bluuebunny/crossref_metadata_2025 huggingface dataset:
Pattern of Neuronal and Axonal Damage, Glial Response, and Synaptic Changes in Rat Cerebellum within the First Week following Traumatic Brain Injury
Authors: Dolenec Petra , Pilipović Kristina , Janković Tamara , Župan Gordana
Published: October 2020

We examined damage and repair processes in the rat cerebellum within the first week following moderate traumatic brain injury (TBI) induced by lateral fluid percussion injury (LFPI) over the left parietal cortex. Rats were killed 1, 3, or 7 days after the injury or sham procedure. Fluoro-Jade B staining revealed 2 phases of neurodegenerative changes in the cell bodies and fibers: first, more focal, 1 day after the LFPI, and second, widespread, starting on post-injury day 3. Purkinje cell loss was detected in posterior lobule IX 1 day following LFPI. Apoptosis was observed in the cerebellar cortex, on days 1 and 7 following LFPI, and was not caspase- or apoptosis-inducing factor (AIF)-mediated. AIF immunostaining indicated axonal damage in the cerebellar white matter tracts 3- and 7-days post-injury. Significant astrocytosis and microgliosis were noticed on day 7 following LFPI at the sites of neuronal damage and loss. Immunohistochemical labeling with the presynaptic markers synaptophysin and growth-associated protein-43 revealed synaptic perturbations already on day 1 that were more pronounced at later time points following LFPI. These results provide new insights into pathophysiological alterations in the cerebellum and their mechanisms following cerebral TBI.
How Are Residents Trained in Neuropathology? A Survey of Neurology Program Directors in the United States
Authors: Rayi Appaji , Rajneesh Kiran , Punia Vineet , Start Amanda R
Published: October 2020

To understand the current state of neurology residents training in neuropathology, we electronically distributed a 16-item survey to 150 adult and 70 child neurology program directors (PDs). The survey inquired about their program characteristics, neuropathology curriculum and assessment methods, trainee performance, and attitudes. Descriptive analysis was used to summarize categorical variables as frequencies and percentages and continuous as means and standard deviations. We conducted a series of Mann-Whitney U and Fisher’s exact tests to evaluate differences between various program characteristics. Sixty-four (29%) PDs responded to the survey, including 45 (30%) adult and 19 (27%) child neurology PDs. Thirty-one programs required a dedicated neuropathology rotation. The majority (92%) used the Residency In-Service Training Examination (RITE) to assess trainee’s knowledge. Approximately 86% of the PDs agreed that neuropathology is essential and a defined curriculum is necessary during residency training. There was no difference in the RITE scores between programs. We conclude that a neuropathology rotation was felt to be essential even though the RITE scores did not differ between programs with and without a dedicated rotation. Alternative evaluation and training methods may need consideration. A future survey of all the stakeholders may be required to thoroughly understand and disseminate the neuropathology education well.
Morphometry as a probe of the evolution of jellyfish galaxies: evidence of broadening in the surface brightness profiles of ram-pressure stripping candidates in the multicluster system A901/A902
Authors: Roman-Oliveira Fernanda , Chies-Santos Ana L , Ferrari Fabricio , Lucatelli Geferson , Rodríguez Del Pino Bruno
Published: October 2020

We explore the morphometric properties of a group of 73 ram-pressure stripping candidates in the A901/A902 multicluster system, at z∼ 0.165, to characterize the morphologies and structural evolution of jellyfish galaxies. By employing a quantitative measurement of morphometric indicators with the algorithm morfometryka on Hubble Space Telescope (F606W) images of the galaxies, we present a novel morphology-based method for determining trail vectors. We study the surface brightness profiles and curvature of the candidates and compare the results obtained with two analysis packages, morfometryka and iraf/ellipse on retrieving information of the irregular structures present in the galaxies. Our morphometric analysis shows that the ram-pressure stripping candidates have peculiar concave regions in their surface brightness profiles. Therefore, these profiles are less concentrated (lower Sérsic indices) than other star-forming galaxies that do not show morphological features of ram-pressure stripping. In combination with morphometric trail vectors, this feature could both help identify galaxies undergoing ram-pressure stripping and reveal spatial variations in the star formation rate.
Implications of Einstein–Maxwell dilaton–axion gravity from the black hole continuum spectrum
Authors: Banerjee Indrani , Mandal Bhaswati , SenGupta Soumitra
Published: October 2020

String inspired models can serve as potential candidates to replace general relativity (GR) in the high-energy/high-curvature regime where quantum gravity is expected to play a vital role. Such models not only subsume the ultraviolet nature of gravity but also exhibit promising prospects in resolving issues like dark matter and dark energy, which cannot be adequately addressed within the framework of GR. The Einstein–Maxwell dilaton–axion (EMDA) theory that is central to this work is one such string inspired model arising in the low energy effective action of the heterotic string theory with interesting implications in inflationary cosmology and in the late-time acceleration of the Universe. It is therefore important to survey the role of such a theory in explaining astrophysical observations, e.g. the continuum spectrum of black holes which is expected to hold a wealth of information regarding the background metric. The Kerr–Sen space–time corresponds to the exact, stationary, and axisymmetric black hole solution in EMDA gravity, possessing dilatonic charge and angular momentum originating from the axionic field. In this work, we compute the theoretical spectrum from the accretion disc around quasars in the Kerr–Sen background assuming the thin accretion disc model due to Novikov and Thorne. This is then used to evaluate the theoretical estimates of optical luminosity for a sample of eighty Palomar Green quasars which are subsequently compared with the available observations. Our results based on χ2 analysis indicate that the dilaton parameter r2 ∼ 0.2 is favoured by optical observations of quasars which is further corroborated by other error estimators e.g. the Nash–Sutcliffe efficiency, the index of agreement and their modified versions. We further report that strong dilaton charges (r2 > 1.6) are disfavoured by quasar optical data and the spins associated with the quasars are also estimated.
Neutron star crust in Voigt approximation: general symmetry of the stress–strain tensor and an universal estimate for the effective shear modulus
Authors: Chugunov Andrey I
Published: October 2020

I discuss elastic properties of neutron star crust in the framework of static Coulomb solid model when atomic nuclei are treated as non-vibrating point charges; electron screening is neglected. The results are also applicable for solidified white dwarf cores and other materials, which can be modelled as Coulomb solids (dusty plasma, trapped ions, etc.). I demonstrate that the Coulomb part of the stress–strain tensor has additional symmetry: contraction Bijil = 0. It does not depend on the structure (crystalline or amorphous) and composition. I show as a result of this symmetry the effective (Voigt averaged) shear modulus of the polycrystalline or amorphous matter to be equal to −2/15 of the Coulomb (Madelung) energy density at undeformed state. This result is general and exact within the model applied. Since the linear mixing rule and the ion sphere model are used, I can suggest a simple universal estimate for the effective shear modulus: $\sum _Z 0.12\, n_Z Z^{5/3}e^2 /a_\mathrm{e}$. Here summation is taken over ion species, nZ is number density of ions with charge Ze. Finally, ae = (4πne/3)−1/3 is electron sphere radius. Quasi-neutrality condition ne = ∑ZZnZ is assumed.
OMA orthology in 2021: website overhaul, conserved isoforms, ancestral gene order and more
Authors: Altenhoff Adrian M , Train Clément-Marie , Gilbert Kimberly J , Mediratta Ishita , Mendes de Farias Tarcisio , Moi David , Nevers Yannis , Radoykova Hale-Seda , Rossier Victor , Warwick Vesztrocy Alex , Glover Natasha M , Dessimoz Christophe
Published: October 2020

OMA is an established resource to elucidate evolutionary relationships among genes from currently 2326 genomes covering all domains of life. OMA provides pairwise and groupwise orthologs, functional annotations, local and global gene order conservation (synteny) information, among many other functions. This update paper describes the reorganisation of the database into gene-, group- and genome-centric pages. Other new and improved features are detailed, such as reporting of the evolutionarily best conserved isoforms of alternatively spliced genes, the inferred local order of ancestral genes, phylogenetic profiling, better cross-references, fast genome mapping, semantic data sharing via RDF, as well as a special coronavirus OMA with 119 viruses from the Nidovirales order, including SARS-CoV-2, the agent of the COVID-19 pandemic. We conclude with improvements to the documentation of the resource through primers, tutorials and short videos. OMA is accessible at https://omabrowser.org.
Impact of dialysis modality on major adverse cardiovascular events and all-cause mortality: a national population-based study
Authors: Hu Ping-Jen , Chen Yu-Wei , Chen Tzu-Ting , Sung Li-Chin , Wu Mei-Yi , Wu Mai-Szu
Published: October 2020

Background

Only few studies with inconsistent results comparing the relative risk of cardiac mortality between peritoneal dialysis (PD) and hemodialysis (HD). Switches between renal replacement therapy (RRT) modalities render objective assessment of survival benefits a greater challenge.

Methods

Data were retrieved from Taiwan’s National Health Insurance Database from 1 January 2006 to 31 December 2015. We included 13 662 and 41 047 long-term dialysis patients in a propensity score matching study design and a time-varying study design, respectively, to compare major adverse cardiovascular events (MACEs) between patients receiving PD and HD. We also included 109 256 dialysis patients to compare the all-cause mortality among different RRT modalities.

Results

For MACE, the hazard ratio (HR) for PD patients compared to HD patients was 0.95 [95% confidence interval (CI) 0.89–1.02] in the propensity score study design and 1.06 (95% CI 1.01–1.12) in the time-varying study design. For all-cause mortality, the HR for PD patients compared to HD patients was 1.09 (95% CI 1.05–1.13) in the propensity score study design and 1.13 (95% CI 1.09–1.17) in the time-varying study design. The HR for death was higher at a level of statistical significance for females (1.21, 95% CI 1.15–1.28), patients ≥65 years old (1.30, 95% CI 1.24–1.36) and diabetes mellitus (DM; 1.28, 95% CI 1.22–1.34).

Conclusions

The HR for MACE is significantly higher among PD patients in time-varying design analysis. In addition, all-cause mortality was higher in PD patients compared to patients with HD, especially in those who were aged ≥65 years, female or DM.
Preoperative Navigated Transcranial Magnetic Stimulation Improves Gross Total Resection Rates in Patients with Motor-Eloquent High-Grade Gliomas: A Matched Cohort Study
Authors: Hendrix Philipp , Dzierma Yvonne , Burkhardt Benedikt W , Simgen Andreas , Wagenpfeil Gudrun , Griessenauer Christoph J , Senger Sebastian , Oertel Joachim
Published: October 2020

BACKGROUND

Navigated transcranial magnetic stimulation (nTMS) is an established, noninvasive tool to preoperatively map the motor cortex. Despite encouraging reports from few academic centers with vast nTMS experience, its value for motor-eloquent brain surgery still requires further exploration.

OBJECTIVE

To further elucidate the role of preoperative nTMS in motor-eloquent brain surgery.

METHODS

Patients who underwent surgery for a motor-eloquent supratentorial glioma or metastasis guided by preoperative nTMS were retrospectively reviewed. The nTMS group (n = 105) was pair-matched to controls (non-nTMS group, n = 105). Gross total resection (GTR) and motor outcome were evaluated. Subgroup analyses including survival analysis for WHO III/IV glioma were performed.

RESULTS

GTR was significantly more frequently achieved in the entire nTMS group compared to the non-nTMS group (P = .02). Motor outcome did not differ (P = .344). Bootstrap analysis confirmed these findings. In the metastases subgroup, GTR rates and motor outcomes were equal. In the WHO III/IV glioma subgroup, however, GTR was achieved more frequently in the nTMS group (72.3%) compared to non-nTMS group (53.2%) (P = .049), whereas motor outcomes did not differ (P = .521). In multivariable Cox-regression analysis, prolonged survival in WHO III/IV glioma was significantly associated with achievement of GTR and younger patient age but not nTMS mapping.

CONCLUSION

Preoperative nTMS improves GTR rates without jeopardizing neurological function. In WHO III/IV glioma surgery, nTMS increases GTR rates that might translate into a beneficial overall survival. The value of nTMS in the setting of a potential survival benefit remains to be determined.
Improved risk stratification in youngerIDHwild-type glioblastoma patients by combining a 4-miRNA signature withMGMTpromoter methylation status
Authors: Unger Kristian , Fleischmann Daniel F , Ruf Viktoria , Felsberg Jörg , Piehlmaier Daniel , Samaga Daniel , Hess Julia , Suresh Marian Preetham , Mittelbronn Michel , Lauber Kirsten , Budach Wilfried , Sabel Michael , Rödel Claus , Reifenberger Guido , Herms Jochen , Tonn Jörg-Christian , Zitzelsberger Horst , Belka Claus , Niyazi Maximilian
Published: October 2020

Background

The potential benefit of risk stratification using a 4-miRNA signature in combination with MGMT promoter methylation in IDH1/2 wild-type glioblastoma patients was assessed.

Methods

Primary tumors from 102 patients with comparable treatment from the LMU Munich (n = 37), the University Hospital Düsseldorf (n = 33), and The Cancer Genome Atlas (n = 32) were included. Risk groups were built using expressions of hsa-let-7a-5p, hsa-let-7b-5p, hsa-miR-615-5p, and hsa-miR-125a-5p to assess prognostic performance in overall survival (OS). MGMT promoter methylation and age were considered as cofactors. Integrated miRNA, DNA methylome, and transcriptome analysis were used to explore the functional impact of signature miRNAs.

Results

The 4-miRNA signature defined high-risk (n = 46, median OS: 15.8 months) and low-risk patients (n = 56, median OS: 20.7 months; univariable Cox proportional hazard analysis: hazard ratio [HR]: 1.8, 95% confidence interval [CI]: 1.14–2.83, P = .01). The multivariable Cox proportional hazard model including the 4-miRNA signature (P = .161), MGMT promoter methylation (P < .001), and age (P = .034) significantly predicted OS (Log-rank P < .0001). Likewise to clinical routine, analysis was performed for younger (≤60 years, n = 50, median OS: 20.2 months) and older patients (>60 years, n = 52, median OS: 15.8) separately. In younger patients, the 4-miRNA signature had prognostic value (HR: 1.92, 95% CI: 0.93–3.93, P = .076). Particularly, younger, MGMT methylated, 4-miRNA signature low-risk patients (n = 18, median OS: 37.4 months) showed significantly improved survival, compared to other younger patients (n = 32, OS 18.5 months; HR: 0.33, 95% CI: 0.15–0.71, P = .003). Integrated data analysis revealed 4-miRNA signature-associated genes and pathways.

Conclusion

The prognostic 4-miRNA signature in combination with MGMT promoter methylation improved risk stratification with the potential for therapeutic substratification, especially of younger patients.
Pharmacology, Dosing, and Side Effects of Rifabutin as a Possible Therapy for Antibiotic-Resistant Acinetobacter Infections
Authors: Phillips Matthew C , Wald-Dickler Noah , Loomis Katherine , Luna Brian M , Spellberg Brad
Published: October 2020

Acinetobacter baumannii has among the highest rates of antibiotic resistance encountered in hospitals. New therapies are critically needed. We found that rifabutin has previously unrecognized hyperactivity against most strains of A. baumannii. Here we review the pharmacology and adverse effects of rifabutin to inform potential oral dosing strategies in patients with A. baumannii infections. Rifabutin demonstrates dose-dependent increases in blood levels up to 900 mg per day, but plateaus thereafter. Furthermore, rifabutin induces its own metabolism after prolonged dosing, lowering its blood levels. Pending future development of an intravenous formulation, a rifabutin oral dose of 900–1200 mg per day for 1 week is a rational choice for adjunctive therapy of A. baumannii infections. This dosage maximizes AUC24 to drive efficacy while simultaneously minimizing toxicity. Randomized controlled trials will be needed to definitively establish the safety and efficacy of rifabutin to treat A. baumannii infections.
Analytic solutions for neutrino-light curves of core-collapse supernovae
Authors: Suwa Yudai , Harada Akira , Nakazato Ken’ichiro , Sumiyoshi Kohsuke
Published: October 2020

Neutrinos are a guaranteed signal from supernova explosions in the Milky Way, and a most valuable messenger that can provide us with information about the deepest parts of supernovae. In particular, neutrinos will provide us with physical quantities, such as the radius and mass of protoneutron stars (PNS), which are the central engine of supernovae. This requires a theoretical model that connects observables such as neutrino luminosity and average energy with physical quantities. Here, we show analytic solutions for the neutrino-light curve derived from the neutrino radiation transport equation by employing the diffusion approximation and the analytic density solution of the hydrostatic equation for a PNS. The neutrino luminosity and the average energy as functions of time are explicitly presented, with dependence on PNS mass, radius, the total energy of neutrinos, surface density, and opacity. The analytic solutions provide good representations of the numerical models from a few seconds after the explosion and allow a rough estimate of these physical quantities to be made from observational data.
Design and characterization of plasticized bacterial cellulose/waterborne polyurethane composite with antibacterial function for nasal stenting
Authors: Feng Zhaoxuan , Li Minglu , Jin Xing , Zheng Yudong , Liu Junxiu , Zhao Liang , Wang Yansen , Li Hao , Zuo Danlin
Published: October 2020

A nasal stent capable of preventing adhesions and inflammation is of great value in treating nasal diseases. In order to solve the problems of tissue adhesion and inflammation response, we prepared plasticized bacterial cellulose (BCG) and waterborne polyurethane (WPU) composite with antibacterial function used as a novel nasal stent. The gelation behavior of BCG could contribute to protecting the paranasal sinus mucosa; meanwhile, the WPU with improved mechanical property was aimed at supporting the narrow nasal cavity. The thickness, size and the supporting force of the nasal stent could be adjusted according to the specific conditions of the nasal. Thermogravimetric analysis, contact angle and water absorption test were applied to investigate the thermal, hydrophilic and water absorption properties of the composite materials. The composite materials loaded with poly(hexamethylene biguanide) hydrochloride maintained well antibacterial activity over 12 days. Animal experiments further revealed that the mucosal epithelium mucosae damage of BCG−WPU composite was minor compared with that of WPU. This new type of drug-loaded nasal stent can effectively address the postoperative adhesions and infections while ensuring the health of nasal mucosal, and thus has an immense clinical application prospects in treating nasal diseases.
Balance Sheet Channel with Information-Trading Frictions in Secondary Markets
Authors: Asriyan Vladimir
Published: October 2020

This article develops a theory of the balance sheet channel that places a central emphasis on the liquidity of secondary markets for macro-contingent claims. We show that the presence of dispersed information and imperfect competition in secondary markets, interacted with financial constraints, results in mispricing and misallocation of aggregate risk, distorts aggregate investment, and exacerbates asset price and output volatility. The magnitude of balance sheet amplification effects becomes endogenously tied to the severity of market frictions, which likely vary over time and across economies. The laissez-faire equilibrium is constrained inefficient due to a novel externality originating from rent-extracting behaviour of agents in secondary markets. Optimal corrective policy boosts secondary market liquidity through subsidies to trade in macro-contingent claims, which enhances aggregate risk-sharing and stabilizes the business cycle.
CT DOSIMETRY FOR THE AUSTRALIAN COHORT DATA LINKAGE STUDY
Authors: Brady Zoe , Forsythe Anna , McBain-Miller Jasmine , Scurrah Katrina J , Smoll Nicolas , Lin Yaqi , Lee Choonsik , Berrington de Gonzalez Amy , Roberts Leo J , Mathews John D
Published: October 2020

Children undergoing computed tomography (CT) scans have an increased risk of cancer in subsequent years, but it is unclear how much of the excess risk is due to reverse causation bias or confounding, rather than to causal effects of ionising radiation. An examination of the relationship between excess cancer risk and organ dose can help to resolve these uncertainties. Accordingly, we have estimated doses to 33 different organs arising from over 900 000 CT scans between 1985 and 2005 in our previously described cohort of almost 12 million Australians aged 0–19 years. We used a multi-tiered approach, starting with Medicare billing details for government-funded scans. We reconstructed technical parameters from national surveys, clinical protocols, regulator databases and peer-reviewed literature to estimate almost 28 000 000 individual organ doses. Doses were age-dependent and tended to decrease over time due to technological improvements and optimisation.
Using the Design Sprint process to enhance and accelerate behavioral medicine progress: a case study and guidance
Authors: Jake-Schoffman Danielle E , McVay Megan A
Published: October 2020

While challenges in the translation of behavioral medicine knowledge from academic settings to real-world use are well documented, they could potentially be reduced through the use of the Design Sprint process, a roadmap that facilitates progression from an idea to a product in 5 days via agile design and user-centered design principles. The Design Sprint is well aligned with several priorities of and methods common in behavioral medicine, including obtaining end-user feedback and thinking about implementation during intervention development. The Design Sprint could be used by behavioral medicine researchers for the development of research tools, implementation strategies, and behavior change interventions. The process may encourage creative and focused thinking, speed product development, and facilitate early user input. However, translating the Design Sprint to behavioral medicine research may present challenges, such as difficulty getting buy-in from team members, inconsistencies between the Design Sprint timeline, the need to obtain institutional review board approval for user testing, and the lack of traditional research processes (e.g., incorporating scientific research into intervention design). Several solutions and adaptations are possible to overcome these challenges while still maintaining the core features of the Design Sprint process. To demonstrate the use of the Design Sprint and potential adaptations, we present a case study of the development of a patient-facing digital tool for weight management and an accompanying implementation strategy. In conclusion, the Design Sprint offers behavioral medicine researchers an approach to developing new products with numerous potential benefits to researchers and to the individuals and communities we seek to impact.
Availability and Accessibility of Emergency Contraception: Misunderstood, Understocked and in Need of Plan A [7G]
Authors: Bunkis Brittany , Liongson Franzes , Tuckfield Lynnia , Anasti James N.
Published: October 2020

INTRODUCTION:

For emergency contraception (EC) to be effective, it has to be readily available. Thus, in 2013 the FDA approved EC Levonorgestrel (LNG) for sale over-the-counter (OTC) without a prescription or age limit. Although requiring a prescription, Ulipristal acetate (UPA) approved in 2010 for EC may be more effective than LNG in certain circumstances. We sought to determine the accessibility of these EC medications at pharmacies in the Lehigh Valley Area of Pennsylvania (population 850,000).

METHODS:

Phone surveys were conducted of Corporate and Independent pharmacies. Only the pharmacist or pharmacy tech provided information about availability, age requirements and accessibility of EC. Corporate and Independent pharmacies were compared using chi squared test with appropriate correction.

RESULTS:

The EC survey included 104 Corporate (CorP) and 26 Independent pharmacies (IndP) in the prescribed area. EC was in stock in 95/104 (91%) of CorP and 14/26 (54%) of IndP (p<.001). UPA was in stock at 12/104 (11%) of CorP and none of the IndP (p=.15). Age restriction was noted in 24/104 (23%) of CorP and 8/26 (31%) of IndP (p=.58). LNG over the counter location was found in 75/104 (72%) of CorP and 2/26 (8%) of IndP (p<.001).

CONCLUSION:

Although regional differences may apply, the availability/accessibly of EC is not ideal. Although the corporate pharmacies appear better than independents, the lack of UPA is a concern. Physicians should be aware of the availability of EC in their area.
Contraception Use and Attitudes Among Women Seeking Pregnancy Termination [9G]
Authors: Rivet Dana Lynn , Ross Sue , Robinson Heather E.
Published: October 2020

INTRODUCTION:

Unintended pregnancies pose negative health and social outcomes to mother and child. North America's unplanned pregnancy rate of 51% is higher than the worldwide rate of 40%. The purpose of this research is to investigate contraceptive use and future contraceptive plans among women presenting for pregnancy termination.

METHODS:

For this descriptive study, women presenting for pregnancy termination were recruited by clinic counsellors. Consenting women completed a self-administered anonymous survey. Ethics approval was obtained. Data were entered using REDCap and analyzed using descriptive statistics.

RESULTS:

Of the 334 participants, 45% used contraception at the time of conception including condoms (54%), combined hormonal contraception (CHC) (35%), withdrawal (30%), rhythm (6%) and intrauterine device (IUD) (3%). Among contraceptive users (n=149) the most common reason for method failure was imperfect use (50%). Among contraceptive non-users (n=185) the most common reason for non-use was perceived low risk of pregnancy (60%). Awareness of emergency contraception (EC) was 97% for Plan B, 33% for copper IUD and 6% for Ulipristal acetate, yet only 53% had ever used EC. 93% of women planned to use contraception in the future, including IUD (32%), CHC (34%), condoms (8%), rhythm (1%) and withdrawal (0.3%).

CONCLUSION:

This study suggests that educating women on the risk of pregnancy and proper use of contraceptive methods would provide the highest yield in reducing unplanned pregnancies. Widespread awareness of EC is not sufficient to ensure its use in the population at risk of unplanned pregnancy. Furthermore, pregnancy termination presents an opportunity to initiate highly effective methods of contraception.
Pediatric Subspecialists and Contraception for Adolescent Women With Chronic Diseases [8P]
Authors: Stanton Taylor Alise , Proussaloglou Ellie , Haider Sadia
Published: October 2020

INTRODUCTION:

Adolescent women with chronic diseases need effective contraception as pregnancy may exacerbate their disease. Additionally, they often take teratogenic medications that may harm a developing fetus. This study aims to understand current practices of pediatric subspecialists caring for adolescents with regards to contraception counseling and provision.

METHODS:

Pediatric subspecialists at a Chicago based academic center completed a Qualtrics survey assessing current practices and knowledge about contraception.

RESULTS:

A total of 37 pediatric subspecialists routinely caring for adolescent women were surveyed. Nearly all stated their patients were on teratogens (78.1%). Many reported that none (40.6%) or few (21.9%) of their patients desired pregnancy. They were comfortable talking to their patients (81.3%) and parents (72.0%) about contraception, however only a minority believed that pediatric subspecialists should be the ones to provide contraceptive counseling (41.4%) or initiate contraception (17.2%). Physicians surveyed refer patients to gynecologists (65.2%), adolescent medicine (17.4%), and general pediatricians (8.7%) for prescription or placement of contraceptives. However, some never refer patients to gynecologists (25.0%) or refer at ages 15 and above (56.3%). 75.9% of subspecialists note barriers to providing contraception to their patients, including lack of time and inadequate training.

CONCLUSION:

Pediatric subspecialists generally recognize contraception as important to their patients. However, self-reported referral for contraception is often later in the teenage years and a sizeable minority of physicians never refer adolescents, despite having a significant proportion of patients on teratogens. Increased training of pediatric subspecialists about contraception and facilitating referral for contraception services could decrease barriers for adolescent women with chronic diseases.
Perinatal Outcomes in Persistent Fetal Growth Restriction and Growth Restriction Based Upon Growth Velocity [34S]
Authors: Sun Chenchen , Hoffman Mallory Michelle , Lash Kayla Alene , Vowels Patricia C. , Chauhan Suneet P. , Sibai Baha M.
Published: October 2020

INTRODUCTION:

Fetal growth restriction (FGR) is associated with adverse perinatal outcomes. The aim of our study was to assess NICU admission rates and composite neonatal morbidity (CNM) in pregnancies with persistent FGR, and to evaluate fetal outcomes based on FGR associated with negative growth velocity.

METHODS:

We conducted a retrospective cohort study of women with non-anomalous singleton pregnancies complicated by FGR who delivered at our institution. Growth velocity was calculated by subtracting the EFW percentile at the final growth scan from the percentile at the first growth scan and dividing by the number of weeks between the scans.

RESULTS:

124 women with pregnancies complicated by FGR were identified. 82 women met inclusion criteria for growth velocity evaluation, 91 women met criteria for assessment of perinatal outcomes of interest. Patients with persistent FGR had an earlier gestational age at time of delivery (36.2 vs. 37.7 wks, p= 0.01), and lower birth weight (2150 gm vs 2601 gm, p=0.005). NICU admission and CNM were higher in pregnancies with persistent FGR (40.3% vs. 13.6%, p=0.036, 37.7% vs. 13.6, p=0.039). Neonates with negative growth velocity more likely delivered at an earlier gestational age (36.2 vs 37.6 weeks, p=0.027), delivered by cesarean section (59.1% vs 36.8%, p=0.044) and had lower birthweight (2154 vs 2475 grams, p=0.020).

CONCLUSION:

Pregnancies with persistent FGR are associated with increased NICU admissions, and composite neonatal morbidity. Similarly, pregnancies with FGR and negative growth velocity are more likely to deliver early, have lower birthweight, and deliver by cesarean section compared to those with growth.
Urologic Injury and Fistula Following Hysterectomy for Benign Indications [37S]
Authors: Dallas Kai B. , Rogo-Gupta Lisa , Elliott Christopher
Published: October 2020

INTRODUCTION:

Genitourinary injury is a rare but devastating complication following hysterectomy. Literature regarding this topic is limited, so we explored genitourinary injury rates (and risk factors for injury) in a population based dataset with long term follow-up.

METHODS:

All women who underwent a hysterectomy for benign indications were identified using data from the Office of Statewide Health Planning and Development in California from 2005-2011. Cases of genitourinary injury were identified (either identified intraoperatively or missed).

RESULTS:

Of the 296,130 women who underwent hysterectomy, 5,455 (1.8%) suffered at least one urologic injury: 2,817 (1.0%) ureteral, 2,058 (0.70%) bladder and 831 (0.3%) fistulas. Sustaining an injury increased the risk of future fistula (1.1% and 2.7% versus 0.3%, p<0.001), however immediate identification and repair of the injury decreased this risk for both ureteral (0.7% versus 3.4%, p<0.001) and bladder (2.5% versus 6.5%, p<0.001) injuries. Multivariate modeling revealed that concomitant POP repair (OR 1.12, p=0.019), a diagnosis of endometriosis (OR 1.40 p<0.001) and surgery at a facility in the bottom 25% of hysterectomy volume (OR 1.37, p=0.049) were associated with increased likelihood of injury, while vaginal (OR 0.85, p=<0.001) or laparoscopic (OR 0.81, p<0.001) approach and diagnosis of endometrial hyperplasia/abnormal uterine bleeding (OR 0.91, p=0.004) were associated with a decreased risk of injury.

CONCLUSION:

Benign hysterectomy carries a ∼1.8% risk of genitourinary injury. Although injury increases the chance of fistula formation, recognizing the injury immediately reduces this risk. We identify several factors that are associated with injury, providing insight where a higher index of suspicion might be held.
Identification of Modifiable and Non-Modifiable Factors Associated With Mid-Urethral Sling Revision Surgery [40S]
Authors: Keslar Melissa Marie , Katz Justin , Margossian Haroutyoun , Lakhi Nisha
Published: October 2020

INTRODUCTION:

The objective of this study was to identify modifiable factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction.

METHODS:

Retrospective analysis of 56 sling revisions performed during the 12-year study period. Those with complete medical records (n=40) were matched to 123 control cases that did not require revision, randomly selected from a total of 946 procedures to obtain a 3:1 control: case ratio. Demographic, history, patient reported symptoms, urodynamic study results, intraoperative data, and post-operative data were collected.

RESULTS:

Significant demographic findings predictive of sling revision included younger age (52.95 vs. 64.48 years, p<0.001) and greater than two previous cesarean deliveries (OR 13.556, 95% CI 1.468-125.137, p=0.013). Presence of posterior pelvic organ prolapse (OR 0.302, 95% CI 0.163-0.803, p=0.011), retropubic sling (OR 2.685, 95% CI 1.037, 6.955, p=0.037) and concomitant apical prolapse repair procedure (OR 3.086, 95% CI 1.299-7.332, p=0.009) was significantly associated with the revision group. Urodynamic factors were not predictive, except a maximum urethral closure pressure less 40 cm H2O was found to be protective (OR 0.0394, 95% CI 0.159-0.978). After multiple regression analysis, younger age, increasing number of cesarean deliveries, and concomitant apical prolapse repair retained statistical significance.

CONCLUSION:

Urodynamic studies were not useful in determining revision risk as compared to patient age, previous surgical history, and concomitant procedures.
Prevalence of Shoulder Dystocia by Maternal Height and Diabetes Status [5T]
Authors: Thayer Sydney Marie , Owens Sarah N. , Skeith Ashley , Valent Amy , Caughey Aaron B.
Published: October 2020

INTRODUCTION:

Our objective was to investigate the association between maternal height and shoulder dystocia in women with and without diabetes.

METHODS:

This is a retrospective cohort study of singleton, non-anomalous, term pregnancies between 2007 and 2011 using linked vital statistics and ICD-9 data. Chi-square tests were used to compare rates of shoulder dystocia by maternal height and diabetes status. Height was stratified in 2 inch increments from 56 inches (4' 8") to 72 inches (6' 0"). Multivariable logistic regression was used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) of shoulder dystocia by height and diabetes status. Regression analysis controlled for maternal BMI, race/ethnicity, age, education, insurance status, and prenatal care.

RESULTS:

In a cohort of 2,069,817 pregnant women, we found that increasing maternal height was associated with decreasing prevalence of shoulder dystocia, independent of diabetes status. After controlling for confounders of interest, there remained a statistically significant decrease in the odds of shoulder dystocia as height increased (aOR 0.97, 95% CI 0.97-0.98). When compared to women without diabetes, those with diabetes had significantly increased odds of shoulder dystocia (aOR 1.61, 95% CI 1.54-1.68), independent of maternal height.

CONCLUSION:

While height is not a modifiable risk factor for shoulder dystocia, odds of this adverse obstetrical outcome should be addressed in patient education and counseling. Particular consideration for shoulder dystocia risk should be given to pregnant women with diabetes and short stature.
Applying Skin Barrier Film for Skin Tear Management in Patients with Central Venous Catheterization
Authors: Chen Ya-Hui , Hsieh Hui-Ling , Shih Whei-Mei
Published: October 2020

OBJECTIVE

To examine and compare different methods of dressing change on skin tears at the periductal wound for ICU patients with central venous catheterization (CVC).

METHODS

This research used a quasi-experimental design. Participants included 98 patients from the ICU of a medical center in Taiwan using a convenience sampling technique from April 1, 2017 to March 31, 2018.

RESULTS

Applying skin barrier film at the CVC insertion site effectively protected the skin and significantly reduced the risk of skin tears among ICU patients (P < .01).

CONCLUSIONS

This study showed that use of skin barrier film at the site of CVC insertion can increase skin strength, maintain skin integrity, and decrease the incidence of skin tears. Skin barrier film is thus recommended for routine use in peripheral skin care for patients receiving CVC.
Failure of Healing in Chronic Diabetic Wounds: A Case Report
Authors: Stiehl James B.
Published: October 2020

Stalled healing in chronic wounds is a challenging problem for providers and remains multifactorial in etiology. Older adults with insulin-dependent diabetes are at very high risk. In this case report, two patients with large nonhealing wounds were considered for treatment with daily jet lavage irrigation in an attempt to remove the inflammatory products of their respective chronic wounds and eliminate the persisting biofilm bacteria. Several attempts were made to reduce treatments to two to three times per week, and negative-pressure wound therapy was initiated in both cases only to see the return of inflammation and necrosis of the wound bed. In both cases, the daily jet lavage irrigation was successful in creating a granulating wound bed that slowly healed over many months. One patient died with an open sacral pressure injury, and the other patient died 4 months after complete healing of a large heel pressure injury. The interesting observation is the necessity of daily high-intensity wound irrigation to correct the chronic infectious process. Diabetic chronic wounds in high-risk older adults are recalcitrant to standard wound treatments, and providers should consider daily jet lavage wound irrigation to deal with this problem.
Creating a Program to Support Registering and Reporting Clinical Trials at Johns Hopkins University
Authors: Keyes Anthony , Mayo-Wilson Evan , Nuamah Prince , Lalji Aliya , Tetteh Oswald , Ford Daniel E.
Published: October 2020

Problem

The Food and Drug Administration Amendments Act of 2007 (FDAAA) and the National Institutes of Health (NIH) require that many clinical trials register and report results on ClinicalTrials.gov. Noncompliance with these policies denies research participants and scientists access to potentially relevant findings and could lead to monetary penalties or loss of funding. After discovering hundreds of potentially noncompliant trials affiliated with the institution, the Johns Hopkins University School of Medicine (JHUSOM) sought to develop a program to support research teams with registration and reporting requirements.

Approach

JHUSOM conducted a baseline assessment of institutional compliance in 2015, launched the ClinicalTrials.gov Program in June 2016, and expanded the program to the Sidney Kimmel Comprehensive Cancer Center in April 2018. The program is innovative in its comprehensive approach, and it was among the first to bring a large number of trials into compliance.

Outcomes

From September 2015 to September 2020, JHUSOM brought completed and ongoing trials into compliance with FDAAA and NIH policies and maintained almost perfect compliance for new trials. During this period, the proportion of trials potentially noncompliant with the FDAAA decreased from 44% (339/774) to 2% (32/1,304).

Next Steps

JHUSOM continues to develop and evaluate tools and procedures that facilitate trial registration and results reporting. In collaboration with other academic medical centers, JHUSOM plans to share resources and to identify and disseminate best practices. This report identifies practical lessons for institutions that might develop similar programs.
Emergency Airway Management During Awake Craniotomy: Comparison of 5 Techniques in a Cadaveric Model
Authors: Gruenbaum Shaun E. , Bilotta Federico , Bertasi Tais G.O. , Bertasi Raphael A.O. , Clifton William E. , Gruenbaum Benjamin F. , De Biase Gaetano , Garcia Diogo M. , Bojaxhi Elird , Torp Klaus D. , Quinones-Hinojosa Alfredo
Published: October 2020

Background:

During awake craniotomy, securing the patient’s airway might be necessary electively or emergently. The objective of this study was to compare the feasibility of airway management using a laryngeal mask airway (LMA) and 4 alternative airway management techniques in an awake craniotomy simulation.

Methods:

After completing a questionnaire, 9 anesthesia providers attempted airway management in a cadaver positioned to simulate awake craniotomy conditions. Following the simulation, participants rated and ranked the devices in their order of preference.

Results:

Only 3 approaches resulted in the successful securement of an airway device for 100% of participants: LMA (median; interquartile range time to secure the airway 6 s, 5 to 10 s), fiberoptic bronchoscopy through an LMA (41 s; 23 to 51 s), and video laryngoscopy (49 s; 43 to 127 s). In contrast, the oral and nasal fiberoptic approaches demonstrated only 44.4% (154.5 s; 134.25 to 182 s) and 55.6% (75 s; 50 to 117 s) success rates, respectively. The LMA was the fastest and most reliable primary method to secure the airway (P=0.001). After the simulation, 100% of participants reported that an LMA would be their first choice for emergency airway management, followed by fiberoptic intubation through the LMA (7 of 9 participants) if the LMA failed to properly seat.

Conclusions:

We demonstrated that an LMA was the fastest and most reliable primary method to secure an airway in a laterally positioned cadaver with 3-pin skull fixation. Fiberoptic and video laryngoscope airway equipment should be readily available during awake craniotomy procedures, and an attempt to visualize the vocal cords through the LMA should be attempted before removing it for alternative techniques.
Modulatory effect of aquaporin 5 on estrogen-induced epithelial-mesenchymal transition in prostate epithelial cells
Authors: Fan Yu , Song Tu-Run , Wei Qiang , Yang Lu , Lin Tao , Feng Xiao-Bing , Wang Xian-Ding , Huang Zhong-Li , Feng Shi-Jian
Published: October 2020

Background

Estrogen is involved in the pathophysiological process of benign prostatic hyperplasia (BPH), in which epithelial-mesenchymal transition (EMT) plays an important role. Upregulation of aquaporin (AQP) 5, which is directly activated by estrogen, has been reported to promote EMT in multiple cells. This study aimed to examine the effects of AQP5 on estrogen-induced EMT in the prostate.

Methods

Normal prostate (NP) tissue samples without any histopathological changes and BPH tissue samples with pathologically confirmed hyperplasia were obtained. An EMT cell model was subsequently established by adding estradiol (E2) to RWPE-1 cells, after which AQP5 knockdown was performed. Tissue morphological and immunohistochemical features were examined using hematoxylin-eosin and immunohistochemical staining. Western blot analysis was performed to determine the expression of AQPs, estrogen receptors, and EMT-related proteins. Cell proliferation was assessed and supernatants were collected for enzyme-linked immunosorbent assay to determine transforming growth factor-β1 (TGF-β1) concentrations. Immunofluorescence staining was performed to assess protein expressions in RWPE-1 cells.

Results

BPH tissues exhibited greater EMT (TGF-β1: 1.362 ± 0.196 vs. 0.107 ± 0.067, P = 0.003; vimentin: 1.581 ± 0.508 vs. 0.221 ± 0.047, P < 0.001; E-cadherin: 0.197 ± 0.188 vs. 1.344 ± 0.088, P < 0.001), higher AQP5 (1.268 ± 0.136 vs. 0.227 ± 0.055, P < 0.001) and estrogen receptor (ER) α (1.250 ± 0.117 vs. 0.329 ± 0.134, P < 0.001) expression but lower ERβ (0.271 ± 0.184 vs. 1.564 ± 0.130, P < 0.001) expression than NP tissues. E2-stimulated cells had higher AQP5 expression (1.298 ± 0.058 vs. 1.085 ± 0.104, P = 0.049), increased cell proliferation (1.510 ± 0.089 vs.1.000 ± 0.038, P < 0.001), and EMT (TGF-β1 concentration: 0.352 ± 0.021 ng/mL vs. 0.125 ± 0.014 ng/mL, P < 0.001; vimentin: 1.641 ± 0.120 vs. 0.188 ± 0.020, P = 0.002; E-cadherin: 0.075 ± 0.030 vs. 0.843 ± 0.046, P < 0.001) than controls. E2-stimulated cells with AQP5 knockdown exhibited decreased EMT (TGF-β1 concentration: 0.223 ± 0.041 ng/mL vs. 0.352 ± 0.021 ng/mL, P = 0.016; vimentin: 0.675 ± 0.056 vs. 1.641 ± 0.120, P = 0.001; E-cadherin: 0.159 ± 0.037 vs. 0.075 ± 0.030, P = 0.040) than E2-stimulated cells with non-related small interfering RNA (siRNA).

Conclusion

Our findings suggest that estrogen induces BPH possibly by promoting AQP5 expression. Hence, AQP5 might be a novel target for modulating EMT in prostate epithelial cells.