic dyspeptic symptoms, including abdominal pain, postprandial nausea, bloating, and early satiety. She did not have any history of previous malignancy or gastro-intestinal haemorrhage. The patient had no other significant past medical history.

Diagnoses:

Endoscopy revealed a 2 cm nodular lesion in the gastric antrum which was confirmed to be GIST on endoscopic ultrasound and computed tomography.

Intervention:

The 2 cm GIST was successfully resected (RO) endoscopically.

Outcomes:

The patient was discharged from the hospital the next day, and follow-up suggested no disease recurrence.

Lessons:

To the best of our knowledge, this is the first reported case of endoscopic submucosal dissection for a 2 cm GIST. The current gold standard for the majority of GISTs is laparoscopic resection, with open resection sometimes needed for larger malignant tumours with multi-visceral involvement. Endoscopic or combined endoscopic/laparoscopic techniques are evolving and may become the preferred choice for smaller lesions and for lesions in areas that are more difficult to approach surgically, such as around the esophagogastric junction and the pre-pyloric antrum.
Factors of Hospitals Associated With an Independent Hospice Care Unit
Authors: Park Young-Taek , Chang Hyejung , Shin Hyunchul
Published: September 2021

Few studies have examined why some hospitals operate independent hospice units (IHUs) and others do not. This study aims to investigate the organizational factors of hospitals having IHU. The units of analysis were individual hospitals. The study had a cross-sectional design and used health insurance claims data of 349 hospitals in Korea from January 1 to December 31, 2019. The dependent variable was whether a hospital operated an IHU. The independent variables were the percentage of patients with cancer, overall severity of patients, percentage of patients 60 years and older, health care cost per patient, percentage of inpatients, and nurse staffing level. Independent hospice units were present at 21.2% of the hospitals (74/349). The odds of having an IHU were significantly associated with the following factors: the percentage of patients with cancer (odds ratio [OR], 1.228; 95% confidence interval [CI], 1.071-1.408; P = .003), disease severity (OR, 5.129; 95% CI, 2.477-10.622; P < .001), percentage of patients 60 years and older (OR, 1.053; 95% CI, 1.015-1.092; P = .006), health care cost per patient (OR, 1.018; 95% CI, 1.009-1.027; P < .001), and nurse staffing level (OR, 0.439; 95% CI, 0.292-0.661; P < .001). The organizational factors of hospitals operating IHUs were similar to those of hospice facilities.
Management of Complicated Monochorionic Twin Gestations: An Evidence-Based Protocol
Authors: Narang Kavita , Novoa Victoria A. N. , Alrahmani Layan , Parikh Pavan , Codsi Elisabeth , Rose Carl H. , Davies Norman P. , Trinidad Mari Charisse , Favre Romain , Szymanski Linda M. , Ruano Rodrigo
Published: September 2021

Importance

Monochorionic (MC) twins are hemodynamically connected by vascular anastomoses within the single shared placenta. The transfer of fluid or blood from one fetus to the other may result in development of pathologic complications, such as twin-twin transfusion syndrome, twin anemia polycythemia sequence, selective intrauterine growth restriction, and twin reversed arterial perfusion sequence. Monoamniotic gestations, which comprise a small fraction of MC pregnancies, can also present with unique challenges, particularly antepartum umbilical cord entanglement. All these complications carry a high risk of fetal morbidity and mortality if not recognized and managed in a timely fashion.

Objective

The purpose of this article is to review evidence-based management of complicated MC twin gestations and propose a standardized approach to surveillance.

Evidence Acquisition

Monochorionic gestations account for the majority of complications that occur in twin pregnancies; however, there is unclear evidence on the appropriate surveillance for and management of specific complications associated with these pregnancies.

Results

This article summarizes management for each specific type of MC complication in a structured and clear manner.

Conclusions

Early pregnancy ultrasound, ideally between 10 and 13 weeks' gestation, is critical for the diagnosis and characterization of twin pregnancies. To improve outcomes for MC twins, appropriate fetal surveillance should be initiated at 16 weeks' gestation and continued until delivery.

Relevance

Improve perinatal outcomes in MC twin pregnancies.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to describe the sonographic findings used to establish the diagnosis of MC twin pregnancies; identify complications unique to MC twins pregnancies, including twin-twin transfusion syndrome, twin reversed arterial perfusion sequence, twin anemia polycythemia syndrome, co-twin demise, cord entanglement, and conjoined twins; and explain the management of complications associated with MC twin pregnancies.
Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management
Authors: Cardenas Raquel T. , Doiron Tucker E. , Ramseyer Abigail M. , Pates Jason A. , Po William D. , Magann Everett F.
Published: September 2021

Importance

Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome.

Objective

This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy.

Evidence Acquisition

A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review.

Results

The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported.

Conclusions

When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication.

Relevance

Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to identify the risk factors of spontaneous renal rupture in pregnancy; outline the presenting signs and symptoms of renal system rupture during pregnancy; explain the preferred diagnostic tools and imaging modalities for diagnosing renal system rupture in pregnancy, including the risks and benefits to the fetus; and describe the management and potential complications of pregnant patients presenting with renal system rupture.
Olaparib Tablets as Maintenance Therapy in Patients With Platinum-Sensitive Relapsed Ovarian Cancer and a BRCA1/2 Mutation (SOLO2/ENGOT-Ov21): A Final Analysis of a Double-Blind, Randomised, Placebo-Controlled, Phase 3 Trial
Authors: Poveda Andrés , Floquet Anne , Ledermann Jonathan A. , Asher Rebecca , Penson Richard T. , Oza Amit M. , Korach Jacob , Huzarski Tomasz , Pignata Sandro , Friedlander Michael , Baldoni Alessandra , Park-Simon Tjoung-Won , Tamura Kenji , Sonke Gabe S. , Lisyanskaya Alla , Kim Jae-Hoon , Filho Elias Abdo , Milenkova Tsveta , Lowe Elizabeth S. , Rowe Phil , Vergote Ignace , Pujade-Lauraine Eric ,   The SOLO2/ENGOT-Ov21 Investigators
Published: September 2021

(Abstracted from Lancet Oncol 2021;22:620–631)

The poly (ADP-ribose) polymerase (PARP) inhibitor olaparib is approved as maintenance therapy in newly diagnosed ovarian cancer or in patients with platinum-sensitive, relapsed ovarian cancer regardless of BRCA1/2 mutation status. The primary analysis of the SOLO2/ENGOT-Ov21 phase 3 trial found a significant improvement in median progression-free survival associated with olaparib treatment compared with placebo in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation.
Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial
Authors: Burkett Linda S. , Siddique Moiuri , Zeymo Alexander , Brunn Elizabeth A. , Gutman Robert E. , Park Amy J. , Iglesia Cheryl B.
Published: September 2021

(Abstracted from Obstet Gynecol 2021;137:968–978)

Vulvar lichen sclerosus (LS) is a dermatologic condition characterized by labial atrophy, hypopigmentation, and synechiae leading to pruritis and vulvar pain. Lichen sclerosus also is associated with a 3% to 9% incidence of vulvar squamous cell carcinoma that may be mitigated by adequate treatment.
Video Virtual Clinical Encounters Versus Office Visits for Postoperative Care After Pelvic Organ Prolapse Surgery: A Randomized Clinical Trial
Authors: Lee Daniel D. , Arya Lily A. , Andy Uduak U. , Harvie Heidi S.
Published: September 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:432–438)

Nowadays, patients expect to have telehealth options when accessing care. Besides the expanded access to care, benefits of telehealth include increased efficiency and improved patient engagement and adherence to care plans.
Long-Term Patency and Fluid Dynamics of Recipient Artery after End-to-Side Anastomosis for Free Tissue Transfer
Authors: Treiser Matthew D. , Miles Megan R. , Albino Frank P. , Giladi Aviram M. , Katz Ryan D. , Higgins James P.
Published: September 2021

Background:

End-to-end microvascular anastomoses sacrifice downstream inline perfusion of the recipient vessels. End-to-side anastomoses, in theory, maintain distal inline flow of the recipient vessel. The proposed benefit of the end-to-side technique depends on patency of the distal vessels and subsequent flow parameters, but maintenance of distal perfusion has not been conclusively demonstrated.

Methods:

Fifteen patients who underwent a successful extremity free flap procedure via end-to-side anastomoses to a noncritical vessel between 2003 and 2017 were enrolled. Recipient artery patency distal to the anastomosis was assessed using pulse volume recordings and duplex ultrasound imaging. Resistance indices, flow velocities, vessel diameters, volumetric flow, and turbulent flow dimensionless number (Reynolds number) were measured. Comparisons were made to the ipsilateral collateral vessel as well as to the vessels on the nonoperative contralateral limb using paired t tests.

Results:

Downstream flow was identified in 14 of 15 patients (93 percent patency). There was no statistical difference in resistive indices comparing the anastomotic vessel (0.859 ± 0.300) and the collateral vessel (0.853 ± 0.179) of the ipsilateral extremity. Ultrasound flows were similar; the anastomotic vessel demonstrated downstream volumetric flows of 139 ± 92.0 cm3/min versus 137 ± 41.6 cm3/min within the same vessel of the nonoperative contralateral limb. The anastomotic vessel had Reynolds numbers well below the turbulent threshold (448 ± 202 and 493 ± 127 for the anastomotic and nonoperative contralateral limb, respectively).

Conclusion:

End-to-side anastomosis to noncritical vessels resulted in a 93 percent long-term recipient vessel patency rate, with no statistically significant changes in volumetric flows, resistive indices, or fluid dynamics in the vessels that remained patent.
Evaluation of Social Media Utilization by Academic Plastic Surgery Programs during the COVID-19 Pandemic
Authors: Shiah Eric , Laikhter Elizabeth , Manstein Samuel M. , Comer Carly D. , Shen Abra H. , Lin Samuel J.
Published: September 2021

Background:

In response to the cancellation of away rotations and the shift to virtual interviews due to the coronavirus disease of 2019 (COVID-19) pandemic, residency programs have pursued other methods of sharing program details, most notably with the use of social media. This study aimed to evaluate the extent of social media utilization in the setting of the COVID-19 pandemic by plastic surgery residency programs.

Methods:

Instagram, Twitter, and Facebook accounts of plastic surgery programs, program directors, and chiefs were identified. Number of followers, total posts, and posts since March 1, 2020, were extracted. Account content was categorized as informational, social, operative, research, self-promotional, guest lecture, education, or other. Spearman’s coefficient was used to determine correlations among account data. Differences among regions and program pathways were evaluated using the Kruskal-Wallis test.

Results:

Since March 1, 2020, 17 Instagram, five Twitter, and three Facebook accounts have been created. Instagram was most widely used and followed (1720 posts, 1235.7 ± 735.9 followers) compared with Twitter (722 tweets, 325.6 ± 451.0 followers) and Facebook (430 posts, 338.3 ± 363.3 followers). Although the majority of content was informational (45.1 percent), Instagram contained more social content (21 percent), Twitter contained more research (21 percent), and Facebook contained more self-promotional content (25 percent). Integrated-only programs on average posted more on Instagram (21.5 ± 15.1 posts) than did independent-only programs (9.4 ± 8.5 posts), and post volume moderately correlated with number of followers. There were no statistically significant differences among regional means.

Conclusion:

Plastic surgery residency programs have incorporated social media into their recruitment strategies and will likely continue to increase and diversify their posts to effectively engage with future applicants.
Neurotoxicity with high-dose disulfiram and vorinostat used for HIV latency reversal
Authors: McMahon James H. , Evans Vanessa A. , Lau Jillian S.Y. , Symons Jori , Zerbato Jennifer M. , Chang Judy , Solomon Ajantha , Tennakoon Surekha , Dantanarayana Ashanti , Hagenauer Michelle , Lee Sulggi , Palmer Sarah , Fisher Katie , Bumpus Namandje , Heck Carley J.S. , Burger David , Wu Guoxin , Zuck Paul , Howell Bonnie J. , Zetterberg Henrik H. , Blennow Kaj , Gisslen Magnus , Rasmussen Thomas A. , Lewin Sharon R.
Published: September 2021

Objective:

The aim of this study was to examine whether administering both vorinostat and disulfiram to people with HIV (PWH) on antiretroviral therapy (ART) is well tolerated and can enhance HIV latency reversal.

Design:

Vorinostat and disulfiram can increase HIV transcription in PWH on ART. Together, these agents may lead to significant HIV latency reversal.

Methods:

Virologically suppressed PWH on ART received disulfiram 2000 mg daily for 28 days and vorinostat 400 mg daily on days 8–10 and 22–24. The primary endpoint was plasma HIV RNA on day 11 relative to baseline using a single copy assay. Assessments included cell-associated unspliced RNA as a marker of latency reversal, HIV DNA in CD4+ T-cells, plasma HIV RNA, and plasma concentrations of ART, vorinostat, and disulfiram.

Results:

The first two participants (P1 and P2) experienced grade 3 neurotoxicity leading to trial suspension. After 24 days, P1 presented with confusion, lethargy, and ataxia having stopped disulfiram and ART. Symptoms resolved by day 29. After 11 days, P2 presented with paranoia, emotional lability, lethargy, ataxia, and study drugs were ceased. Symptoms resolved by day 23. CA-US RNA increased by 1.4-fold and 1.3-fold for P1 and P2 respectively. Plasma HIV RNA was detectable from day 8 to 37 (peak 81 copies ml−1) for P2 but was not increased in P1 Antiretroviral levels were therapeutic and neuronal injury markers were elevated in P1.

Conclusion:

The combination of prolonged high-dose disulfiram and vorinostat was not safe in PWH on ART and should not be pursued despite evidence of latency reversal.
A farewell to
R
: time-series models for tracking and forecasting epidemics
Authors: Harvey Andrew , Kattuman Paul
Published: September 2021

The time-dependent reproduction number,
R

t

, is a key metric used by epidemiologists to assess the current state of an outbreak of an infectious disease. This quantity is usually estimated using time-series observations on new infections combined with assumptions about the distribution of the serial interval of transmissions. Bayesian methods are often used with the new cases data smoothed using a simple, but to some extent arbitrary, moving average. This paper describes a new class of time-series models, estimated by classical statistical methods, for tracking and forecasting the growth rate of new cases and deaths. Very few assumptions are needed and those that are made can be tested. Estimates of
R

t

, together with their standard deviations, are obtained as a by-product.
Modelling collective navigation via non-local communication
Authors: Johnston S. T. , Painter K. J.
Published: September 2021

Collective migration occurs throughout the animal kingdom, and demands both the interpretation of navigational cues and the perception of other individuals within the group. Navigational cues orient individuals towards a destination, while it has been demonstrated that communication between individuals enhances navigation through a reduction in orientation error. We develop a mathematical model of collective navigation that synthesizes navigational cues and perception of other individuals. Crucially, this approach incorporates uncertainty inherent to cue interpretation and perception in the decision making process, which can arise due to noisy environments. We demonstrate that collective navigation is more efficient than individual navigation, provided a threshold number of other individuals are perceptible. This benefit is even more pronounced in low navigation information environments. In navigation ‘blindspots’, where no information is available, navigation is enhanced through a relay that connects individuals in information-poor regions to individuals in information-rich regions. As an expository case study, we apply our framework to minke whale migration in the northeast Atlantic Ocean, and quantify the decrease in navigation ability due to anthropogenic noise pollution.
Inferring kinetic parameters of oscillatory gene regulation from single cell time-series data
Authors: Burton Joshua , Manning Cerys S. , Rattray Magnus , Papalopulu Nancy , Kursawe Jochen
Published: September 2021

Gene expression dynamics, such as stochastic oscillations and aperiodic fluctuations, have been associated with cell fate changes in multiple contexts, including development and cancer. Single cell live imaging of protein expression with endogenous reporters is widely used to observe such gene expression dynamics. However, the experimental investigation of regulatory mechanisms underlying the observed dynamics is challenging, since these mechanisms include complex interactions of multiple processes, including transcription, translation and protein degradation. Here, we present a Bayesian method to infer kinetic parameters of oscillatory gene expression regulation using an auto-negative feedback motif with delay. Specifically, we use a delay-adapted nonlinear Kalman filter within a Metropolis-adjusted Langevin algorithm to identify posterior probability distributions. Our method can be applied to time-series data on gene expression from single cells and is able to infer multiple parameters simultaneously. We apply it to published data on murine neural progenitor cells and show that it outperforms alternative methods. We further analyse how parameter uncertainty depends on the duration and time resolution of an imaging experiment, to make experimental design recommendations. This work demonstrates the utility of parameter inference on time course data from single cells and enables new studies on cell fate changes and population heterogeneity.
A platform for high-fidelity patient-specific structural modelling of atherosclerotic arteries: from intravascular imaging to three-dimensional stress distributions
Authors: Kadry Karim , Olender Max L. , Marlevi David , Edelman Elazer R. , Nezami Farhad R.
Published: September 2021

The pathophysiology of atherosclerotic lesions, including plaque rupture triggered by mechanical failure of the vessel wall, depends directly on the plaque morphology-modulated mechanical response. The complex interplay between lesion morphology and structural behaviour can be studied with high-fidelity computational modelling. However, construction of three-dimensional (3D) and heterogeneous models is challenging, with most previous work focusing on two-dimensional geometries or on single-material lesion compositions. Addressing these limitations, we here present a semi-automatic computational platform, leveraging clinical optical coherence tomography images to effectively reconstruct a 3D patient-specific multi-material model of atherosclerotic plaques, for which the mechanical response is obtained by structural finite-element simulations. To demonstrate the importance of including multi-material plaque components when recovering the mechanical response, a computational case study was conducted in which systematic variation of the intraplaque lipid and calcium was performed. The study demonstrated that the inclusion of various tissue components greatly affected the lesion mechanical response, illustrating the importance of multi-material formulations. This platform accordingly provides a viable foundation for studying how plaque micro-morphology affects plaque mechanical response, allowing for patient-specific assessments and extension into clinically relevant patient cohorts.
How much calcium to shell out? Eggshell calcium carbonate content is greater in birds with thinner shells, larger clutches and longer lifespans
Authors: McClelland Stephanie C. , Cassey Phillip , Maurer Golo , Hauber Mark E. , Portugal Steven J.
Published: September 2021

The avian eggshell is a bio-ceramic structure that protects the embryo. It is composed almost entirely of calcium carbonate and a small amount of organic material. An optimal amount of calcium carbonate in the eggshell is essential for the embryo's development, yet how the ratio of calcium carbonate to organic matter varies between species has not been investigated. Calcium is a limiting resource for most birds, so its investment in their eggs should be optimized for a bird's life history. We measured the relative calcium carbonate content of eggshells in 222 bird species and tested hypotheses for how this trait has evolved with the life-history strategies of these species and other traits of their respective egg physiologies. We found that (i) eggshell calcium carbonate content was positively correlated with species having thinner eggshells and smaller than expected eggs relative to incubating parental mass, (ii) species with small mean clutch sizes had lower calcium carbonate content in their eggshells, and (iii) for species with larger clutch sizes, eggshell calcium carbonate content was negatively correlated with their mean lifespan. The pattern of lower eggshell calcium carbonate in longer lived, larger clutched birds suggests that calcium provision to the eggshell has long-term costs for the individual.
Age differences in COVID-19 risk-taking, and the relationship with risk attitude and numerical ability
Authors: Wolfe Kelly , Sirota Miroslav , Clarke Alasdair D. F.
Published: September 2021

This study aimed to investigate age differences in risk-taking concerning the coronavirus pandemic, while disentangling the contribution of risk attitude, objective risk and numeracy. We tested (i) whether older and younger adults differed in taking coronavirus-related health risks, (ii) whether there are age differences in coronavirus risk, risk attitude and numerical ability and (iii) whether these age differences in coronavirus risk, attitude and numerical ability are related to coronavirus risk-taking. The study was observational, with measures presented to all participants in random order. A sample of 469 participants reported their coronavirus-related risk-taking behaviour, objective risk, risk attitude towards health and safety risks, numerical ability and risk perception. Our findings show that age was significantly related to coronavirus risk-taking, with younger adults taking more risk, and that this was partially mediated by higher numeracy, but not objective risk or risk attitude. Exploratory analyses suggest that risk perception for self and others partially mediated age differences in coronavirus risk-taking. The findings of this study may better our understanding of why age groups differ in their adoption of protective behaviours during a pandemic and contribute to the debate whether age differences in risk-taking occur due to decline in abilities or changes in risk attitude.
Human mortality at extreme age
Authors: Belzile Léo R. , Davison Anthony C. , Rootzén Holger , Zholud Dmitrii
Published: September 2021

We use a combination of extreme value statistics, survival analysis and computer-intensive methods to analyse the mortality of Italian and French semi-supercentenarians. After accounting for the effects of the sampling frame, extreme-value modelling leads to the conclusion that constant force of mortality beyond 108 years describes the data well and there is no evidence of differences between countries and cohorts. These findings are consistent with use of a Gompertz model and with previous analysis of the International Database on Longevity and suggest that any physical upper bound for the human lifespan is so large that it is unlikely to be approached. Power calculations make it implausible that there is an upper bound below 130 years. There is no evidence of differences in survival between women and men after age 108 in the Italian data and the International Database on Longevity, but survival is lower for men in the French data.