bluuebunny/crossref_metadata_2025 huggingface dataset:
GapRepairer: a server to model a structural gap and validate it using topological analysis
Authors: Jarmolinska Aleksandra I , Kadlof Michal , Dabrowski-Tumanski Pawel , Sulkowska Joanna I
Published: April 2018

Motivation

Over 25% of protein structures possess unresolved fragments. On the other hand, approximately 6% of protein chains have non-trivial topology (and form knots, slipknots, lassos and links). As the topology is fundamental for the proper function of proteins, modeling of topologically correct structures is decisive in various fields, including biophysics, biotechnology and molecular biology. However, none of the currently existing tools take into account the topology of the model and those which could be modified to include topology, demand experience in bioinformatics, protein topology and knot theory.

Results

In this work, we present the GapRepairer—the server that fills the gap in the spectrum of structure modeling methods. Its easy and intuitive interface offers the power of Modeller homology modeling to many non-experts in the field. This server determines the topology of templates and predicted structures. Such information when possible is used by the server to suggest the best model, or it can be used by the user to score models or to design artificially (dis)entangled structures.

Availability and implementation

GapRepairer server along with tutorials, usage notes, movies and the database of already repaired structures is available at http://gaprepairer.cent.uw.edu.pl.

Supplementary information

Supplementary data are available at Bioinformatics online.
Universal evolutionary selection for high dimensional silent patterns of information hidden in the redundancy of viral genetic code
Authors: Goz Eli , Zafrir Zohar , Tuller Tamir
Published: April 2018

Motivation

Understanding how viruses co-evolve with their hosts and adapt various genomic level strategies in order to ensure their fitness may have essential implications in unveiling the secrets of viral evolution, and in developing new vaccines and therapeutic approaches. Here, based on a novel genomic analysis of 2625 different viruses and 439 corresponding host organisms, we provide evidence of universal evolutionary selection for high dimensional ‘silent’ patterns of information hidden in the redundancy of viral genetic code.

Results

Our model suggests that long substrings of nucleotides in the coding regions of viruses from all classes, often also repeat in the corresponding viral hosts from all domains of life. Selection for these substrings cannot be explained only by such phenomena as codon usage bias, horizontal gene transfer and the encoded proteins. Genes encoding structural proteins responsible for building the core of the viral particles were found to include more host-repeating substrings, and these substrings tend to appear in the middle parts of the viral coding regions. In addition, in human viruses these substrings tend to be enriched with motives related to transcription factors and RNA binding proteins. The host-repeating substrings are possibly related to the evolutionary pressure on the viruses to effectively interact with host's intracellular factors and to efficiently escape from the host's immune system.

Supplementary information

Supplementary data are available at Bioinformatics online.
hts-nim: scripting high-performance genomic analyses
Authors: Pedersen Brent S , Quinlan Aaron R
Published: April 2018

Motivation

Extracting biological insight from genomic data inevitably requires custom software. In many cases, this is accomplished with scripting languages, owing to their accessibility and brevity. Unfortunately, the ease of scripting languages typically comes at a substantial performance cost that is especially acute with the scale of modern genomics datasets.

Results

We present hts-nim, a high-performance library written in the Nim programming language that provides a simple, scripting-like syntax without sacrificing performance.

Availability and implementation

hts-nim is available at https://github.com/brentp/hts-nim and the example tools are at https://github.com/brentp/hts-nim-tools both under the MIT license.
A Conceptual History of Recognition in British International Legal Thought
Authors: Clark Martin
Published: April 2018

This article examines the development of the concept of recognition in the writings of British jurists. It first outlines methodologies of conceptual history as applied to international legal concepts, before examining four strands of development of the concept of recognition from the mid-nineteenth to mid-twentieth centuries. It shows how the concept of recognition moved from examining intra-European diplomatic disagreements, to a focus on Christianity, civilisation and progress that barred non-European communities, to a late colonial-era emphasis on technicalities of government and territory, and eventually a state-centric account that normalised inferiority into difference, before emerging in the interwar period as a ‘basic concept’ of international law: intensely debated and closely tied to a range of political projects. The article concludes with reflections on why British thinking turns away from recognition in the 1950s, as the decolonising world turns to a new international law and self-determination.
Biodegradable coronary scaffolds: their future and clinical and technological challenges
Authors: Hytönen Jarkko P , Taavitsainen Jouni , Tarvainen Santeri , Ylä-Herttuala Seppo
Published: April 2018

Angioplasty and stenting are standard treatment options for both stabile occlusive coronary artery disease and acute myocardial infarctions. Over the last years, several biodegradable stent systems have entered pre-clinical and clinical evaluation and into clinical practice. A strong supporting scaffold is necessary after angioplasty to prevent elastic recoil of the vessel but in the long term a permanent metallic stent will only impair normal physiology of the artery wall. Thus, the main advantage of a resorbable system is the potential for better vessel recovery and function in the long term. The new stent systems differ from traditional stents in size and biological responses and questions have risen regarding their mechanical strength and increased risk of stent thrombosis. Here, we present current treatment options with biodegradable scaffolds, discuss further key areas for improvements and review novel technological advances in the context of all up-to-date clinical trial information. New material choices are also covered as well as special considerations for pre-clinical testing.
Scandal and Narrative in the
Heptaméron
Authors: Butterworth Emily
Published: April 2018

This article explores the relationships between scandal and narrative in Marguerite de Navarre’s
Heptaméron
. Scandal was a controversial and shifting keyword in the sixteenth century: the medieval secular connotations of socially reprehensible behaviour and outrage were still current, while Protestant discussions revived its biblical sense of the stumbling block in an individual’s path to salvation. The
Heptaméron
contains both kinds of scandal. Its stories are socially scandalous in their plots of adultery, treachery, and hypocrisy, but the storytellers also probe the theological idea that such behaviour could be a spiritual snare or stumbling block, especially in relation to what is presented frequently as the false teaching of the Franciscans. This article traces the dynamics of scandal in the
nouvelles
and between the storytellers, and argues that stories about scandalous behaviour might themselves constitute a scandal to the unwary reader. The
Heptaméron
acknowledges this possibility, exploring both the narrative of scandal and the scandal of narrative and emphasizing the contagious power of both.
Symmetries of Projective Spaces and Spheres
Authors: Gehér György Pál
Published: April 2018

Let H be either a complex inner product space of dimension at least two or a real inner product space of dimension at least three, and let us fix an $\alpha \in (0,\tfrac{\pi }{2} )$. The purpose of this paper is to characterise all bijective transformations on the projective space P(H) which preserve the quantum angle $\alpha$ (or Fubini–Study distance $\alpha$) between lines in both directions. (Let us emphasise that we do not assume anything about the preservation of other quantum angles). For real inner product spaces and when $H=\mathbb{C}^2$ we do this for every $\alpha$, and when H is a complex inner product space of dimension at least three we describe the structure of such transformations for $\alpha \leq \tfrac{\pi }{4}$. Our result immediately gives an Uhlhorn-type generalisation of Wigner’s theorem on quantum mechanical symmetry transformations, that is considered to be a cornerstone of the mathematical foundations of quantum mechanics. Namely, under the above assumptions, every bijective map on the set of pure states of a quantum mechanical system that preserves the transition probability $\cos ^2\alpha$ in both directions is a Wigner symmetry (thus automatically preserves all transition probabilities), except for the case when $H=\mathbb{C}^2$ and $\alpha = \tfrac{\pi }{4}$ where an additional possibility occurs. (Note that the classical theorem of Uhlhorn is the solution for the $\alpha = \tfrac{\pi }{2}$ case). Usually in the literature, results which are connected to Wigner’s theorem are discussed under the assumption of completeness of H; however, here we shall remove this unnecessary hypothesis in our investigation. Our main tool is a characterisation of bijective maps on unit spheres of real inner product spaces which preserve one spherical angle in both directions.
Medically Indicated Preterm Deliveries – Are Placental Dysfunction and Vasculopathies Related? [9A]
Authors: Boggess Kim A. , Saade George R. , Cousins Larry M. , Coonrod Dean , Lueth Amir J. , Randolph Todd L.
Published: April 2018

INTRODUCTION:

To examine the relationship between placental dysfunction disorders (PDD), vasculopathies (VP), medically indicated preterm delivery (miPTD) and spontaneous preterm delivery (sPTD).

METHODS:

Retrospective cohort study of women with singleton gestations. Preterm delivery defined as delivery prior to 37 weeks gestation. The type of delivery (term, miPTD, or sPTD) was determined, and clinical diagnoses were categorized into PDD (preeclampsia, fetal distress, IUGR, oligohydramnios, abruption, gestational hypertension) and VP (Type 1 or 2 diabetes, gestational diabetes, chronic hypertension). The prevalence for each diagnosis was examined for each type of delivery.

RESULTS:

Study population included 3049 term deliveries, 190 sPTD, and 232 miPTD. There were no significant differences in maternal age and parity among these three groups. Patients with miPTD were more likely to be non-Hispanic and to have a higher BMI. As expected, the fraction of patients with at least one PDD or VP were significantly higher for miPTB compared to sPTB and term. Also, the fraction of patients with at least one PDD AND at least one VP were markedly and significantly (p less than 0.0001) higher for miPTD (20%) compared to sPTD (4.2%) or term (2.7%). Interestingly, patients with a more severe vasculopathy or multiple concurrent vasculopathies were associated with higher rates of PTD, particularly miPTD.

CONCLUSION:

The combination, PDD/VP, is significantly increased in miPTD versus sPTD or terms, and severe vasculopathies or concurrent vasculopathies show increased rates of PTD. These conditions may indicate severe epithelial damage resulting in poor perfusion and primary placental dysfunction requiring miPTD.
Tracking the Development of Risk Factors for Vascular Disease After Pregnancy with Pre-Eclampsia [16A]
Authors: Wong Adriana J. , Lederer Madeline , Diego Daniela , Nguyen Desiree , Verma Usha , Chaturvedi Seemant
Published: April 2018

INTRODUCTION:

Women with a history of preeclampsia have a higher lifetime risk for cardiovascular disease and cerebrovascular disease. Therefore, tracking the development of risk factors for heart disease and stroke after preeclampsia is necessary.

METHODS:

This is a retrospective chart review of women who were diagnosed with preeclampsia at Jackson Memorial Hospital between 2012-2013 and subsequently followed up within the Jackson Health System between 2014-2016. EMR’s were reviewed to determine whether these women developed hypertension, hyperlipidemia, migraines, obesity, and diabetes mellitus 2-3 years after an event of preeclampsia and whether these conditions were managed with medication. Descriptive statistics were calculated using SAS statistical software.

RESULTS:

183 women met inclusion criteria (average age of 32.3 years). Controlling for preexisting conditions, 14.2% (22/183) of women with a history of preeclampsia developed hypertension, 3.8% (7/183) developed dyslipidemia, 3.8% (7/183) developed migraine, 3.8% (7/183) developed obesity, and 4.9% (9/183) developed diabetes mellitus within 2-3 years. The mean duration of follow up care was 2.9 years after preeclampsia. 73.6% (42/57) of all hypertensive women were prescribed an antihypertensive medication, 88.9% (16/18) women with diabetes were on pharmacologic therapy, yet 0% (0/10) women with dyslipidemia were prescribed a statin.

CONCLUSION:

During short-term follow-up after pregnancy with preeclampsia, a significant group of women develop risk factors for cardiovascular disease. Not all patients with these risk factors receive optimal care. Our data suggest a need for the development of structured interventions to reduce stroke and myocardial infarction incidence in this population.
Thrombocytosis is a Prognostic Factor in Women Treated with Chemoradiation for Advanced Cervical Cancer [21A]
Authors: Martin Alexandra , Manahan Kelly , Geisler John
Published: April 2018

INTRODUCTION:

Prior to the addition of chemotherapy to radiation, thrombocytosis was seen as a poor prognostic factor for women with advanced cervical cancer. The objective of this study was to see in the chemoradiation era whether thrombocytosis was still a prognostic factor.

METHODS:

An IRB study was performed analyzing all patients with cervical cancer receiving primary chemoradiation as therapy with a diagnosis between January 1, 2001 and December 31, 2011. Minimum follow up was 30 months. Records were examined for initial platelet count at diagnosis, stage, grade, histology and survival. Only patients receiving chemoradiation with stage IIa-Vb cervical cancer were studied included in the final analysis.

RESULTS:

209 women with cervical cancer were diagnosed with 173 women treated with primary chemoradiation. The most common stage was IIIb (88, 50.9%). The mean platelet counts of those receiving chemoradiation was significantly higher (396k/ml; 95%CI 376-416k) than those with lower stage disease (313k/ml; 292-334k)(p<0.001). Of the 173 patients, 42 (24.3%) had a platelet count > 450k/ml and 24 (13.9%) had a platelet count >500k/ml. Patients who died of disease had significantly higher initial platelet counts (mean 433k/ml; 95%CI 407-458k) than those who were alive at the completion of follow-up (mean 326k/ml; 95%CI 303-350k). None of the patients with an initial platelet count >500k/ml were alive at the time of follow-up.

CONCLUSION:

High platelet count at initial diagnosis is a poor prognostic factor in women with cervical cancer treated by chemoradiation.
Sentinel Lymph Node Mapping in Endometrioid Endometrial Cancer: Does it Work in the Real World? [22A]
Authors: Valieva Olga , Greer Danielle M. , Kram Jessica J. F. , Schmit Eric , Dickson Elizabeth , Kamelle Scott A.
Published: April 2018

INTRODUCTION:

To investigate the utility of sentinel lymph node mapping (SLNM) for endometrioid endometrial cancer (EEC) in a community setting.

METHODS:

We retrospectively studied women with EEC who underwent hysterectomy plus surgical staging during January 2011-March 2016. Data were extracted from our local Cancer Registry and confirmed via chart review. Patients underwent either traditional lymphadenectomy (TL) or SLNM with subsequent dissection. Mapping was performed following the protocol of Sloan Kettering. Patient characteristics were compared between lymph node (LN) dissection methods using parametric and nonparametric tests. Differences in recurrence risk were assessed via proportional hazards regression.

RESULTS:

A total of 540 patients with EEC were identified: 180 patients underwent TL and 360 patients underwent SLNM. SLNM attempts were successful in 95% of 377 patients (83% with bilateral detection, 12% with unilateral detection). The total number of LNs dissected was significantly greater in the TL versus SLNM group (median 17.0 vs. 5.00; P<0.01), as was the percentage of patients with positive nodes (10.6 vs. 5.83%; P=0.04). Pathology identified patients who underwent TL as higher risk based on standard risk factors, namely greater tumor diameter extent of myometrial invasion and presence of lymphovascular space invasion. Notably, recurrence risk was not associated with dissection method (hazard ratio [HR] 1.04, confidence interval [CI] 0.48-2.27; P=0.91) or number of LNs retrieved (HR 1.01, CI 0.98-1.04; P=0.45).

CONCLUSION:

SLNM was highly successful (95%) in our community setting. For low-risk EEC patients with tumor diameter <50 mm, myometrial invasion <33%, and grade 1-2, SLNM may be a feasible surgical staging option.
Evaluation of Screening and Risk Reducing Surgery for Women Followed in a High Risk Breast/Ovarian Cancer Clinic [25A]
Authors: Stewart Martha E. , Knisely Anne T. , Sullivan Mackenzie W. , Ring Kari L. , Modesitt Susan C.
Published: April 2018

INTRODUCTION:

Up to 20% of ovarian cancers are attributed to inherited predispositions, however current screening methods (Ca-125 and pelvic ultrasound) do not improve outcomes compared to risk-reducing (RR) surgery. The study objective was to evaluate surgical outcomes of women followed in an academic center’s High-Risk Breast/Ovarian Cancer (HBOC) clinic following RR surgery.

METHODS:

Retrospective chart review of women from the past decade who underwent RR surgery in a HBOC clinic. Surgical outcomes, pathology, pre-operative screening results, and pre-/post-operative cancer diagnoses were evaluated.

RESULTS:

One hundred and eighty-six high risk women were identified with a mean age of 50.2 years and a mean BMI of 28.9 kg/m2 at the time of surgery. The majority (106; 57%) had strong family history of ovarian cancer without an identified mutation but the rest had deleterious mutations (BRCA2-17.7%, BRCA1-15.1%, Lynch 3.2%, or p53 0.5%). The most common procedure was a risk-reducing bilateral salpingo-oophorectomy with or without hysterectomy (RRBSO, 88.7%). All women underwent the SEE-FIM protocol with extensive pathologic analysis which found 2 (0.8%) invasive ovarian cancers (1 ovary/tube carcinosarcoma, 1 granulosa cell), 3 (1.6%) serous tubal intraepithelial carcinomas (STIC), and 1 fallopian tube cancer (0.8%). All tubal pathology was diagnosed in women with documented BRCA mutations. No cancers were found on screening.

CONCLUSION:

Among all high-risk women undergoing RR surgery, about 3% are ultimately diagnosed with a STIC or an ovarian cancer of which none were identified on screening. All STIC and tubal cancers were diagnosed in women with BRCA mutations (6.6% rate).
Multiparameter Single Cell Characterization of Ovarian Intratumor Heterogeneity [29A]
Authors: Beaumont Kristin , Copperman Alan B. , Dottino Peter , Martignetti John , Schadt Eric , Sebra Robert
Published: April 2018

INTRODUCTION:

Rapid advances in single-cell and deep sequencing technologies has revealed the genetic and functional complexity of bulk tumor tissue, particularly with regard to heterogeneous and clonal composition. This is especially relevant to HGSOC patients, where existing analyses of these tumors have uncovered a high degree of intratumoral heterogeneity. In this work, we present methods for the isolation of single- and multi-cellular batches to better characterize clonal diversity from HGSOC patient-derived cells.

METHODS:

We demonstrate single- and multi-cellular manipulation and sequencing using multiple technologies. Lysed genomic DNA from single or batched cells was characterized using the AmpliSeq 207-target HotSpot and comprehensive 143-target Oncomine cancer panels. Single cell, differential expression was conducted using Chromium high diversity mRNA sequencing.

RESULTS:

We integrate phenotypic and genotypic profiling of single cells to characterize clonal heterogeneity in HGSOC tumors. Specifically, growth kinetics, differential expression, and clonal TP53 mutation profiling will be discussed in the context of primary samples. Analysis of TP53 mutation demonstrated a clear sub-population (31%) of single cells exhibiting >75% mutation frequency, which is much higher than the 25-40% observed in bulk control samples, indicating that a cellular subset likely drives downstream signaling effects. In addition to genetic data, single cell real-time cloning alongside CA125 and HE4 secretion assays were combined.

CONCLUSION:

Collectively, this genomic data was used to identify cellular clonality and address the degree of heterogeneity across HGSOC tumors when compared to bulk sequencing. We illustrate the potential for utilizing single cell sequencing data in the development of future therapeutic interventions.
Cancer Panel Sequencing to Guide Personalized Therapy of Breast and Gynecologic Cancers [32A]
Authors: Li Shuyu , Gross Susan Joy , Donovan Michael , Sebra Robert , Housman Laura , Chen Rong
Published: April 2018

INTRODUCTION:

Recent genomic studies have demonstrated significant heterogeneity in breast and gynecologic cancers, characterized by distinctive genomic profiles in individual patients that could affect treatment responses. The aim of this study was to determine what percentage of patients may have findings that are of potential clinical consequence.

METHODS:

We analyzed 56 tumor samples from 32 breast cancers and 24 gynecologic cancers (ovarian, uterine, cervical) using the Ion AmpliSeq Hotspot Panel v2 or the Oncomine Comprehensive Assay v2 to identify somatic mutations. We also generated copy number alteration and RNA-sequencing data to further characterize the tumors.

RESULTS:

TP53 was the most frequently mutated genes in this cohort, consistent with genomic sequencing studies by TCGA and ICGC. Mutations with therapeutic implications were identified in many cases. PI3-Kinase pathway is likely activated in 31% and 42% of the breast and gynecologic cancers respectively due to PIK3CA activating mutations, PTEN loss and/or TSC1 loss. We also observed EGFR exon-20 insertions in 3 breast tumor samples, representing a novel mechanism of activating the ERK pathway in breast cancers.

CONCLUSION:

Given that everolimus has been approved by the FDA for post-menopausal, advanced hormone-receptor positive, HER2-negative breast cancers, and in light of recent promising results from several clinical trials of PI3-Kinase pathway inhibitors in breast, ovarian, and uterine cancers, breast and gynecologic cancer panel sequencing in precision oncology holds promise for more directed therapies, clinical trial recruitment and future research.
Addressing Weight Management Among Endometrial Cancer Survivors [34A]
Authors: McKay Isabelle , Robinson William
Published: April 2018

INTRODUCTION:

Gynecologists who practice in areas with a high burden of obesity are particularly affected by the challenge of weight management as a component of cancer survivorship. The primary goal of this study was to assess changes in the average BMI among survivors of endometrial adenocarcinoma at a high-volume cancer center in New Orleans, Louisiana. We aimed to determine the frequency of weight management interventions and discuss practical measures that gynecologists and oncologists can take to support their patients' attempts at weight loss.

METHODS:

Body Mass Index (BMI) data on 58 endometrial adenocarcinoma survivors seen between 2010 and 2016 was obtained from the Tulane Cancer Registry. BMI's at diagnosis, 6, 12, 24 and 36 months were tracked and compared. Medical records were reviewed for documentation of weight loss interventions and comorbidities, such as diabetes mellitus and hypertension.

RESULTS:

Average BMI at diagnosis or within 6 months of treatment was 39.3 (N: 58). Average BMI at 6, 12, 24, and 36 months was 40.5 (N: 27), 42.9 (N: 20), 41.57 (N: 16), and 39.9 (N: 9), respectively. 8.6% of survivors had chart documentation of weight loss intervention. One third of the women who attended a surveillance visit at 36 months received weight loss intervention. 36.2% and 43.1% of survivors had chart documentation of diabetes mellitus and hypertension, respectively.

CONCLUSION:

This data suggests profound under-utilization of weight management interventions among endometrial cancer survivors. A practical and time-efficient method to encourage these discussions is the use of obesity management tools available through the American Cancer Society and Society of Gynecologic Oncology.
Ovulation Induction for Infertility the Risk of Breast Cancer: A Population-Based Case-Control Study [11B]
Authors: Petrangelo Adriano , Czuzoj-Shulman Nicholas , Tulandi Togas , Azoulay Laurent , Abenhaim Haim Arie A
Published: April 2018

INTRODUCTION:

There is a well-established interplay between reproductive hormone levels and breast cancer. Questions remain in regards to the potential ovulation-inducing fertility treatments, which elevate serum estrogen and progesterone to supraphysiologic levels the treatment period, to affect breast tumorigenesis.

METHODS:

A population-based case-control study using the Clinical Practice Research Datalink (CPRD) was performed. All cases of breast cancer occurring between 1995-2013 were matched with 10 age-matched controls. Cases and controls were assessed for exposure to clomiphene or in-vitro fertilization (IVF) via their clinical records. Odds ratios and 95% confidence intervals for each exposure were computed using multivariate logistic regression, adjusted for smoking, alcohol use, BMI, oral contraceptive use, hormone replacement therapy and oophorectomy.

RESULTS:

The study population consisted of 27,026 cases of breast cancer and their matched controls, with 1,717 subjects having a history of clomiphene exposure and 1,137 subjects having a history of IVF. Ever-exposure to clomiphene was significantly associated with breast cancer, OR 1.34 95% CI [1.26-1.44]. IVF-exposure was similarly associated with breast cancer, OR 1.52 95% CI [1.40-1.65]. The stratified analysis indicated clomiphene was associated with pre-menopausal cancers (OR 1.59 95% CI [1.47-1.73]) but not post-menopausal malignancies (OR 0.94 95% CI [0.83-1.06]). IVF was associated with both pre- and post-menopausal cancers.

CONCLUSION:

Ovulation induction with clomiphene citrate and gonadotropins increases the risk of breast cancer. Women should be advised of this elevated risk understanding the associated implications.
Does Obesity Affect the Frequency or Severity of Acute Placental Inflammation at Term? [18B]
Authors: Saeed Haleema , Jacques Suzanne , Qureshi Faisal
Published: April 2018

INTRODUCTION:

Histologic acute placental inflammation, particularly low stage inflammation, is a frequent finding at term. Much of it is sterile inflammation, and its causes are poorly understood. Maternal obesity, a proinflammatory condition associated with adverse obstetrical outcomes, may affect the frequency, stage, or grade of histologic placental acute maternal inflammatory response (MIR) and fetal inflammatory response (FIR) at term.

METHODS:

Histologic acute MIR and FIR, including stage (location of inflammation) and grade (severity of inflammation), were evaluated according to standardized criteria and compared in singleton placentas from 205 obese (BMI>30kg/m2) and 204 non-obese mothers, all delivering at term with labor. Maternal medical records were reviewed.

RESULTS:

MIR was present in 54% of the obese compared to 56% of the non-obese group (p=NS), while FIR was present in 38% of the obese compared to 34% of the non-obese group (p=NS). FIR stage >1 was more frequent in the obese group (25% vs 3%, p<0.001); however, there was no significant difference in MIR stage. MIR grade >1 was more frequent in the obese group (13% vs 3%, p=0.005). FIR grade >1 was present in only 4 cases. Hypertension and diabetes were more frequent in the obese group, with no significant differences in other clinical features evaluated. The majority of mothers were African-American (80%).

CONCLUSION:

Histologic acute FIR stage >1 and MIR grade > 1 were more frequent in the obese group suggesting that obesity may affect placental inflammation and supporting a role for systemic inflammation in adverse obstetrical outcomes associated with obesity.
Signs of Poor Placental Perfusion In Placental Pathology in Stillbirth Fetuses [19B]
Authors: Leftwich Heidi , Nicasio Erica , Masiero Jessica , Novak Brittany , Leung Katherine , Vanguri Vijay
Published: April 2018

INTRODUCTION:

Over 50% stillbirths have preceding growth restriction. Our objective was to determine whether placental changes commonly seen in fetal growth restriction are associated with placentas of stillbirth infants.

METHODS:

Secondary analysis of a retrospective chart review on singleton placentas January 2011-January 2016. Exclusion criteria were less than 24 weeks’ gestation, multiple gestations, known aneuploidy. Primary outcome was decreased placental weight. Secondary outcomes were infarcts, villitis, fibrin deposition, calcium deposition, villous hypermaturity, meconium staining, intervillous thrombus. Pathology reports, and demographics from the electronic medical records were reviewed. Chi square was used for categorical variables and logistic regression for adjusted analyses.

RESULTS:

3111 placental reports met inclusion/exclusion criteria. There were 78 stillbirths were noted in the study period, 71 (91%) with placenta evaluation. Nineteen (28%) of stillbirths were born SGA at birth. Placentas of stillbirths were more likely to have decreased placental weight (44% vs 20%), more than 2 (54% vs 26%) and 3 placental outcomes (28% vs 7%), p <0.01. Of the 67 with documented fetal weight at delivery, those placentas associated with small for gestational age (SGA) fetus were more likely to have decreased placental weight, infarcts, calcium deposition, and greater than 2 and 3 placental outcomes.

CONCLUSION:

Placentas from pregnancies with stillbirth have increased rates of placental pathology. Those stillbirths born SGA were more likely to have decreased placental weight, infarcts, calcium deposition and greater than 2 and 3 placental outcomes. These placental findings have been associated with poor placental perfusion and may represent cases of placental insufficiency prior to demise.
A Retrospective Study: Performing Opportunistic Salpingectomy at Time of Cesarean at a Community Residency Program [21B]
Authors: Marie Davenport Rachel , Multani Sukhpreet
Published: April 2018

INTRODUCTION:

The American College of Obstetricians and Gynecologists (ACOG) supports discussing opportunistic salpingectomy at the time of pre-operative counseling period for benign gynecologic surgery. Cesarean section is the most common procedure an obstetrician-gynecologist performs in the United States; however, little data exists regarding performing opportunistic salpingectomies at the time of cesarean delivery. This retrospective study sought to evaluate the safety of performing an opportunistic salpingectomy at the time of cesarean section.

METHODS:

A total of 56 patients with singleton intrauterine pregnancy >37 weeks gestational age undergoing a scheduled cesarean at St. Vincent Women’s Hospital were identified from January 1, 2015 to August 1, 2017. Data was abstracted from electronic medical records. Estimated blood loss (EBL), length of operating room (OR) time, differences in hemoglobin pre and post-operatively, and return to operating room within 30 days were analyzed. Other data abstracted included age, body mass index, gravidity/parity, pregnancy complications (e.g., diabetes), training level of surgeon, and surgical technique.

RESULTS:

The average drop in hemoglobin was 1.25 g/dL. Average EBL was 745cc. The most common method was using a Ligasure device, followed by traditional clamp, cut, and tie. One patient required transfusion postoperatively for hemoglobin of 6.7 g/dL. Average OR time was 99.5 minutes. No patients returned to the OR for complications related to surgery.

CONCLUSION:

Performing bilateral salpingectomy at the time of cesarean section appears to be safe. Physicians performing cesarean sections should offer opportunistic salpingectomies to women at average-risk for developing ovarian cancer.
Enhanced Recovery after Surgery Implementation in a Cesarean Section Population in an Integrated Healthcare System [35B]
Authors: Lee Kimberly L. , Lee Derrick C. , Huang Mengfei , Hunt Eric J. , Hedderson Monique M.
Published: April 2018

INTRODUCTION:

Enhanced Recovery After Surgery (ERAS) programs are evidence-based care pathways that focus on optimizing pain control, nutrition, fluids, and mobility. We evaluated implementation of a multi-faceted ERAS program among a cesarean section surgical population within Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system. We compared process measures before and after ERAS implementation at two pilot hospitals.

METHODS:

We evaluated changes in perioperative pain management (morphine equivalents and multimodal analgesics), mobility (early ambulation within 12 hours) and nutrition (early feeding within 12 hours), from pre-Implementation (March 2015-August 2015, n=1390 cesarean patients) to post-Implementation (March 2016-August 2016, n=1471 cesarean patients) of the multifaceted ERAS program. All urgent and elective cases were included. We quantified these metrics based on medication administration records, preoperative checklists, and/or nursing shift assessments recorded in the EMR.

RESULTS:

Process metrics among ERAS patients demonstrated significant changes between pre- and post-Implementation phases. The rate of early ambulation increased from 33% to 51% (p<0.001), early postoperative resumption of nutrition increased from 17% to 57% (p<0.001), and opioid consumption decreased significantly from 13.1 mg morphine equivalents to 7.7 mg (p<0.001), while the use of multimodal analgesics increased from 5% to 87% (p<0.001).

CONCLUSION:

ERAS program implementation successfully altered the process-of-care metrics for cesarean section surgical patients across two pilot hospitals. Further research is needed to determine the impact of ERAS implementation on complications and other outcomes following surgery among women undergoing cesarean sections.
A Qualitative Study of Pregnancy and Childbirth Experience for Women with a History of Sexual Trauma [37B]
Authors: O'Rourke-Suchoff Danielle , Sobel Lauren , Holland Erica , Resnick Kirsten , Perkins Rebecca , Bell Shannon L.
Published: April 2018

INTRODUCTION:

Women with a sexual trauma history are more likely to perceive pregnancy and childbirth as traumatic. Our objective was to identify triggers that provoke anxiety or flashbacks for women with a sexual trauma history in order to design interventions to improve their labor and delivery experience.

METHODS:

Semi-structured qualitative interviews were conducted with 20 adult women who reported a sexual trauma history, and 10 without a sexual trauma history. All delivered since 2014. Interviews focused on antenatal, intrapartum, and immediate post-partum experiences.

RESULTS:

Triggers included language reflective of that used during a past sexual assault, the presence of unfamiliar providers, and cervical exams and vaginal repairs that were not adequately explained. Some women found regional anesthesia helpful, while others were triggered by a perceived lack of control. Women who disclosed their sexual trauma history to prenatal providers expected appropriate documentation so that subsequent providers were aware. Some participants desired elective cesarean section due to their sexual trauma history. Many described pregnancy, childbirth and breastfeeding as healing through the creation of positive connections to their bodies. They found advocates in family, trained birth support and medical staff. Our control group suggests that many of these findings are specific to women with a history of sexual trauma.

CONCLUSION:

Women with a sexual trauma history have unique priorities and needs during pregnancy and childbirth. Discussing medically safe delivery preferences during prenatal care, documenting sexual trauma history and clear communication during exams may improve labor and delivery experiences for this group of women.
Attitudes and Perceptions of Healthcare Providers Regarding the Safe Reduction of the Cesarean Section [7C]
Authors: Shah Ishani , Ogunyemi Dotun , Ronk Anne
Published: April 2018

INTRODUCTION:

The American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) identified risk factors that increase the likelihood for a cesarean section (C/S). Analysis of these factors can aid in the safe reduction of the C/S rate within an institution.

METHODS:

Surveys comprised of clinical scenarios regarding the ACOG/SMFM C/S risk factors were sent to all providers within a hospital system. 250 surveys were analyzed using profession, experience, multiple hospital system exposure, and malpractice influence as outcome variables. Analysis was performed using Pearson correlation, Student's T-test, Chi-square Analysis, and Levene’s test.

RESULTS:

Baseline results showed that most C/S are done for category 2 fetal heart rate, about 40% of providers practice defensively, and that more providers are willing to speak up to a nurse, as compared to an attending. Significant findings showed that providers with a previous lawsuit are more likely to practice defensively (66.4% vs 47.8%, P-.002) and to speak up when they disagree with a care plan (80% vs 63%, P-.002). Nurses, as opposed to physicians, are more willing to wait during labor rather than support a C/S (91.6% vs 70%, P-.000), but are less likely to speak up (64.1% vs 79.6%, P-.006). More experienced providers are more likely to speak up (85.3% vs 57%, P-.000) and less likely to induce at 41 weeks (19.9% vs 31.5%, P-.021).

CONCLUSION:

These results suggest local risk factors that may be associated with increased C/S rates; this knowledge can be utilized to develop appropriate interventions to safely reduce the C/S rate.
Trends in Psychiatric Education Among Obstetrics and Gynecology Residency Programs: A Program Director Survey [9C]
Authors: Garbarino Abigail H. , Kohn Jaden R. , Coverdale John H.
Published: April 2018

INTRODUCTION:

One-third of women in the U.S. receive primary care exclusively from Obstetrician/Gynecologists. Recent literature reveals gaps in recognition of common psychiatric issues by Ob/Gyns.

METHODS:

Program directors of 239 Ob/Gyn residencies received a 17-item anonymous questionnaire to assess the status of psychiatric education. Analysis included descriptive statistics, Student’s t-tests, and logistic regression.

RESULTS:

95 programs (40%) responded. 84% offered didactic instruction in psychiatric topics, of which 70% were taught by Ob/Gyn faculty. Few programs covered intimate partner violence (47%), non-obstetric depression (44%), anxiety (43%), medication management (31%), eating disorders (26%), human trafficking (20%), or PTSD (11%). 20% of programs offered an elective rotation.

The most common barriers to psychiatric training were lack of sufficient integration between Ob/Gyn and psychiatry (46%), ACGME surgical requirements (42%), and lack of sufficiently knowledgeable instructors (38%).

81% of program directors did not agree that their residents are fully equipped to identify psychiatric needs in patients; however, only 22% agreed with the addition of an ACGME milestone for mental health. Community programs and those who identified lack of integration as a barrier were more likely to agree with adding a milestone (p=0.003).

CONCLUSION:

Significant gaps exist in psychiatric education of Ob/Gyn residents, and most program directors perceive that residents are not equipped to identify patient psychiatric needs. The most common barrier to providing additional training was a lack of integration between Ob/Gyn and psychiatry; future efforts should be directed towards this. However, the addition of a new milestone would likely meet considerable resistance.
Gestational Age at Delivery in Preeclampsia with Severe Features Stratified by Race [20C]
Authors: Speranza Rosa , Greiner Karen Scrivner , Luck Marissa , Savitsky Leah , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

There are known racial disparities in preeclampsia, but there are limited data exploring the impact of race on gestational age at delivery for preeclampsia with severe features (PE-SF). We sought to describe rates of deliveries by week of gestation in PE-SF stratified by race.

METHODS:

This is a retrospective cohort study of singleton, non-anomalous deliveries from 2005-2008 using linked vital statistics and ICD-9 data. Women self-reported into racial categories of white, black, Hispanic/Latina, Asian/Pacific Islander, or other. We used chi-squared tests to compare outcomes by gestational age and multiple logistic regression to adjust for age, education, insurance status, chronic hypertension, diabetes, and birthweight.

RESULTS:

Of the 2,039,870 births in our cohort, 16,073 (0.79%) were from pregnancies complicated by PE-SF. Delivery rates for PE-SF were highest between 28-32 weeks gestation across all racial categories. Black women had the highest rate of delivery of any week in any race during the 31st week of gestation (12.5%, p<0.001). There was a decrease in rates of delivery in Asian/Pacific Islanders from 7.9% during the 28th week down to 3.3% in the 29th week (p<0.001). After the 37th week of gestation there was a decline in delivery rates across all racial categories and limited variation beyond that point.

CONCLUSION:

There are consistent trends in the rates of deliveries in PE-SF across racial groups when stratified by gestational age, likely reflecting the prevalence of diagnosis by gestational week. Black women have the highest rates of preterm birth and more research should be directed within this racial category.
A Change in Cervical Ripening Agents Leads to a Significant Reduction in Expenditure [33C]
Authors: Juusela Alexander , Nazir Munir , Gimovsky Martin Larry
Published: April 2018

INTRODUCTION:

Each year approximately 3,000 deliveries occur at NBIMC labor and delivery. Of these deliveries, approximately 700 begin as inductions of labor. In June of 2016 the primary induction medication was switched from dinoprostone $428.53 per insert to misoprostol $1.85 per induction. The purpose of this project was to determine the outcomes in regard to inductions leading to vaginal birth versus cesarean delivery and estimated expenditures per cervical ripening medication.

METHODS:

IRB approval was obtained and then a retrospective chart review of all deliveries at NBIMC from January 1st 2016 until December 31st 2016 was performed with an analysis of successful vaginal deliveries for each induction medication versus failed inductions resulting in cesarean deliveries and the indications for cesarean delivery. The data was extrapolated to estimate the approximated savings from changing induction medication and a comparison for reasons for induction failure.

RESULTS:

There was a no significant difference between the two groups regarding delivery method (misoprostol cesarean delivery 29.72% versus dinoprostone cesarean delivery 35.51%, p-value 0.194). The dinoprostone 10mg vaginal insert was used a single time per induction of labor and cost approximately $428.53. Thus, the 245 inductions had an estimated cost of $104,989.85. In contrast, the misoprostol cervical ripening protocol consisted of misoprostol 25mcg PV for 3 doses followed by misoprostol 50mcg PO for 3 doses. This totaled 225mcg of misoprostol at a cost of $1.85. The total cervical ripening cost of 286 inductions is therefore estimated at $530.35. This is a stark contrast to the single dinoprostone insert costing $428.53. Extrapolating the data to approximately 700 inductions per year: the total cost for dinoprostone would be $299,971 versus misoprostol at $1,295, and the savings from switching to misoprostol would be $298,676.

CONCLUSION:

Changing the induction cervical ripening medication from dinoprostone to misoprostol has saved the department and NBIMC approximately $298,676 per year with a statistically significant similar successful induction rate. Our study has led to changing our institutions cervical ripening agent to a more cost effective agent with a similar delivery outcome.
The Effect Of Oral Anticoagulation Agents On Hemoglobin Levels in Reproductive Age Women [7D]
Authors: Gonzalez Aaron Herrera , Stough Alexandra , Palacio Danica , Palvia Vijay , Anasti James
Published: April 2018

INTRODUCTION:

Oral anticoagulation in reproductive age women is not uncommon. Some studies have reported increased incidence of abnormal uterine bleeding and heavy menstrual bleeding in those receiving anticoagulation. However, studies comparing the effect of different oral anticoagulants on hemoglobin levels on menstruating women are lacking.

METHODS:

We retrospectively reviewed charts of reproductive age women on oral direct activated Factor X inhibitors (FXaI), vitamin K antagonist (vKa), or aspirin (ASA). Demographics and indication for anticoagulation were recorded. Hemoglobin before and 6 to 12 months after initiation of oral anticoagulation were recorded. Pre and post treatment hemoglobin values were compared using paired t-test for each individual anticoagulant and ANOVA was employed to compare initial Hemoglobin levels and pre and post treatment Hemoglobin differences.

RESULTS:

FXaI, vKa, ASA groups included 91, 73 and 68 patients, respectively. They did not differ in mean age (44.2 ± 6.2 yrs) or BMI (32.5 ± 8.1 kg/m2). Indications for FXaI were Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE) (64/91), Atrial fibrillation (Afib) (8/91) or antiphospholipid syndrome(7/91). vKa was used for DVT/PE (28/73), stroke (12/73), or Afib (10/73). ASA indications included stroke (27/68), DVT/PE (11/68), or Factor V Leiden (10/68). Post treatment Hemoglobin values were less than 2% lower than pretreatment Hemoglobin levels in all groups. This was not clinically or statistically significant. Differences in Hemoglobin were similar between groups.

CONCLUSION:

There was no clinically significant decrease in Hemoglobin levels in menstruating women receiving oral anticoagulants at 6 to 12 months post initiation of oral anticoagulation.