bluuebunny/crossref_metadata_2025 huggingface dataset:
Hedge Fund Activism vs Other Activist Investors
Authors: von Lilienfeld-Toal Ulf , Schnitzler Jan
Published: November 2021

This chapter reviews the growing empirical literature on shareholder activism by hedge funds. The aim is a comparative approach contrasting the impact of hedge fund activism on target firms with outcomes for other types of activist investors. Following recent research, the chapter provides an empirical analysis based on the disclosure of equity blockholdings by activist investors in a large sample of all US listed companies. In addition, it summarizes which types of investors engage in other events linked to activism, such as takeovers, proxy contests, or shareholder proposals. Overall, there is evidence that not only hedge funds but also other types of investors can be effective monitors, but there are nuanced differences with respect to targeting decisions and payout policies.
Modeling temporal and hormonal regulation of plant transcriptional response to wounding
Authors: Moore Bethany M , Lee Yun Sun , Wang Peipei , Azodi Christina , Grotewold Erich , Shiu Shin-Han
Published: November 2021

Plants respond to wounding stress by changing gene expression patterns and inducing the production of hormones including jasmonic acid. This wounding transcriptional response activates specialized metabolism pathways such as the glucosinolate pathways in Arabidopsis thaliana. While the regulatory factors and sequences controlling a subset of wound-response genes are known, it remains unclear how wound response is regulated globally. Here, we how these responses are regulated by incorporating putative cis-regulatory elements, known transcription factor binding sites, in vitro DNA affinity purification sequencing, and DNase I hypersensitive sites to predict genes with different wound-response patterns using machine learning. We observed that regulatory sites and regions of open chromatin differed between genes upregulated at early and late wounding time-points as well as between genes induced by jasmonic acid and those not induced. Expanding on what we currently know, we identified cis-elements that improved model predictions of expression clusters over known binding sites. Using a combination of genome editing, in vitro DNA-binding assays, and transient expression assays using native and mutated cis-regulatory elements, we experimentally validated four of the predicted elements, three of which were not previously known to function in wound-response regulation. Our study provides a global model predictive of wound response and identifies new regulatory sequences important for wounding without requiring prior knowledge of the transcriptional regulators.
‘Wind, Wind, Wind, Always Winding Am I’: Dickens’s Metafictional Clockwork
Authors: Dema Eva
Published: November 2021

This article considers the importance of timepieces and clockwork to Dickens’s conception of composition. Whilst the many clocks and watches that saturate his writing have often been read as indicative of an interest in time, the present study considers what the materiality of timepieces—namely, their markets and mechanisms—might also reveal of Dickens’s fiction. Taking Little Dorrit (1855–7) and Great Expectations (1860–1) as two central case studies demonstrating Dickens’s obsession with the horological, it traces a relationship between ‘works’ and ‘winders’ through these novels, before attempting to unveil the metafictional implications of the act of ‘winding’. The study also investigates the various malpractices of the contemporary horological market, positioning this context as crucial to our understanding of Dickensian winding as a particularly deceptive practice. Having unveiled the capacity for duplicity contained within mid-nineteenth-century clockwork, the article concludes by turning its attention towards the equally murky inner workings of the Dickensian plot and to Dickens’s curious sense of its clock-like construction. Departing from the imagery more traditionally associated with Dickens’s portrayal of composition, it asks how and why he envisioned writing as a kind of winding.
‘George Crabbe and the Place of Amusement’
Authors: Fay Jessica
Published: November 2021

Hazlitt’s judgement that George Crabbe was an enemy of the imagination epitomizes contemporary opinions about the lack of musing, amusement, and pleasure in Crabbe’s verse. In the Preface to Tales (1812), Crabbe effectively confirms those judgements by defending his interest in ‘the painful realities of actual existence’ rather than the ‘fairy-land’ of ‘fancy’. In his late poem, ‘Silford Hall; or, The Happy Day’ (composed c. 1822–1824), however, the struggle between matter-of-factness and reverie is less decidedly resolved than Hazlitt—and Crabbe himself—liked to suggest. Silford Hall is modelled on Belvoir Castle in Leicestershire (the home of Crabbe’s patrons, the Dukes of Rutland), a place the poet visited repeatedly—in imagination and in reality—for over five decades. Taking account of a draft ending that was detached from the main body of the poem printed in Posthumous Tales (1834), the essay traces allusions to Johnson’s Rasselas as a means of understanding Crabbe’s emphasis on dwelling, revisiting, and retrospection. It shows how those processes engender a tussle between the perspectives of enchanted youth and disillusioned age, making ‘Silford Hall’ a more complex mode of place-writing than Crabbe had attempted previously. Unseen by his critics, the poem catches Crabbe disavowing flights of imaginative fancy while acknowledging their part in the history of his poetic maturation.
Neuraxial Anesthesia and the Ubiquitous Platelet Count Question: How Low Is Too Low?
Authors: Scavone B.M. , Wong C.A.
Published: November 2021

(Anesth Analg. 2021;132:1527–1530)

Recently, the Society for Obstetric Anesthesia and Perinatology (SOAP) issued a consensus statement regarding neuraxial procedures in patients with thrombocytopenia. When considering the cutoff platelet count for providing neuraxial labor analgesia or neuraxial anesthesia for cesarean, this statement might not provide clinicians with all the answers.
Neuraxial and Peripheral Misconnection Events Leading to Wrong-route Medication Errors: A Comprehensive Literature Review
Authors: Viscusi E.R. , Hugo V. , Hoerauf K. , Southwick F.S.
Published: November 2021

(Reg Anesth Pain Med. 2021;46:176–181)

Neuraxial and peripheral anesthetic techniques are used in a variety of perioperative and peripartum settings. Opportunities for misconnection and drug administration errors occur, which can negatively and substantially impact patient morbidity and mortality. In addition, they create financial burdens on patients and hospitals. The aim of this narrative review is to identify and characterize misconnection errors and motivate organizations to mitigate them.
Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the United States, 2010-2017
Authors: Hirai A.H. , Ko J.Y. , Owens P.L. , Stocks C. , Patrick S.W.
Published: November 2021

(JAMA. 2021;325:146–155)

The rates of maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in the United States rose substantially between 2000 and 2014. Opioid misuse and exposure can have adverse outcomes for both parturients and neonates. There are wide variations in the rates of NAS and maternal OUD in part due to an expansion in opioid-related disease identification codes in 2015. This study aimed to update estimated rates of NAS and maternal opioid-related diagnoses (MODs) in the United States, examine changes in rates since 2010, and describe variation in rates between states.
Birth Hospital and Racial and Ethnic Differences in Severe Maternal Morbidity in the State of California
Authors: Mujahid M.S. , Kan P. , Leonard S.A. , Hailu E.M. , Wall-Wieler E. , Abrams B. , Main E. , Profit J. , Carmichael S.L.
Published: November 2021

(Am J Obstet Gynecol. 2021;224:219.e1–15)

A persistent difference in the rate of severe maternal morbidity (SMM) continues to exist between White women and those of other racial and ethnic groups. This is especially true for Black women, who are up to 3 times more likely to experience SMM than White women. The factors underlying this inequity are unclear. Sociodemographic characteristics, clinical presentation, and hospital type and quality may play a role. The aim of this study was to examine the impact that certain factors may have on racial and ethnic differences in SMM.
Geographic Access to Critical Care Obstetrics for Women of Reproductive Age by Race and Ethnicity
Authors: Kroelinger C.D. , Brantley M.D. , Fuller T.R. , Okoroh E.M. , Monsour M.J. , Cox S. , Barfield W.D.
Published: November 2021

(Am J Obstet Gynecol. 2021;224:304.e1–304.e11. doi: 10.1016/j.ajog.2020.08.042)

Minority groups are growing in the United States, and projections show that by 2044 over half of Americans will belong to a minority group. Those who belong to ethnic or racial minorities, reside in rural areas, and are low-income receive suboptimal health care. Further, racial and ethnic minorities have increased rates of maternal and neonatal morbidity and mortality. Addressing care disparities among pregnant and postpartum women is critical. No studies to date have examined the association between racial and ethnic distribution of perinatal women and the distance to high-level obstetric care facilities. Critical care obstetrics (CCO) is high-level, intensive care that traditional obstetric units don’t offer which provides medical intervention and diagnostic imaging for high-risk perinatal women. The aim of this study was to conduct an analysis of spatial proximity to CCO to identify where geographical access gaps are within the United States and the impact by race and ethnicity in order to better address disparities in health care for women of reproductive age.
A Cross-sectional Study of Immune Seroconversion to SARS-CoV-2 in Frontline Maternity Health Professionals
Authors: Bampoe S. , Lucas D.N. , Neall G. , Sceales P. , Aggarwal R. , Caulfield K. , Siassakos D. , Odor P.M.
Published: November 2021

(Anaesthesia. 2020;75:1614–1619)

Seroconversion rates for COVID-19 provides data on the pervasiveness and spread of the infection. One challenge is the rate of asymptomatic seroconversion. This has implications for health care providers on the frontline of obstetric care, who may be at increased risk of COVID-19 transmission to and from patients and staff. To date, there are no studies that have provided a baseline rate of seroconversion in frontline, obstetric care providers. The aim of this study was to assess the prevalence of seroconversion in obstetric providers who were not previously diagnosed with SARS-CoV-2 and examine the associations among their characteristics, symptoms, and seroconversion.
Postpartum-specific Vital Sign Reference Ranges
Authors: Green L.J. , Pullon R. , Mackillop L.H. , Gerry S. , Birks J. , Salvi D. , Davidson S. , Loerup L. , Tarassenko L. , Mossop J. , Edwards C. , Gauntlett R. , Harding K. , Chappell L.C. , Knight M. , Watkinson P.J.
Published: November 2021

(Obstet Gynecol. 2021;137:295–304. doi: 10.1097/AOG.0000000000004239. PMID: 33417320)

The majority of maternal deaths occur in the postpartum period (57% in the United States), compared with the antenatal and intrapartum periods. However, maternal deaths in the postpartum period have not been studied as extensively as the antenatal and intrapartum periods. Venous thromboembolism, hemorrhage, sepsis, and gestational hypertensive disorders are the leading causes of death during postpartum. Little data exists describing normal postpartum vital signs. This study aimed to estimate maternal postpartum vital sign ranges.
Safety Considerations for Neuraxial Anaesthesia in Parturients With COVID-19
Authors: Sun X. , Liu Y. , Mei W.
Published: November 2021

(Br J Anaesth. 2020;125:e313–e314)
Women’s Experiences of Decision-making and Beliefs in Relation to Planned Cesarean Section: A Survey Study
Authors: Coates D. , Donnolley N. , Thirukumar P. , Lainchbury A. , Spear V. , Henry A.
Published: November 2021

(Aust N Z J Obstet Gynaecol. 2021;61:106–115)

The decision for planned cesarean delivery (CD) is often based on the preferences and beliefs of the patient or clinician. When decision-making is shared, patient satisfaction improves. The extent to which shared decision-making (SDM) occurs in Australia is unclear. Moreover, no studies have directly compared the preferences and beliefs of women undergoing planned CD at the recommendation of the clinician or at their own request. This study aimed to assess the mode of birth preferences of women in Australia and their experiences with SDM for CD. It also aimed to compare the experiences of SDM depending on whether a woman requested a CD or it was recommended by a clinician.
Cesarean Section in the Second Delivery to Prevent Anal Incontinence After Asymptomatic Obstetric Anal Sphincter Injury: The EPIC Multicenter Randomized Trial
Authors: Abramowitz L. , Mandelbrot L. , Bourgeois Moine A. , Tohic A.L. , Carne Carnavalet C. , Poujade O. , Roy C. , Tubach F.
Published: November 2021

(BJOG. 2021;128:685–693. doi: 10.1111/1471-0528.16452)

Anal incontinence negatively impacts the quality of life and sexual health of 14.8% of women in the United States. Third-degree and fourth-degree obstetric anal sphincter injuries, reported in 2% to 12% of vaginal deliveries (VD), contribute. Between 38% and 53% of obstetric anal sphincter lesions are associated with long-term anal incontinence. Up to 27% of women experience occult anal sphincter lesions following their first VD, and 9% of women with undiagnosed anal sphincter lesions experience anal incontinence. Instrumental delivery increases risk of anal incontinence with sphincter lesions occurring in 63% to 82% of forceps deliveries; 23% of these parturients experiencing anal incontinence. When anal sphincter injuries occur during the first VD, cesarean delivery (CD) is an option for future births. Although CD may have beneficial maternal outcomes, there are risks to both mother and neonate and no clear evidence to aid decision making. The aim of this study was to identify whether CD for the second delivery could prevent anal incontinence in women with a history of asymptomatic obstetric anal sphincter injuries.
Programmed Intermittent Epidural Bolus vs. Patient-controlled Epidural Analgesia for Maintenance of Labour Analgesia: A 2-Center, Double-blind, Randomized Study
Authors: Roofthooft E. , Barbé A. , Schildermans J. , Cromheecke S. , Devroe S. , Fieuws S. , Rex S. , Wong C.A. , Van de Velde M.
Published: November 2021

(Anaesthesia. 2020;75:1635–1642)

Many institutions use patient-controlled epidural analgesia (PCEA) for pain relief during labor; however, programmed intermittent epidural bolus+PCEA (PIEB) has emerged as possibly superior to PCEA alone. PIEB has been found to provide pain relief with less local anesthetic, fewer or later patient-administered boluses and less motor block than PCEA strategies. PIEB has also been shown to reduce the need for instrumental vaginal delivery and manual bolus intervention by the anesthetist, and to improve maternal satisfaction. To date, there are no known studies comparing PIEB with PCEA without background infusion. The aim of this study is to compare the incidence of breakthrough pain with PIEB and PCEA.
Effect of a Stepwise Opioid-sparing Analgesic Protocol on In-hospital Oxycodone Use and Discharge Prescription After Cesarean Delivery
Authors: Landau R. , Romanelli E. , Daoud B. , Shatil B. , Zheng X. , Corradini B. , Aubey J. , Wu C. , Ha C. , Guglielminotti J.
Published: November 2021

(Reg Anesth Pain Med. 2021;46:151–156)

Between 1999 and the 2014, the use of opioids during and after pregnancy increased 5-fold. Between 2007 and 2016, opioid-related deaths during pregnancy tripled. One factor that may contribute to these increasing rates is exposure to opioids during hospitalization after cesarean delivery (CD). Implementing stepwise protocols for analgesia after CD both in-hospital and postdischarge is recommended to help minimize the risk of opioid use. The aim of this study was to examine the effect of a multimodal, stepwise opioid-sparing analgesic order set on oxycodone use in women undergoing CD.
Effect of Sugammadex During Transcranial Electrical Motor Evoked Potentials Monitoring in Spinal Surgery: A Randomized Controlled Trial
Authors: Liu Haiyang , Jian Minyu , Wang Chengwei , Nie Lanyi , Liang Fa , Liu Kuo , Zhang Kaiying , Qiao Hui , Han Ruquan
Published: November 2021

Introduction:

Neuromuscular blockade suppresses transcranial electrical motor evoked potential (TceMEP) amplitude and is usually avoided during TceMEP monitoring. In this randomized controlled trial, we investigated whether rocuronium-induced suppression of TceMEP amplitude could be reversed by sugammadex in patients undergoing spine surgery.

Methods:

Seventy-six patients undergoing spinal surgery were randomly allocated into sugammadex and control groups. In the sugammadex group, a rocuronium infusion was titrated to maintain moderate neuromuscular blockade (2 twitches on train-of-four) until dural opening when the rocuronium infusion was discontinued and 2 mg/kg sugammadex administered. In the control group, no neuromuscular blockade was administered after induction of anesthesia. The primary outcome was a comparison between sugammadex and control groups of mean TceMEP amplitudes in the abductor pollicis brevis muscles of both upper extremities 5 minutes after dural. Secondary outcomes included TceMEP amplitudes at 10, 20, 30, and 60 minutes after dural opening.

Results:

Sixty-six patients were included in the analysis. TceMEP amplitudes were significantly greater in the sugammadex group (629 μV, interquartile range: 987 μV) than in the control group (502 μV, interquartile range: 577 μV; P=0.033) at 5 minutes after dural opening. TceMEP amplitudes were also greater in the sugammadex group at 10 minutes (P=0.0010), 20 minutes (P=0.003), 30 minutes (P=0.001), and 60 minutes (P=0.003) after dural opening.

Conclusions:

Moderate neuromuscular blockade induced by continuous infusion of rocuronium was effectively reversed by sugammadex. This suggests that sugammadex could be used to enhance TceMEP waveform monitoring during spine surgery requiring muscle relaxation.
Individualized Functional Knee Alignment in Total Knee Arthroplasty: A Robotic-assisted Technique
Authors: Clark Gavin W. , Esposito Christina I. , Wood David
Published: November 2021

Introduction:

The use of robotic technology is becoming a well-recognized alternative to conventional total knee arthroplasty (TKA). The quantitative soft tissue information generated in robotic surgery can be used to balance the knee and achieve functional alignment (FA) of the components. This paper describes a novel FA technique using an individualized preoperative plan that is then adjusted to achieve soft tissue balance.

Materials and Methods:

We report on surgical technique, indications, considerations, and complications after our experience of performing 650 functionally aligned TKAs. We collected 2-year patient reported outcomes on 165 TKAs in this series (165 of 193 TKAs have reached 2 years follow-up in the series of 650 TKAs; 85% follow-up rate).

Results:

We found significant postoperative improvements with few infections and no revisions for mechanical reasons 2 years after surgery with this technique. Patients had improved knee range-of-motion (105 degrees° flexion preoperatively vs. 125 degrees flexion postoperatively; P<0.001), higher Forgotten Joint Scores (17 preoperatively vs. 77 postoperatively; P<0.001), improved Oxford Knee Scores (22 preoperatively vs. 43 postoperatively; P<0.001), higher KOOS Jr scores (48 preoperatively vs. 88 postoperatively; P<0.001) and lower visual analogue score pain scores (70 preoperatively vs. 12 postoperatively; P<0.001) 2 years postoperatively.

Discussion:

The described surgical technique is a promising method for conducting a robotic TKA. Benefits of FA include improved efficiency with preresection balancing, reduced soft tissue releases compared with a mechanical alignment technique, and accurate bony cuts with robotic assistance. Further studies are required to compare this technique with established methods to determine any differences in outcomes.
Clinical features, molecular characteristics and surgical management of primary penile mucosal melanoma based on the European Association of Urology Penile Cancer Guidelines
Authors: Cakir Omer Onur , Pozzi Edoardo , Castiglione Fabio , Freeman Alex , Haider Aiman , Rees Rowland , Alnajjar Hussain M. , Bunker Christopher , Muneer Asif
Published: November 2021

Penile mucosal melanoma is an aggressive and rare genital malignancy. The aim of the present study was to review the management and outcomes of a homogenous cohort of patients with histologically confirmed penile mucosal melanoma, at a single specialist centre. A retrospective review of an institutional database identified patients with penile mucosal melanoma over a 10-year period. Patient demographics, histopathological characteristics, type of primary surgery, recurrence, presence of metastatic disease and molecular markers were evaluated. The management of the patients was initially based on the European Association of Urology (EAU) penile cancer guidelines which are primarily for squamous cell carcinoma with inputs from a melanoma multidisciplinary team. Twelve patients with penile mucosal melanoma were analysed. Median [interquartile range (IQR)] age was 69.5 (67.25−81) years. The overall median follow-up (IQR) was 69.5 (20−114) months, while median follow-up for cancer-specific survival (CSS) was 11.5 (8−37) months. Location of the primary tumour was glans penis (n = 7), urethra (n = 2) and inner prepuce (n = 3). The CSS at 1, 2 and 5 years after primary surgery was 33%, 16.7% and 0%, respectively. The recurrence-free survival at 1, 3 and 5 months after the primary surgery was 90%, 67% and 56%, respectively. All patients with metastatic disease or with inguinal lymph node invasion at presentation, died within 25 months of the primary diagnosis. Management based on the modified EAU penile cancer guidelines still led to poor outcomes. We present a management diagram based on our experience.
Acellular Porcine Cornea Produced by Supercritical Carbon Dioxide Extraction: A Potential Substitute for Human Corneal Regeneration
Authors: Liang Chang-Min , Hsieh Dar-Jen , Tseng Fan-Wei , Srinivasan Periasamy , Yeh Ming-Long , Tai Ming-Cheng
Published: November 2021

Purpose:

The aim of this study was to develop a non-cytotoxic, biocompatible innovative acellular porcine cornea (APC) for corneal wound healing and corneal blindness treatment.

Methods:

APC was produced by using supercritical carbon dioxide (SCCO2) to decellularize the porcine cornea. Decellularization of the porcine cornea was examined by hematoxylin and eosin staining and 4,6-diamidino-2-phenylindole, dihydrochloride staining. The residual DNA content of APC was analyzed in comparison with the native porcine cornea. Virus inactivation up to at least 6 log10 was confirmed for the stepwise process of APC for 4 different model viruses. In addition, a series of in vitro and in vivo tests in accordance with ISO-10993 biocompatibility assay and animal performance tests were performed.

Results:

APC produced by the SCCO2 process revealed complete decellularization, without any residual non-collagenous proteins. The scanning electron microscopy structural features of the decellularized cornea were similar to those of human. APC was found to be nontoxic and exhibited excellent biocompatibility in both in vitro and in vivo studies. The animal performance test proved that APC exerted excellent adaptability on the cornea and no sign of irritation and good compatibility in lamellar corneal transplantation.

Conclusions:

APC manufactured by SCCO2 technology revealed complete cells and non-collagenous protein removal compared with the Triton–sodium dodecyl sulfate decellularization process. APC showed excellent biocompatibility in rabbit lamellar corneal transplantation with a follow-up to 1 year. APC can be a potential substitute for human-donated cornea for corneal transplantation in the near future.
Effects of Blood Flow Restriction Therapy for Muscular Strength, Hypertrophy, and Endurance in Healthy and Special Populations: A Systematic Review and Meta-Analysis
Authors: Perera Edward , Zhu Xi Ming , Horner Nolan S. , Bedi Asheesh , Ayeni Olufemi R. , Khan Moin
Published: November 2021

Objectives:

Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates the effectiveness of BFR training relative to other forms of training on muscle strength, hypertrophy, and endurance.

Data sources:

We performed systematic searches of MEDLINE, Embase, and PubMed and assessed the methodological quality of included studies using the Cochrane risk of bias tool.

Main results:

We included 53 randomized controlled trials with 31 included in meta-analyses. For muscular strength comparing low-intensity BFR (LI-BFR) training with high-intensity resistance training (HIRT), the pooled mean difference (MD) for 1 repetition maximum was 5.34 kg (95% CI, 2.58-8.09; P < 0.01) favoring HIRT. When comparing LI-BFR training with HIRT for torque, the MD was 6.35 N·m (95% CI, 0.5-12.3; P = 0.04) also favoring HIRT. However, comparing LI-BFR with low-intensity resistance training (LIRT) for torque, there was a MD of 9.94 N·m (95% CI, 5.43-14.45; P < 0.01) favoring BFR training. Assessing muscle hypertrophy, the MD in cross-sectional area was 0.96 cm2 (95% CI, 0.21-1.7; P = 0.01) favoring pooled BFR training compared with nonocclusive training. Assessing endurance, V̇o
2 maximum demonstrated a greater mean increase of 0.37 mL/kg/min (95% CI, −0.97 to 3.17; P = 0.64) in BFR endurance training compared with endurance training alone.

Conclusion:

Blood flow restriction training produced increases in muscular strength, hypertrophy, and endurance. Comparing LI-BFR training with HIRT, HIRT was a significantly better training modality for increasing muscle hypertrophy and strength. However, LI-BFR was superior when compared with a similar low-intensity protocol. Blood flow restriction training is potentially beneficial to those unable to tolerate the high loads of HIRT; however, better understanding of its risk to benefit ratio is needed before clinical application.

Level of evidence:

Level 1.
Study on the Correlation Between Ischemic Leukoaraiosis and Cerebral Large Artery Stenosis Using the Stages of the Preinfarction Period Based on the Result of Computed Tomography Perfusion
Authors: Ren Taojie , Sun Shifu , Li Bo , Chen Yuan , Qu Xiaofeng , Li Chunxing , Deng Xiaowen , Ni Caifang
Published: November 2021

Background and Objective:

The influence of cerebral large artery stenosis (CLAS) on ischemic leukoaraiosis (LA) remains elusive. Based on the proposed stages of the preinfarction period, this study aimed to adopt the staging system to assess the correlation between ischemic LA and CLAS.

Materials and Methods:

Patients with unilateral CLAS ≥50% and without cerebral stroke were screened. The severity and distribution of stenosis were evaluated on computed tomography angiography images. The degree of regional cerebral perfusion was rated according to the stages of preinfarction period: 0=normal, 1=stage Ia, 2=stage Ib, 3=stage IIa, 4=stage IIb. Stage I included stage Ia and stage Ib. Stage II included stage IIa and stage IIb. LA was scored with Fazakas scale on T2-weighted image and/or fluid-attenuated inversion recovery sequences.

Results:

The cohort consisted of 212 patients (mean age, 66.89±11.39 y), including 145 (68.40%) males. CLAS severity and distribution did not differ between patients with and without LA (P>0.05). Normal, stage I, and stage II had significantly different incidences of LA and hemispheric LA scores in the left and right hemispheres (P<0.05). The degree of regional cerebral perfusion was independently associated with LA in the left (P=0.0094) and right hemispheres (P=0.0091).

Conclusions:

Ischemic LA is not directly related to CLAS but is independently associated with the degree of CLAS-induced cerebral hypoperfusion. The stages of the preinfarction period are helpful in identifying people at high risk of LA progression.
High Serum Levels of Resistin is Associated With Acute Cerebral Infarction
Authors: Lee Kee Ook , Lee Kyung-Yul , Lee Cheol-Young , Kim Ji Hoon , Kang Jaeku , Lee Hoi Young , Na Sang-Jun , Oh Seung-Hun , Heo Ji Hoe
Published: November 2021

Background:

The inflammatory process is involved in the pathogenesis of atherosclerosis and brain tissue injury following cerebral ischemia. Human resistin is a member of small cysteine-rich secreted proteins and has been implicated in inflammatory responses. This study investigated the association of serum resistin level with acute cerebral infarction (ACI). We also investigated its association with the short-term functional outcome.

Methods:

This study included 106 patients with ACI and 106 age-matched and sex-matched healthy control subjects. Serum resistin level was assessed by using enzyme-linked immunosorbent sandwich assay. The association of serum resistin levels with ACI was analyzed by logistic regression analysis.

Results:

The serum resistin level was significantly higher in patients with ACI than the control group [median (interquartile range), 35.7 ng/mL (13.0 to 70.5) ng/mL vs. 10.5 ng/ml (15.4 to 16.6), P<0.001]. Logistic regression analysis showed that serum resistin level was associated with an ACI (odds ratio=1.055, 95% confidence interval: 1.035-1.074, P<0.001). Among stroke subtypes, the serum resistin level was higher in the patients with large artery atherosclerosis than those with other subtypes (P=0.013). High resistin levels were also significantly associated with unfavorable functional outcome at discharge (odds ratio=1.043, 95% confidence interval: 1.024-1.063, P<0.001).

Conclusions:

This study suggests the potential association of resistin with stroke and cerebral atherosclerosis. Increased serum resistin levels were also associated with early unfavorable neurological outcome.
Quadriparesis Due to Delayed Tension Pneumoventricle
Authors: Maramattom Boby Varkey
Published: November 2021

Introduction:

Although pneumocephalus is very common after intracranial or spinal surgeries, pneumoventricle is uncommon. Tension pneumoventricle (tPV) occurs when air in the ventricles expands to cause neurological deficits or mass effect. It is usually seen with a combination of a ball-valve defect postoperatively that sucks in air and a ventriculoperitoneal shunt that drains cerebrospinal fluid and allows the ingress of air.

Case Report:

A young man developed delayed tPV after surgery for craniopharyngioma. He required multiple surgeries and occlusion of the ventriculoperitoneal shunt before the tPV resolved.

Conclusions:

The probable mechanisms of tPV and the importance of early recognition and treatment are discussed. A review of the literature of this uncommon entity has also been performed.
Is Selenium Supplementation Beneficial in Acute Ischemic Stroke?
Authors: Ramezani Mahtab , Simani Leila , Abedi Sahar , Pakdaman Hossein
Published: November 2021

Background:

Selenium (Se) plays a significant role in brain physiology. The existing human data demonstrate that stroke is associated with significantly reduced Se levels and glutathione peroxidase (GPx) activity. This study proposed to investigate the effect of intravenous Se (Selenase) administration in patients with acute ischemic stroke (AIS) on neurological outcomes, antioxidant enzyme activity, and inflammatory marker levels.

Methods:

AIS patients (n=50) were recruited from a neurology unit of a university-affiliated hospital. Patients were randomly assigned to receive either Selenase or placebo (saline) for 5 days. The modified ranking scale, the national institute of health stroke scale, and the mini-mental state examination, as primary outcomes, and the serum GPx concentration, total antioxidant activity, and tumor necrosis factor-α levels, as secondary outcomes, were measured at the baseline and on day 30.

Results:

Eventually, 44 patients with AIS completed the intervention study. A notable increase in GPx and total antioxidant activity levels was detected in the treatment group compared with the placebo group (110.63±52.48 m/mL, 1.34±0.30 mmol/L, P<0.05), whereas the serum tumor necrosis factor-α level in the Selenase group was significantly lower than that of the placebo group (58.58±61.33 pg/mL, P<0.05). In addition, Selenase improved the modified ranking scale and national institute of health stroke scale scores significantly (P<0.05 and <0.04, respectively), but no statistical difference was observed between the 2 groups in the mini-mental state examination score.

Conclusion:

Selenase, plausibly due to its antioxidant function, results in positive outcomes in terms of neurological deficits, antioxidant enzyme activity, and inflammatory marker levels.
Inadvertent Acute Lipid Injectable Emulsion Overdose Resulting in Fat Overload Syndrome and Pancreatitis in a Patient with TPN Dependence
Authors: Schlegelmilch Michael , Feder Joshua , Creery David
Published: November 2021

We report a case of an acute, inadvertent, 7.5-fold intravenous lipid emulsion overdose with 20% SMOFlipid in an 11-month-old female with tetratricopeptide repeat domain 7A (TTC7A) mutation, intestinal failure, and parenteral nutrition dependence. The overdose resulted in critical deterioration with evidence of fever, metabolic acidosis, respiratory failure, and pancreatitis that resulted in admission to the intensive care unit. This is a unique case of fat overload syndrome with acute pancreatitis following an accidental lipid injectable emulsion overdose in a pediatric patient.
CD4 Trends With Evolving Treatment Initiation Policies Among Children Living With HIV in Zambézia Province, Mozambique, 2012–2018
Authors: Carlucci James G. , De Schacht Caroline , Graves Erin , González Purificación , Bravo Magdalena , Yu Zhihong , Amorim Gustavo , Arinze Folasade , Silva Wilson , Tique Jose A. , Alvim Maria F. S. , Simione Beatriz , Fernando Anibal N. , Wester C. William
Published: November 2021

Background:

Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with "Test and Start" wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique.

Methods:

This retrospective evaluation was performed using routinely collected data. Children living with HIV (CL aged 5–14 years) with CD4 data in the period of 2012–2018 were included. ART initiation “policy periods” corresponded to implementation of evolving guidelines: in period 1 (2012–2016), ART was recommended for CD4 <350 cells/mm3; during period 2 (2016–2017), the CD4 threshold increased to <500 cells/mm3; Test and Start was implemented in period 3 (2017–2018). We described temporal trends in the proportion of children with severe immunodeficiency (CD4 <200 cells/mm3) at enrollment and at ART initiation. Multivariable regression models were used to estimate associations with severe immunodeficiency.

Results:

The cohort included 1815 children with CD4 data at enrollment and 1922 at ART initiation. The proportion of children with severe immunodeficiency decreased over time: 20% at enrollment into care in period 1 vs. 16% in period 3 (P = 0.113) and 21% at ART initiation in period 1 vs. 15% in period 3 (P = 0.004). Children initiating ART in period 3 had lower odds of severe immunodeficiency at ART initiation compared with those in period 1 [adjusted odds ratio (aOR) = 0.67; 95% CI: 0.51 to 0.88]. Older age was associated with severe immunodeficiency at enrollment (aOR = 1.13; 95% CI: 1.06 to 1.20) and at ART initiation (aOR = 1.14; 95% CI: 1.08 to 1.21).

Conclusions:

The proportion of children with severe immunodeficiency at ART initiation decreased alongside more inclusive ART initiation guidelines. Earlier treatment of children living with HIV is imperative.
Why are rhizobial symbiosis genes mobile?
Authors: Wardell Grace E. , Hynes Michael F. , Young Peter J. , Harrison Ellie
Published: November 2021

Rhizobia are one of the most important and best studied groups of bacterial symbionts. They are defined by their ability to establish nitrogen-fixing intracellular infections within plant hosts. One surprising feature of this symbiosis is that the bacterial genes required for this complex trait are not fixed within the chromosome, but are encoded on mobile genetic elements (MGEs), namely plasmids or integrative and conjugative elements. Evidence suggests that many of these elements are actively mobilizing within rhizobial populations, suggesting that regular symbiosis gene transfer is part of the ecology of rhizobial symbionts. At first glance, this is counterintuitive. The symbiosis trait is highly complex, multipartite and tightly coevolved with the legume hosts, while transfer of genes can be costly and disrupt coadaptation between the chromosome and the symbiosis genes. However, horizontal gene transfer is a process driven not only by the interests of the host bacterium, but also, and perhaps predominantly, by the interests of the MGEs that facilitate it. Thus understanding the role of horizontal gene transfer in the rhizobium–legume symbiosis requires a ‘mobile genetic element's-eye view' on the ecology and evolution of this important symbiosis.

This article is part of the theme issue ‘The secret lives of microbial mobile genetic elements’.
Harmful behaviour through plasmid transfer: a successful evolutionary strategy of bacteria harbouring conjugative plasmids
Authors: Domingues Célia P. F. , Rebelo João S. , Monteiro Francisca , Nogueira Teresa , Dionisio Francisco
Published: November 2021

Conjugative plasmids are extrachromosomal mobile genetic elements pervasive among bacteria. Plasmids' acquisition often lowers cells' growth rate, so their ubiquity has been a matter of debate. Chromosomes occasionally mutate, rendering plasmids cost-free. However, these compensatory mutations typically take hundreds of generations to appear after plasmid arrival. By then, it could be too late to compete with fast-growing plasmid-free cells successfully. Moreover, arriving plasmids would have to wait hundreds of generations for compensatory mutations to appear in the chromosome of their new host. We hypothesize that plasmid-donor cells may use the plasmid as a ‘weapon’ to compete with plasmid-free cells, particularly in structured environments. Cells already adapted to plasmids may increase their inclusive fitness through plasmid transfer to impose a cost to nearby plasmid-free cells and increase the replication opportunities of nearby relatives. A mathematical model suggests conditions under which the proposed hypothesis works, and computer simulations tested the long-term plasmid maintenance. Our hypothesis explains the maintenance of conjugative plasmids not coding for beneficial genes.

This article is part of the theme issue ‘The secret lives of microbial mobile genetic elements’.
Prenatal opioid exposure inhibits microglial sculpting of the dopamine system selectively in adolescent male offspring
Authors: Smith Caroline J. , Lintz Tania , Clark Madeline J. , Malacon Karen E. , Constantino Nicholas J. , Kim Veronica J. , Jo Young C. , Alonso-Caraballo Yanaira , Abiad Alia , Bilbo Staci D. , Chartoff Elena H.
Published: November 2021

The current opioid epidemic has dramatically increased the number of children who are prenatally exposed to opioids, including oxycodone. A number of social and cognitive abnormalities have been documented in these children as they reach young adulthood. However, little is known about the mechanisms underlying developmental effects of prenatal opioid exposure. Microglia, the resident immune cells of the brain, respond to acute opioid exposure in adulthood. Moreover, microglia are known to sculpt neural circuits during healthy development. Indeed, we recently found that microglial phagocytosis of dopamine D1 receptors (D1R) in the nucleus accumbens (NAc) is required for the natural developmental decline in NAc-D1R that occurs between adolescence and adulthood in rats. This microglial pruning occurs only in males, and is required for the normal developmental trajectory of social play behavior. However, virtually nothing is known as to whether this developmental program is altered by prenatal exposure to opioids. Here, we show in rats that maternal oxycodone self-administration during pregnancy leads to reduced adolescent microglial phagocytosis of D1R and subsequently higher D1R density within the NAc in adult male, but not female, offspring. Finally, we show that prenatal opioid exposure abolishes the extinction of oxycodone-conditioned place preference in these male offspring. This work demonstrates for the first time that microglia play a key role in translating prenatal opioid exposure to long-term changes in neural systems and behavior.

Highlights

Prenatal opioid exposure decreases offspring viability and body weight in males and females

Prenatal opioid exposure decreases microglial phagocytosis of D1R in the nucleus accumbens in males only

Prenatal opioid exposure increases nucleus accumbens dopamine D1 receptor expression in males but not females

Adult males fail to extinguish oxycodone-conditioned place preference following prenatal oxycodone exposure
A facile platform to engineer E. coli tyrosyl-tRNA synthetase adds new chemistries to the eukaryotic genetic code, including a phosphotyrosine mimic
Authors: Grasso Katherine T. , Roy Soumya Jyoti Singha , Yeo Megan Jin Rae , Soni Chintan , Osgood Arianna O. , Hillenbrand Christen M. , Chatterjee Abhishek
Published: November 2021

The E. coli tyrosyl-tRNA synthetase (EcTyrRS)/tRNAEcTyr pair offers an attractive platform to genetically encode new noncanonical amino acids (ncAA) in eukaryotes. However, challenges associated with a eukaryotic selection system, which is needed for its engineering, has impeded its success in the past. Recently, we showed that EcTyrRS can be engineered using a facile E. coli based selection system, in a strain where the endogenous tyrosyl pair has been substituted with an archaeal counterpart. However, a significant cross-reactivity between the UAG-suppressing tRNACUAEcTyr and the bacterial glutaminyl-tRNA synthetase limited the scope of this strategy, preventing the selection of moderately active EcTyrRS mutants. Here we report an engineered tRNACUAEcTyr that overcomes this cross-reactivity. Optimized selection systems using this tRNA enabled efficient enrichment of both strongly and weakly active ncAA-selective EcTyrRS mutants. We also developed a wide-dynamic range (WiDR) antibiotic selection to further enhance the activities of the weaker first-generation EcTyrRS mutants. We demonstrated the utility of our platform by developing several new EcTyrRS mutants that efficiently incorporate useful ncAAs in mammalian cells, including photo-affinity probes, bioconjugation handles, and a non-hydrolyzable mimic of phosphotyrosine.
X chromosomes show relaxed selection and complete somatic dosage compensation acrossTimemastick insect species
Authors: Parker Darren J. , Jaron Kamil S. , Dumas Zoé , Robinson-Rechavi Marc , Schwander Tanja
Published: November 2021

Sex chromosomes have evolved repeatedly across the tree of life. As they are present in different copy numbers in males and females, they are expected to experience different selection pressures than the autosomes, with consequences including a faster rate of evolution, increased accumulation of sexually antagonistic alleles, and the evolution of dosage compensation. Whether these consequences are general or linked to idiosyncrasies of specific taxa is not clear as relatively few taxa have been studied thus far. Here we use wholegenome sequencing to identify and characterize the evolution of the X chromosome in five species ofTimemastick insects with XX:X0 sex determination. The X chromosome had a similar size (approximately 11% of the genome) and gene content across all five species, suggesting that the X chromosome originated prior to the diversification of the genus. Genes on the X showed evidence of relaxed selection (elevated dN/dS) and a slower evolutionary rate (dN + dS) than genes on the autosomes, likely due to sex-biased mutation rates. Genes on the X also showed almost complete dosage compensation in somatic tissues (heads and legs), but dosage compensation was absent in the reproductive tracts. Contrary to prediction, sex-biased genes showed little enrichment on the X, suggesting that the advantage X-linkage provides to the accumulation of sexually antagonistic alleles is weak. Overall, we found the consequences of X-linkage on gene sequences and expression to be similar acrossTimemaspecies, showing the characteristics of the X chromosome are surprisingly consistent over 30 million years of evolution.
Oxonium trans-bis(oxalato)rhodate and related sodium salts: a rare example of crystalline complex acid
Authors: Garkul Ilia , Zadesenets Andrey , Filatov Evgeny , Baidina Iraida , Tkachev Sergey , Samsonenko Denis , Korenev Sergey
Published: November 2021

New coordination compounds trans-bis(oxalato)diaquarhodiate sodium dihydrate Na[Rh(H2O)2Ox2]·2H2O (crystallizes in two polymorphic forms NaRh-1 and NaRh-2), trans-bis(oxalato)hydroxoaquarhodiate sodium tetrahydrate Na2[Rh(H2O)(OH)Ox2]·4H2O (Na2Rh) and trans-bis(oxalato)diaquarhodic acid tetrahydrate (H3O)[Rh(H2O)2Ox2]·4H2O (HRh) are synthesized. The compounds are characterized by IR spectroscopy, elemental analysis and single crystal X-ray diffraction. NaRh-1, NaRh-2 and Na2Rh crystallize in space group P
1. Trans-bis(oxalato)diaquarhodic acid exists not only in solution, but can also crystallize as a tetrahydrate (space group C2/c). The formation of various species in solution of rhodium hydroxide in oxalic acid and their redistribution were studied using 103Rh NMR spectroscopy.
Deciphering the impact of responsiveness on customer satisfaction, cross-buying behaviour, revisit intention and referral behaviour
Authors: Sharma Deepika , Paul Justin , Dhir Sanjay , Taggar Rashi
Published: November 2021

Purpose

The ease and convenience of online shopping are shifting the customers to e-tailers. This has prompted offline retailers to re-examine behavioural patterns along with a reconfiguration for a responsive retail model. The paper investigates the influence of responsiveness on customer satisfaction, cross-buying behaviour, revisit intention and referral behaviour.

Design/methodology/approach

Data were collected via a survey answered by 793 fashion customers from India, and for data analysis, partial least square structural equation modelling (PLS-SEM) was employed. Path analysis was used to determine the interrelationships amongst the constructs used in the study.

Findings

The standardized path coefficients depict competitive responsiveness as the highest contributor of retailers' responsiveness followed by service responsiveness, employee responsiveness and customer responsiveness. The findings suggest that customer satisfaction acts as the biggest contributor to referral behaviour followed by cross-buying behaviour and revisit intentions.

Originality/value

This study has made a substantial contribution to fashion apparel retailing. The findings revealed that responsive retailing influences the customers' post-purchase behaviour as they engage in more cross-buying, revisiting and referral behaviour. The retailers are encouraged to carefully monitor their preparedness to deliver a combination of sensory, emotional, cognitive and social experience to their customers.