bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of aryloxy initiators on the living and immortal polymerization of lactide
Authors: Chile L.-E. , Ebrahimi T. , Wong A. , Aluthge D. C. , Hatzikiriakos S. G. , Mehrkhodavandi P.
Published: May 2017

This report describes two different methodologies for the synthesis of aryl end-functionalized poly(lactide)s (PLAs) catalyzed by indium complexes.
Deprotonated meso-hydroxyporphyrin as a stable π-electronic anion: the building unit of an ion-pairing assembly
Authors: Sasano Yoshifumi , Yasuda Nobuhiro , Maeda Hiromitsu
Published: May 2017

The NiII complex of 5-hydroxy-10,15,20-tris(pentafluorophenyl)porphyrin was synthesized as a precursor of a negatively charged π-electronic system. Deprotonation provided an anionic species as the building unit of an ion-pairing assembly in combination with an aliphatic cation.
Microalgae as healthy ingredients for functional food: a review
Authors: Matos J. , Cardoso C. , Bandarra N. M. , Afonso C.
Published: May 2017

Microalgae are very interesting and valuable natural sources of highly valuable bioactive compounds, such as vitamins, essential amino acids, polyunsaturated fatty acids, minerals, carotenoids, enzymes and fibre.
A robust duplex Cu/PDMS-coated mesh with superhydrophobic surface for applications in cleaning of spilled oil
Authors: Zhu Jingfang , Wu Liyun , Li Jingjing , Liu Bin , Zeng Zhixiang
Published: May 2017

In this study, we created a robust nanostructure coated on the surface of a mesh via the electrodeposition and chemical modification to enhance the mechanical durability of the mesh surface with superhydrophobic performance.
Cinobufagin, a bufadienolide, activates ROS-mediated pathways to trigger human lung cancer cell apoptosis in vivo
Authors: Peng Panli , Lv Junhong , Cai Changqing , Lin Shaohuan , Zhuo Enqing , Wang Senming
Published: May 2017

Lung cancer, as the most common malignancy worldwide, is one of the most threatening diseases for human beings.
A novel long-wavelength fluorescent probe for discrimination of different palladium species based on Pd-catalyzed reactions
Authors: Yu Ting , Yin Guoxing , Yin Peng , Zeng Ying , Li Haitao , Zhang Youyu , Yao Shouzhuo
Published: May 2017

We have synthesized a novel long-wavelength fluorescent probe MFC for detection of palladium (Pd0).
Determination of the crystal structure and photoluminescence properties of NaEu1−xGdx(MoO4)2 phosphor synthesized by a water-assisted low-temperature synthesis technique
Authors: Hasegawa Takuya , Kim Sun Woog , Abe Yusuke , Muto Masaru , Watanabe Mizuki , Kaneko Tatsuro , Uematsu Kazuyoshi , Ishigaki Tadashi , Toda Kenji , Sato Mineo , Koide Junko , Toda Masako , Kudo Yoshiaki
Published: May 2017

Red-emitting NaEu1–xGdx(MoO4)2 nano phosphors with high emission intensity were synthesized by a water assisted solid state reaction (WASSR) method, which is a new low temperature synthesis method developed by our research group.
Palladium(ii)-catalyzed ortho-C–H olefination of phenylalanine and phenylethylamine derivatives directed by removable picolinamide group
Authors: Zhao Fei , Jia Xiuwen , Zhao Jingwei , Fei Chaoli , Liu Liyang , Liu Guannan , Wang Dongping , Chen Fei
Published: May 2017

Palladium-catalyzed ortho-C–H olefination of phenylalanine and phenylethylamine derivatives assisted by a removable picolinamide group has been achieved.
Development of contact-killing non-leaching antimicrobial guanidyl-functionalized polymers via click chemistry
Authors: Peng Kaimei , Zou Tao , Ding Wei , Wang Ruonan , Guo Jinshan , Round John Jay , Tu Weiping , Liu Chao , Hu Jianqing
Published: May 2017

A new contact-killing and non-leaching antimicrobial polymer was prepared by a robust, efficient and orthogonal click-chemistry.
Benchmark characterization of the thermoelectric properties of individual single-crystalline CdS nanowires by a H-type sensor
Authors: Wang Haidong , Zheng Dingshan , Zhang Xing , Takamatsu Hiroshi , Hu Weida
Published: May 2017

A precision H-type sensor method has been developed to measure the thermoelectric performance of individual single-crystalline CdS nanowires for the first time.
Large-scalable RTCVD Graphene/PEDOT:PSS hybrid conductive film for application in transparent and flexible thermoelectric nanogenerators
Authors: Park Chanil , Yoo Dohyuk , Im Soeun , Kim Soyeon , Cho Wonseok , Ryu Jaechul , Kim Jung Hyun
Published: May 2017

Poly(3,4-ethyldioxythiophene):poly(styrene sulfonate) (PEDOT:PSS), as a thermoelectric(TE) material, exhibits a high electrical conductivity and ZT value (10−1–100).
Facile synthesis of mesoporous silica by CO2/N2 switchable templates using a convenient compound
Authors: Jiang Jianzhong , Yin Jinchao , Dai Li , Liu Rukuan , Xiao Zhihong
Published: May 2017

A facile synthesis method for the preparation of mesoporous silica with CO2/N2 recyclable templates was described. The templates could be efficiently removed and recycled by bubbling N2 gas without calcination.
New insights on the dynamics of the γ-Fe/α-Fe phase-transition inside iron-filled carbon nanotubes
Authors: Boi Filippo S. , Hu Yuzhong , Wen Jiqiu
Published: May 2017

One of the challenges in the field of carbon nanotubes (CNTs) is the encapsulation of a single crystalline phase of ferromagnetic α-Fe.
Spirolactam capped cyanine dyes for designing NIR probes to target multiple metal ions
Authors: Kar Chirantan , Shindo Yutaka , Oka Kotaro , Nishiyama Shigeru , Suzuki Koji , Citterio Daniel
Published: May 2017

This work reports cyanine based spirocyclic metal ion probes, showing a fluorescence turn-on response to various metal ions in the near-infrared spectral region.
Phosphomolybdic acid supported atomically dispersed transition metal atoms (M = Fe, Co, Ni, Cu, Ru, Rh, Pd, Ag, Os, Ir, Pt, and Au): stable single atom catalysts studied by density functional theory
Authors: Wang Shujiao , Feng Yingxin , Lin Sen , Guo Hua
Published: May 2017

This study will provide a guideline for designing stable single atom catalysts by taking advantage of coordination chemistry and homogeneous catalysis.
Fabrication optimization of polyethersulfone (PES)/polyvinylpyrrolidone (PVP) nanofiltration membranes using Box–Behnken response surface method
Authors: Peydayesh Mohammad , Bagheri Maryam , Mohammadi Toraj , Bakhtiari Omid
Published: May 2017

Herein response surface methodology (RSM) is employed to optimize the fabrication of polyethersulfone (PES) nanofiltration (NF) membranes via phase inversion.
Combined use of breath figures process and microphase separation of PS-b-P4VP to produce stable porous nanomaterials
Authors: Wu Baozhen , Zhou Meimei , Zhang Wanlin , Liang Yun , Li Fengting , Li Guangtao
Published: May 2017

Among various templating strategies available for the preparation of porous polymer films, Breath Figures (BFs) as a fast, low-cost and versatile method has aroused extensive interest.
Catalyst tolerance to SO2and water vapor of Mn based bimetallic oxides for NO deep oxidation by ozone
Authors: Lin Fawei , Wang Zhihua , Shao Jiaming , Yuan Dingkun , He Yong , Zhu Yanqun , Cen Kefa
Published: May 2017

Improving the catalyst stabilities under different conditions (water vapor, SO2, both water vapor and SO2) is important for industrial applications regarding catalytic NO deep oxidation by ozone.
External load-dependent degradation of P3HT:PC61BM solar cells: behavior, mechanism, and method of suppression
Authors: Yan Lingpeng , Yi Jinduo , Chen Qi , Dou Junyan , Yang Yongzhen , Liu Xuguang , Chen Liwei , Ma Chang-Qi
Published: May 2017

External load dependent degradation behavior of P3HT:PC61BM solar cells is demonstrated, which can be successfully suppressed by blending with an exciton quencher of PC61BM.
Stability and efficiency of CO2 capture using linear amine polymer modified carbon nanotubes
Authors: Zhou Zheng , Anderson Clifton M. , Butler Steven K. , Thompson Shalauna K. , Whitty Kevin J. , Shen T.-C. , Stowers Kara J.
Published: May 2017

Linear polymeric amines on carbon nanotubes are stable to humidity, require less energy for desorption and adsorb 30 wt% CO2.
Palladium aerogel as a high-performance electrocatalyst for ethanol electro-oxidation in alkaline media
Authors: Zareie Yazdan-Abad Mehdi , Noroozifar Meissam , Modaresi Alam Ali Reza , Saravani Hamideh
Published: May 2017

Noble metal aerogels as three-dimensional (3D) nanostructures with high surface area and large porosity are known to be exceptional materials that can be applied in the area of catalysis applications.
Upper critical solution temperature thermo-responsive polymer brushes and a mechanism for controlled cell attachment
Authors: Xue Xuan , Thiagarajan Lalitha , Braim Shwana , Saunders Brian R , Shakesheff Kevin M , Alexander Cameron
Published: May 2017

We report the synthesis of thermo-responsive polymer brushes with Upper Critical Solution Temperature (UCST)-type behaviour on glass to provide a new means to control cell attachment.
Photothermal triggered protein release from an injectable polycaprolactone-based microspherical depot
Authors: Ge Chunling , Basuki Johan S. , White Jacinta , Hou Ruixia , Peng Yong , Hughes Timothy C. , Tan Tianwei
Published: May 2017

Visible light mediated controlled release of biologically active enzymes was confirmed by released horseradish peroxidase's ability to ameliorate H2O2 cytotoxicity in vitro.
Construction of giant glycosidase inhibitors from iminosugar-substituted fullerene macromonomers
Authors: Trinh Thi Minh Nguyet , Holler Michel , Schneider Jérémy P. , García-Moreno M. Isabel , García Fernández José M. , Bodlenner Anne , Compain Philippe , Ortiz Mellet Carmen , Nierengarten Jean-François
Published: May 2017

A dramatic enhancement in the glycosidase multivalent inhibitory effect was observed while going from a dodecavalent iminosugar ball to the corresponding giant molecule with 120 peripheral subunits.
Fast compact true random number generator based on multiple sampling
Authors: Choi P. , Lee M.‐K. , Kim D.K.
Published: May 2017

A new ring‐oscillator‐based true random number generator (RNG) based on multiple sampling is proposed. The proposed generator uses the outputs of all gates in a ring oscillator, as positive‐ and negative‐edge clock signals. The generator in two field‐programmable gate array families is implemented, and it is verified that the generated bit sequences pass the RNG tests of the National Institute of Standards and Technology. The experimental results show that the proposed generator is faster and more compact than the existing ring‐oscillator‐based true RNGs.
Design and implementation of a standardised framework for the management of a wireless body network in an Mobile Health environment
Authors: Talaminos Alejandro , Naranjo David , Barbarov Gerardo , Roa Laura M. , Reina‐Tosina Javier
Published: May 2017

The design and implementation of a framework that facilitates the development of Mobile Health applications to manage the communications with biomedical sensors in compliance with the CEN ISO/IEEE 11073 standard family are presented. The framework includes a set of functional modules that are responsible, among other tasks, of the communication of sensors and the processing and storage of data. The mobile terminal acts as an intermediary or hub, collecting and presenting the data received in a standardised way, regardless of the sensor type used. In this context, as proof of concept it is presented a mobile app built on the top of the framework to manage the communications with a smart fall detector.
Speech reconstruction using a deep partially supervised neural network
Authors: McLoughlin Ian , Li Jingjie , Song Yan , Sharifzadeh Hamid R.
Published: May 2017

Statistical speech reconstruction for larynx‐related dysphonia has achieved good performance using Gaussian mixture models and, more recently, restricted Boltzmann machine arrays; however, deep neural network (DNN)‐based systems have been hampered by the limited amount of training data available from individual voice‐loss patients. The authors propose a novel DNN structure that allows a partially supervised training approach on spectral features from smaller data sets, yielding very good results compared with the current state‐of‐the‐art.
NOX abatement from filtered diesel engine exhaust using battery‐powered high‐voltage pulse power supply
Authors: Mohapatro Sankarsan , Allamsetty Srikanth
Published: May 2017

The dielectric barrier discharge‐based non‐thermal plasma technique is one of the most prominent techniques which give peerless results in controlling the concentration of NOX. However, when it comes to the automobile diesel engine, availability of high‐voltage pulse power supply is the major constraint. In this study, battery‐powered high‐voltage pulse power supply for NOX treatment has been proposed. Two types of electrodes: rod type and rod with helical spring type are studied for the treatment of exhaust. Cascaded plasma‐adsorbent technique has also been used to enhance NOX removal efficiency. Experiments have been conducted with two different gas flow rates, i.e. 4 l and 6 l/min at laboratory level and have got significant results toward removal of NOX. When the exhaust has been treated with plasma alone, the reactor with rod‐type electrode has shown 85% NOX removal efficiency at a specific energy (SE) of 283 J/l with a flow rate of 4 l/min. When the plasma reactor is cascaded with the adsorbent reactor, both adsorbents: 13x molecular sieve (MS13x) and activated alumina are able to remove 100% of NOX with the proposed power supply at a lesser SE.
Distributed intrusion detection based on hybrid gene expression programming and cloud computing in a cyber physical power system
Authors: Deng Song , Zhou Ai‐Hua , Yue Dong , Hu Bin , Zhu Li‐Peng
Published: May 2017

With the increasingly widespread application of information and communication technology, the smart grid has gradually evolved into a cyber physical system characterised by deep integration between the information space and physical space. All manner of intrusion attacks on cyber physical power systems are growing more and more frequent. Timely and accurate detection and identification of these intrusions are essential for the effective control and protection of cyber physical power systems. For massive and high‐dimensional intrusion behaviour data in cyber physical power systems, distributed intrusion detection based on hybrid gene expression programming and cloud (DID‐HGEPCloud) computing is proposed. In the DID‐HGEPCloud, attribution reduction with noise data based on rough set and a global intrusion model based on non‐linear least squares are applied to improve the efficiency and accuracy of intrusion detection. At the same time, the MapReduce programming framework of cloud computing is adopted, and parallelisation of the model of the proposed algorithm is performed to enhance its ability to manage massive and high‐dimensional data. Comparative experiments show that the algorithm proposed in this paper has obvious advantages in terms of false attack rate, DAR, and average time consumed. Furthermore, the proposed algorithm possesses excellent parallel performance.
Comparative study of new axial field permanent magnet hybrid excitation machines
Authors: Yıldırız Emin , Önbilgin Güven
Published: May 2017

Hybrid excitation synchronous machines (HESMs) are permanent magnet machines which allow the control of the air‐gap flux density. In this study, three new axial field HESM structures, each having two rotors and one stator, are proposed. The operation principles of these machines, considering weakening or supporting the air‐gap flux density, are described. The magnetostatic and transient analyses of the proposed models have been carried out by using finite element method. To have reliable analysis results, the stator length and input and output diameters of the models have been chosen to be identical. Results are compared in terms of efficiency, power density and range of flux control between each other and another axial field HESM in the literature. In conclusion, the proposed HESM models demonstrate satisfactory performance for the generator mode and they are suitable for wind energy applications. Furthermore, because of their field weakening operation ability they can be used as motors in the vehicle industry.
Voltage regulation of the Y‐source boost DC–DC converter considering effects of leakage inductances based on cascaded sliding‐mode control
Authors: Ahmadzadeh Soheil , Arab Markadeh Gholamreza , Blaabjerg Frede
Published: May 2017

In this study, a sliding mode‐based controller is designed for regulating the output voltage of a high step‐up DC–DC converter with three coupled inductors called Y‐source impedance network. As Y‐source converter can provide a very high boost at a lower shoot‐through duty cycle of the switch and it has one more degree of freedom to achieve voltage boost. In order to accurately analyse the converter operation, the leakage inductance impact on diodes function in addition to other parasitic elements has been modelled. Hence, four different time intervals corresponding to switch and diode conduction have been considered. Also, an exposition of a variable structure control approach is mentioned. The method employs cascaded sliding‐mode control (CSMC) to output voltage regulation of the converter. The stability and robustness of the CSMC against the variation of reference voltages and the uncertainties of the load demands have been explained. Simulation and experimental results confirm the capability and effectiveness of the proposed control method.
Luminous intensity bilateral comparison using lamps as transfer standards between LNE (France) and INM-RO (Roumania)
Authors: Obein G , Simionescu M , Dubard J , Seucan A , Bastie J
Published: May 2017

The EUROMET project 823, "Comparison of luminous intensity and luminous flux using lamps as transfer standards" between LNE (formerly BNM), France, and INM-RO, Romania, has linked the INM-RO real-ized candela to the CCPR key comparison reference values. The comparison was registered on BIPM key comparison data base with the numbers EUROMET.PR-K3.a.1.

The comparison has been piloted by LNE. It has been carried out by successive calibrations of a group of four travelling standard lamps in the two laboratories. The lamps were first calibrated by INM-RO, then cal-ibrated by LNE and calibrated by INM-RO in order to check for any drift or instability. The measurements have been performed over the period November 2004 to June 2006.

According to the results of the comparison, the Degree of Equivalence of the candela realized by INM-RO to the Key Comparison Reference Value of CCPR-K3 is - 0,72 % with an expended uncertainty (k = 2) of 2.14 %.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCPR, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Connectivity in ictal single photon emission computed tomography perfusion: a cortico-cortical evoked potential study
Authors: Tousseyn Simon , Krishnan Balu , Wang Zhong I. , Wongwiangjunt Sattawut , Nayak Chetan S. , Mosher John C. , Wu Guiyun , Van Paesschen Wim , Leahy Richard M. , Gonzalez-Martinez Jorge A. , Bulacio Juan , Najm Imad M. , Alexopoulos Andreas V. , Nair Dileep R.
Published: May 2017

Ictal SPECT is used in presurgical evaluations of refractory epilepsy. Tousseyn et al. examine whether ictal perfusion changes correspond to electrically connected networks. Using evoked responses following direct electrical stimulation during stereo-electroencephalography as a connectivity measure, they show that ictal perfusion is not random but is supported by underlying connectivity.
First Description of the Causal Agent of Taproot Decline of Soybean, an Emerging Disease in the Southern United States
Authors: Allen Tom , Bluhm Burt , Conner Kassie , Doyle Vinson , Price Trey , Sikora Edward , Singh Raghuwinder , Spurlock Terry , Tomaso-Peterson Maria , Wilkerson Tessie
Published: May 2017

Over the past decade, a soybean root issue of unknown etiology has been observed across a widespread geography in the southern United States. Recently, pathologists began referring to the problem as taproot decline of soybean, based on the appearance of root symptoms. Taproot decline has been observed to cause foliar symptoms in vegetative and reproductive soybean plants ranging in maturity from V6 to R6. Symptom expression can appear similar to other notable root-associated diseases except that taproot decline exhibits a progression of symptom expression from subtle to severe interveinal chlorosis during the season. However, one distinct symptom associated with taproot decline is observed as darkened, black stroma on the taproot and, in some cases, the lateral roots of affected plants. Pathogenicity was confirmed by isolating the suspected fungus from naturally-infected soybean roots in multiple states and completing Koch’s postulates. The causal agent was identified, based on morphological characters and multilocus phylogenetic inference, as a member of the Xylaria arbuscula aggregate. At present, research projects are underway to address the role of the newly described disease and extent of the pathogen in the southern soybean production region in addition to developing integrated strategies for managing the disease.
Racial Disparities in Perinatal Depression in an Underserved Los Angeles County Population [3OP]
Authors: Celaya Anna K. , Batra Priya , Jackson Ashaki , Robinson Nuriya , Dossett Emily C. , Reina Astrid
Published: May 2017

INTRODUCTION:

Perinatal depression affects one in seven women, and is associated with significant morbidity. Limited data suggest depression rates to be twice as high among low-income, minority women. This study aimed to identify associations between race/ethnicity and perinatal depression in a medically and psychosocially at-risk population.

METHODS:

Study data were collected from interviews conducted from December 2013 through August 2016 by Community Health Workers as part of the initial obstetric assessment. Depression was scored on the Center for Epidemiologic Studies Depression (CES-D) Scale, with depression defined as a score of greater than 16 for clinical symptoms. Race and ethnicity were self-reported. Chi-square analyses were performed.

RESULTS:

A total of 3,214 women were included in the study. Analyses revealed that a larger proportion of African American women (26.2%) met criteria for depression than their White (20.1%), Asian (5.2%) and Mixed Race counterparts (2.6%; chi-square less than .01, P greater than .001). Analyses involving ethnicity revealed that women who identified as Hispanic/Latina (27.1%) were less likely than non-Hispanic women (38.5%) to meet CES-D depression criteria (chi-square=44, P less than .001).

CONCLUSION:

Race and ethnicity were significantly associated with perinatal depression. A higher proportion was seen among African American women, while a lower proportion seen among Hispanic/Latinas. Implications for practice include increasing mental health support and a referral network to access during pregnancy and postpartum. Future research might include examination of protective factors for depressive symptoms in pregnant women of different ethnic/racial backgrounds. Screening tools for other mental health conditions may account for other ethnic/racial differences.
Influence of Periconception Smoking Behavior on Birth Defect Risk [4OP]
Authors: Perry Madeline , Mulcahy Helen , DeFranco Emily
Published: May 2017

INTRODUCTION:

The aim of this study is to assess the association of maternal smoking and the timing of periconception exposure with congenital birth defects.

METHODS:

Population-based retrospective cohort of all live births in Ohio (2006-2015). Rates of major defects were compared between births to non-smoking mothers and those who smoked (1) during the 3 month preconception period and not in the first trimester, and (2) in the preconception period + throughout the first trimester. Multivariate logistic regression quantified the relationship between smoking and birth defects after adjustment for maternal race, age, pregestational diabetes and socio-economic factors.

RESULTS:

Of 1,436,036 live births in the study period, 23.3% smoked during pregnancy; 6.0% preconception only and 17.3% smoked also through the first trimester. Smoking during the preconception period only, even without first trimester exposure, was associated with a 40% increased risk of gastroschisis (adjRR 1.4, CI 1.1-1.9), but no other individual birth defects. However, smoking through the first trimester was associated with a modest but significantly increased risk of several defects including gastroschisis, omphalocele, congenital diaphragmatic hernia, and cleft palate, even after adjustment for coexisting factors.

CONCLUSION:

Smoking during the period of fetal organogenesis, during the first trimester of pregnancy, is associated with increased risk of some birth defects. In this study, we provide novel data that smoking during the few months prior to conception, even with cessation in the first trimester, may also pose risk for fetal malformation such as gastroschisis. These findings highlight the importance of preconception women’s public health education efforts and warrant further investigation.
Pregnancy Outcomes Among Women With Liver Cirrhosis [8OP]
Authors: Palatnik Anna , Rinella Mary
Published: May 2017

INTRODUCTION:

The objective of this study was to compare pregnancy outcomes among women whose pregnancy was complicated by cirrhosis of the liver to women without liver cirrhosis.

METHODS:

This was a retrospective cohort study of women diagnosed with liver cirrhosis prior to their pregnancy and women without cirrhosis between 2005-2015, in a single tertiary care center. Univariable comparisons of patients’ characteristics and pregnancy outcomes were conducted using chi-square or Fisher’s exact test for categorical data and student t-test for continuous measures. Multivariable logistic regression was done to determine independent association of liver cirrhosis and adverse obstetric outcomes.

RESULTS:

31 women with cirrhosis were identified and compared to 124 controls. Most common etiology for liver cirrhosis was ETOH (29.0%), followed by primary biliary cirrhosis (22.7%). In univariable analysis, women with cirrhosis were more likely to be black (29.0% vs. 12.1%, p=0.03), have chronic hypertension (16.1% vs. 3.2%, p=0.006), and presence of fetal anomalies (9.7% vs. 0.0%, p < 0.001), preeclampsia (19.4% vs. 4.0%, p=0.003) fetal or neonatal demise (16.1% vs. 0.0%, p < 0.001) and small-for-gestational-age infant (16.1% vs. 4.8%, p=0.020). In multivariable analysis controlling for potential confounders, diagnosis of cirrhosis remained to be independently associated with preterm delivery and preeclampsia.

CONCLUSION:

Women whose pregnancy is complicated by liver cirrhosis are at higher risk for preterm delivery and preeclampsia.
Effect of Intra-Operative Glove-Changing During Cesarean on Post-Op Complications: A Randomized Controlled Trial [12OP]
Authors: Reddy Buvana , Scrafford Jonathan
Published: May 2017

INTRODUCTION:

An increasing body of literature suggests that vaginal floral bacteria contribute to post-operative infectious morbidity when introduced to normally sterile environments during cesarean section. Surgeon's gloves, exposed to the lower genitourinary tract during delivery of an infant, may be an important vehicle of bacteria to the abdominal wall. Changing gloves during cesarean prior to abdominal wall closure may decreased bacterial transfer to the wound bed and therefore the incidence of wound complications following cesarean section.

METHODS:

This is a randomized controlled trial. Women undergoing non-emergent cesarean section were randomized to control conditions or intra-operative glove-changing, which entailed surgeons changing outer sterile gloves prior to abdominal closure. The primary outcome is composite wound complications, defined as the occurrence of seroma, hematoma, wound infection, skin separation of at least 1cm, or other incisional separation or abnormality requiring a bedside procedure Enrollment of 554 patients provides 80% power to detect a 50% reduction in the primary outcome from the approximately 15% incidence noted in the first 100 control subjects studied during a planned interim analysis.

RESULTS:

Of the first 409 patients analyzed, a significant reduction in composite wound complications is observed in the glove-changing group (11/185, 5.9%) compared to the control group (29/224, 12.9%), with p-value 0.018. At time of this submission, there are 145 subjects remaining to analyze, estimated to complete by December 2016.

CONCLUSION:

Preliminary analysis of this nearly completed randomized controlled trial indicates a trend toward reduction of composite wound complications following cesarean section when gloves are changed prior to abdominal closure.
Outpatient Opioid Use After Cesarean Section [20OP]
Authors: Emerson J.B. , Danilack V.A. , Kulkarni A. , Brousseau E.C. , Matteson K.A.
Published: May 2017

INTRODUCTION:

Cesarean section is the most common major surgery among women in the United States. Guidance on how much opiate medication women need after hospital discharge is unavailable. Our objective was to determine if factors such as amount of opioid medication used inpatient relate to outpatient opioid use.

METHODS:

We conducted a prospective cohort study of women after cesarean delivery. Patient demographic and clinical characteristics (including opioid usage and prescriptions) were collected by survey at enrollment. Between 2-5 weeks post-hospital discharge we obtained self-reported opioid usage information. Medical records were reviewed for additional clinical data. Opioid usage was standardized to Morphine Equivalent Doses (MED) and tertiles of MED were generated for analyses. T-test and ANOVA were used for comparison of MED between groups, and Pearson correlation coefficients evaluated MED correlation between inpatient factors and outpatient use.

RESULTS:

One hundred participants were enrolled; 76 completed follow-up. On average, participants used 59 MED (±43) in the final 24 hours inpatient and 258 MED (±57) per patient were prescribed for outpatient use. Among women completing follow-up, 21% used all opioids prescribed and 20% used none. Overall, 53% of opioid pills prescribed were not taken. Maternal history of psychiatric comorbidities was associated with higher outpatient opiate use (172 MED vs 103 MED; p= 0.046). As inpatient MED use increased across the three MED tertiles (<40, 41-70, >70), there was an association with increased outpatient opiate use (difference between groups p<0.001, correlation r=0.429, p<.001).

CONCLUSION:

Not all opioids prescribed following cesarean section are taken within 5 weeks of hospital discharge. We demonstrate that inpatient opioid use correlates with the number of opioids used outpatient and may be a factor clinicians could consider when providing hospital discharge prescriptions. Prescribing an appropriate amount of post-cesarean opioids is a tangible way obstetricians could impact the public health crisis of opioid abuse.
Does a Large Fetal Abdominal Circumference in Women Without Diabetes Predict Adverse Outcomes? [5P]
Authors: Greenberg Victoria , Jain Vanita
Published: May 2017

INTRODUCTION:

We sought to determine if fetuses that have a large abdominal circumference (AC) have an increase in adverse outcomes.

METHODS:

This is a retrospective cohort study conducted via chart review of women seen for ultrasound at 28-32 weeks gestation with fetal AC measuring >90th percentile during the study period of 1/1/2014 through 12/31/2015. Women with a known diagnosis of diabetes were excluded. Multivariate logistic regressions were conducted to determine relationships between fetal AC and neonatal and maternal outcomes: neonatal hypoglycemia, birth weight, NICU admission, 5-minute Apgar scores, mode of delivery, development of gestational diabetes, and polyhydramnios. These outcomes were adjusted for presence or absence of gestational diabetes, race, maternal age, and gravidity.

RESULTS:

1715 women were included. Mean gestational age was 31 weeks. Increasing fetal AC is predictive of primary cesarean delivery (OR 1.486, p=0.0023). Fetuses with larger abdominal circumferences on antenatal ultrasounds are more likely to be macrosomic with birth weight >4000 grams (OR 2.496, p < 0.0001). Increasing fetal AC is associated with the later development of gestational diabetes (OR 2.343, p=0.0023) and polyhydramnios (OR 2.938, p=0.0003). Fetal AC does not predict lower Apgar score (OR 0.615, p=0.416), NICU admission (OR 0.824, p=0.167), or neonatal hypoglycemia (OR 1.047, p=0.852). Though none of the patients in this study were initially diagnosed with diabetes, 220 (12.8%) were found to have gestational diabetes by the time of delivery.

CONCLUSION:

Women should be counseled about the increased risks of primary cesarean delivery, polyhydramnios, macrosomia, and gestational diabetes when a large fetal AC is found.
Ultrasound Appearance of the Endometrium Post-Radiofrequency Endometrial Ablation [13P]
Authors: Sara Roper , Crisp Catrina , Buckley William , Devaiah Ganga
Published: May 2017

INTRODUCTION:

Nearly one third of gynecology visits are related to abnormal uterine bleeding and many are treated with endometrial ablation. Little research describing the impact of ablation on the structure and appearance of the endometrium and uterus post operatively has been done. The primary objective of this retrospective study is to describe and define changes within the endometrium and uterus seen on ultrasound of the post ablated endometrium.

METHODS:

We conducted a retrospective chart review of hospital electronic medical records from 2012 to 2016 to collect data on patients with ultrasound performed after endometrial ablation. Ultrasound reports were manually reviewed to collect quantitative and qualitative data on the post-ablative uterus.

RESULTS:

The mean endometrial thickness of the study sample (n=74) postoperatively was 7.0 mm (SD 3.3), significantly lower than pre operatively (p < 0.001) and the uterine height was 4.7 mm (SD 0.9), significantly lower than pre operatively (p=0.001). The mean endometrial thickness over time trended down from 9.3 (SD 3.4) to 5.5 (SD 2.2). Appearance of heterogeneity, vascularity, and cystic spaces also increased over time.

CONCLUSION:

Endometrial thickness decreases post operatively while presence of heterogeneity vascular or cystic spaces increase but more data is needed to meaningfully compare the trend over time. A prospective study is ongoing to describe the changes of the uterus overtime after ablation to help providers interpret postoperative ultrasound studies.
Is Midtrimester Cervical Length Predictive of an Induction of Labor With an Unfavorable Cervix? [14P]
Authors: Patel Soha S. , Srinivas Sindhu K. , Downes Katheryne L. , Levine Lisa D.
Published: May 2017

INTRODUCTION:

To assess whether midtrimester cervical length (CL) is predictive of a successful induction of labor (IOL) among women induced at term with an unfavorable cervix.

METHODS:

We performed a retrospective cohort study of women who underwent midtrimester CL assessment during their anatomy ultrasound and subsequently had a term IOL. Women with a term singleton gestation with an unfavorable cervix were included. Outcomes were risk of cesarean delivery (CD) and indication for CD. Student's t-test, Kruskal-Wallis, and Pearson chi-square tests were performed.

RESULTS:

A total of 278 women met inclusion criteria. The CD rate for this cohort was 29.9%. There was no difference between the mean CL for those with a vaginal delivery compared to those with a CD (3.48 ± 0.61 vs. 3.43 ± 0.55 cm, p=0.6). Quartiles of midtrimester CL were created based on distribution of data. When assessing quartiles of CLs, there was no difference by quartile in overall CD rate (p=0.2), which was true regardless of parity (p=0.4 nullips, p=1.0 multips). However, when evaluating indications for CD, there was a higher rate of CD for failed IOL among women with a longer cervix (p=0.03) without a difference noted in rate of CD for arrest of dilation (p=0.6), arrest of descent (p=0.07), or NRFHT (p=0.9).

CONCLUSION:

While the rate of CD for failed IOL was higher for those with a longer CL, the overall CD rate was no different. Therefore, midtrimester CL has limited predictive utility when counseling women undergoing an IOL at term with an unfavorable cervix regarding likelihood of success.
Should We Offer PGS to Poor Prognosis Patients Undergoing IVF? [20P]
Authors: Tulay Pinar , Gultomruk Meral , Findikli Necati , Bahceci Mustafa
Published: May 2017

INTRODUCTION:

A number of complex entities, advanced maternal age (AMA), recurrent miscarriages (RM) and recurrent IVF failures (RIF), may increase the risk of numerical chromosomal abnormalities of the embryos. The aim of study was to analyze if use of aCGH for PGS improves implantation and pregnancy rates in poor prognosis patients and to analyze aneuploidy rates between embryos cultured in all-in-one time-lapse incubation (TLI) systems and standard incubators (SI) in PGS cycles.

METHODS:

PGS was performed for couples with at least one of the following factors; maternal age of 36 years or more, at least three previous miscarriages, at least three RIF and normal karyotype. A total of 205 embryos were biopsied at blastocyst stage. Whole genome amplification and aCGH was performed. The implantation and pregnancy rates for each group were analyzed.

RESULTS:

PGS results showed that 78% of the embryos obtained from poor prognosis patients were aneuploid. The implantation rate for PGS group was 11% higher compared to control group (p=0.1). The pregnancy loss rates for both PGS (28%) and control groups (23%) were similar. The rate of aneuploidy was the same for the embryos cultured in a TLI system (72%) and in a conventional incubator (72%).

CONCLUSION:

In this study, we have shown that poor prognosis patients develop a higher number of chromosomally abnormal embryos. We have shown that applying PGS to these patients to select a euploid blastocyst eliminates the unnecessary embryo transfer that may not result in pregnancy or lead to a miscarriage as well as improving the IVF outcome.
Is Progesterone Deficiency Associated With Early Pregnancy Loss? A Study of 718 High-Risk and Normal Pregnancies [23P]
Authors: Xian Yeap Valerie Shu , Tan Thiam Chye , Ku Chee Wai , Lek Sze Min , Allen John , Tan Nguan Soon
Published: May 2017

INTRODUCTION:

Progesterone is a hormone critical to the maintenance of early pregnancy, yet there is a lack of an established distribution of progesterone levels in early pregnancy. This study aims to establish the distribution of maternal serum progesterone in normal pregnancies and pregnancies complicated by threatened miscarriage. We hypothesize that progesterone deficiency is associated with threatened miscarriage.

METHODS:

This is a single center, prospective cohort study of 718 women. Women from the normal pregnancy group were recruited from routine antenatal clinics and those in the threatened miscarriage group were recruited from emergency walk-in clinics.

Quantile regression was used to characterize serum progesterone levels in these two groups by estimating the 10th, 50th and 90th percentiles from 5 to 13 weeks gestation. Pregnancy outcome was determined at 16 weeks. Subgroup analysis within the threatened miscarriage group, to compare progesterone levels of women who miscarried with those with viable pregnancies was performed.

RESULTS:

Serum progesterone demonstrated an increasing linear trend in the normal pregnancy group, with trend gradient of bN = 4.62 (P < .0001). In the threatened miscarriage group, a linearly increasing trend with reduced gradient of bT= 4.55 (P< .0001) was observed. Median progesterone levels were consistently lower in this group by 10 nmol/L.

CONCLUSION:

Maternal serum progesterone concentration increased linearly with gestational age from 5 to 13 weeks in normal pregnancies. In women with threatened miscarriage, a downward displacement of this linear association was observed. This highlights the association between progesterone deficiency and threatened miscarriage.
Evidence of the Need for Communication Among Obgyns and Gamete Providers for Management of Offspring's Health [29P]
Authors: Callum Pamela
Published: May 2017

INTRODUCTION:

To illustrate how fetal abnormalities in pregnancies conceived through gamete donation can help to identify inherited risks from gamete donors, and to document how communication among gamete providers and obstetric practices can be beneficial to donor management and patient care.

METHODS:

Reviewed reports of health issues in fetuses and offspring from sperm donors in our program from 2012 through September 2016. Two cases were selected for elaboration to illustrate how inherited risks are identified and how donor management and patient care were affected.

RESULTS:

Two reports of abnormalities in fetuses led to significant changes in donor management due to evidence of significant inherited disease risks to donor-conceived individuals. In one case, a chromosome abnormality in a fetus led to identification of a cryptic translocation in a sperm donor. In another case, ultrasound findings in a fetus led to identification of gonadal mosaicism for tuberous sclerosis in a donor. Knowledge of these findings, and internal documentation systems, allowed our facility to identify the inherited risks and communicate risk information to other clients who had used specimens from these donors.

CONCLUSION:

Genetic risks cannot be eliminated through prospective donor screening practices. The knowledge of abnormalities in fetuses conceived through gamete donation can aid in ongoing risk assessment, changes in donor management, and communication to clients when significant risks are identified. Patients are not always able to accurately communicate the findings in their pregnancies to gamete providers. Collaboration and communication among gamete facilities and healthcare providers allows for enhanced patient care.
MEF2 Transcription Factors Regulate Human Trophoblast Invasion and Differentiation [33P]
Authors: Li Lucy , Gong Xiaoming , Rubin Lewis P.
Published: May 2017

INTRODUCTION:

Adverse pregnancy outcomes, including preeclampsia and preterm birth, two significant causes of maternal and fetal morbidity and mortality, are associated with placental trophoblast dysfunction. Myocyte enhancer factor 2 (MEF2) transcription factors play an important role in cell differentiation and invasion in various cell types and tissues. The objective of our study is to explore the role of MEF2 in the invasion/differentiation of trophoblasts in normal placental development and preeclampsia.

METHODS:

Human cytotrophoblasts (CTBs) were isolated from term placentas and used to analyze the expression of MEF2 transcription factors and MEF2-dependent cell signaling. The effect of MEF2 on human trophoblast invasion/differentiation and its underlying mechanisms were examined in two trophoblast cell lines: HTR8/SVneo (first trimester human villous-derived) and BeWo (choriocarcinoma CTB-like) cells.

RESULTS:

MEF2 isoforms are differentially expressed in the CTBs of first and third trimester human placentas. MEF2D and 2B are highly expressed in first trimester trophoblasts. Introduction of MEF2D into HTR8/SVneo promotes cell invasion and migration. The invasive capacity is impeded by exogenous expression of dominant negative MEF2. MEF2A is a major isoform of MEF2 in term CTBs and is required for proper CTB differentiation into syncytiotrophoblasts. During in vitro CTB differentiation, p38 MAPK activity was detected for days 1-4, and diminished for days 5-6 suggesting that p38 MAPK signaling is essential for CTB differentiation but not for the maintenance of syncytiotrophoblasts.

CONCLUSION:

Our studies suggest individual MEF2 family members differentially regulate trophoblast invasion/differentiation. Dysregulation of MEF2 signaling may be associated with placenta-related pregnancy disorders, including preeclampsia.
Hysterectomy as Gender-Affirmation Surgery in Female-to-Male Transgender Persons [37P]
Authors: Makhija Neeta , Mihalov Linda
Published: May 2017

INTRODUCTION:

Persons assigned female gender at birth may seek hysterectomy as part of their gender affirmation. Little is known about the characteristics and outcomes of this population.

METHODS:

Retrospective chart review of 15 trans men (female-to-male transgender persons), age 16-43, who underwent hysterectomy by a single surgeon at our academically-affiliated community hospital from 2012-2016. Three patients participated in a focus group aimed at optimizing perioperative care.

RESULTS:

All patients were nulliparous, 93% had been on testosterone therapy and most had previously undergone bilateral mastectomy (“top surgery”). 66% underwent surgery solely for gender affirmation, the remainder had additional gynecologic indications. Most had robotic laparoscopic hysterectomy, with or without removal of the cervix, tubes and ovaries. Mean duration of surgery was 121.5 minutes (SD 18.75) and EBL was 43 cc (SD 21.9). Mean uterine weight was 91.7 g (SD 47.69). Forty percent of patients had pelvic pathology noted intra-operatively and 46% stayed overnight with mean length of stay of 15.75 hours (SD 1.75). One patient had postoperative vaginal bleeding from introital lacerations requiring two separate re-operations. Access to the vagina was frequently challenging due to absence of prior vaginal intercourse and marked vaginal atrophy due to high dose testosterone. Focus group discussion identified opportunities for creating a welcoming, trans-competent atmosphere for this population.

CONCLUSION:

Regardless of their future plans for genital reassignment surgery (“bottom surgery”), trans men frequently pursue hysterectomy as part of their gender affirmation. Future research is needed to characterize this population, educate providers and improve gynecologic care.
Uterine Transplant: Views Among Medical Professionals [5Q]
Authors: Joudi Noor , Zanelotti Austin , Medina Carlos A.
Published: May 2017

INTRODUCTION:

Since 2014, with successful live-birth following uterine transplant in Sweden, uterine transplant has become a possible future treatment option for absolute uterine factor infertility (AUFI). The objective of this study is to assess acceptability of uterine transplant among medical personnel and determine if it would be more favorable than surrogacy.

METHODS:

After obtaining IRB approval a questionnaire designed to ascertain acceptability of uterine transplant was distributed using Survey Monkey. It consisted of 15 questions assessing demographics and responses to hypothetical questions regarding knowledge of transplant process, perception of surrogacy/transplant, donor type, willingness to donate, etc. The survey was distributed electronically to 891 medical personnel at our institution. The data was analyzed using descriptive and inferential statistics.

RESULTS:

From 891 questionnaires distributed only 22.7% responded. The majority of respondents were younger than 31 years old (93.7%), female (66.5%), and Caucasian (49.0%). No fellows or attending physicians responded. The majority of respondents chose a gestational surrogate (54.9%) over a uterine transplant (45.1%). Uterine transplant was viewed as a complex procedure by most (77.1%), however, 39.4% would attempt uterine transplant. It did not matter if it the transplant was from a living donor or a cadaver. 71.6% of respondents would donate their uterus if they were postmenopausal, and the overwhelmingly majority (95.1%) would donate their uterus as an organ donor.

CONCLUSION:

Although the majority of medical personnel view uterine transplant as a complex procedure, interestingly, the concept of undergoing a hypothetical uterine transplant was well accepted. Almost all survey respondents would consider donating their uterus.