bluuebunny/crossref_metadata_2025 huggingface dataset:
Abnormal timing of slow wave synchronization processes in non-rapid eye movement sleep parasomnias
Authors: Cataldi Jacinthe , Stephan Aurélie M , Marchi Nicola A , Haba-Rubio José , Siclari Francesca
Published: June 2022

Study Objectives

Sleepwalking, confusional arousals, and sleep terrors are parasomnias occurring out of non-rapid eye movement (NREM) sleep. Several previous studies have described EEG changes associated with NREM parasomnia episodes, but it remains unclear whether these changes are specific to parasomnia episodes or whether they are part of the normal awakening process. Here we directly compared regional brain activity, measured with high-density (hd-) EEG, between parasomnia episodes and normal awakenings (without behavioral manifestations of parasomnia).

Methods

Twenty adult patients with non-rapid eye movement parasomnias underwent a baseline hd-EEG recording (256 electrodes) followed by a recovery sleep recording after 25 h of total sleep deprivation, during which auditory stimuli were administered to provoke parasomnia episodes.

Results

Both normal awakenings (n = 25) and parasomnia episodes (n = 96) were preceded by large, steep, and “K-complex-like” slow waves in frontal and central brain regions, and by a concomitant increase in high-frequency EEG (beta) activity. Compared to normal awakenings, parasomnia episodes occurred on a less activated EEG background and displayed higher slow wave activity (SWA) and lower beta activity in frontal and central brain regions after movement onset.

Conclusions

Our results suggest that non-rapid eye movement awakenings, irrespective of behavioral manifestations of parasomnia episodes, involve an arousal-related slow wave synchronization process that predominantly recruits frontal and central brain areas. In parasomnia episodes, this synchronization process comes into play abnormally during periods of high SWA and is associated with higher SWA after movement onset. Thus, an abnormal timing of arousal-related slow wave synchronization processes could underlie the occurrence of NREM parasomnias.
Downregulation of miR‐1270 mediates endothelial progenitor cell function in preeclampsia: Role for ATM in the Src/VE‐cadherin axis
Authors: Schröder‐Heurich Bianca , Büder Tim , Meyer Nadia , Vu Thu Huong , Richter Katja , Ramachandran Dhanya , Brodowski Lars , von Kaisenberg Constantin S. , von Versen‐Höynck Frauke
Published: June 2022

Preeclampsia, a pregnancy‐related hypertensive disorder, is associated with endothelial dysfunction and increased cardiovascular risk of the offspring in adulthood. In preeclampsia, endothelial colony‐forming cells (ECFC) are reduced in number and function. Recently, we have shown that miR‐1270, which is involved in cancer in vitro proliferation, migration, and tumor progression, is downregulated in fetal ECFC from preeclamptic pregnancies. We now hypothesize that miR‐1270 dysregulation contributes to vascular endothelial dysfunction occurring after preeclampsia via ATM (ataxia telangiectasia mutated) overexpression, the key kinase of DNA damage repair. Here, we show that miR‐1270 silencing in normal ECFC and downregulation in preeclamptic ECFC are accompanied by an increase in the expression levels of ATM. Furthermore, ATM activation correlates with upregulated tyrosine kinase Src leading to phosphorylation and internalization of VE‐cadherin (vascular endothelial‐cadherin) which subsequently compromises endothelial barrier permeability and morphodynamic cell parameters. Treatment with specific ATM inhibitors reveals a novel role of ATM upstream of tyrosine kinase Src activation. Subsequently, Src phosphorylation and internalization of VE‐cadherin compromise endothelial barrier permeability. Our findings suggest that downregulation of miR‐1270 contributes to impaired ECFC function via the associated ATM overexpression, which further identifies ATM as a novel and critical factor for ECFC defects in preeclampsia. Our study provides new insights into the understanding of ECFC impairment associated with cardiovascular risk in preeclamptic offspring and identifies potential novel therapeutic targets.
Financial Incentives for Smoking Cessation in Pregnancy: Multicentre Randomised Controlled Trial
Authors: Berlin Ivan , Berlin Noémi , Malecot Marie , Breton Martine , Jusot Florence , Goldzahl Léontine
Published: June 2022

(Abstracted from BMJ 2021;375:e065217)

Smoking cessation during pregnancy is important to reduce the risk of adverse pregnancy and birth outcomes. According to the US Preventive Services Task Force, the benefits of behavioral interventions to stop smoking are substantial.
Success Rate of External Cephalic Version in Relation to the Woman's Body Mass Index and Other Factors—A Population-Based Cohort Study
Authors: Svensson Emelie , Axelsson Daniel , Nelson Marie , Nevander Sofia , Blomberg Marie
Published: June 2022

(Abstracted from Acta Obstet Gynecol Scand 2021;100:2260–2267)

For pregnancies with fetuses in the breech position, external cephalic version (ECV) is used to turn the fetus into a cephalic presentation. The procedure is associated with low complication rates, with the most common being transient fetal heart rate abnormalities, and a success rate up to 65% in various studies.
Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction on Prevention of Small-for-Gestational Age Birth Weights in Newborns Born to At-Risk Pregnant Individuals: The IMPACT BCN Randomized Clinical Trial
Authors: Crovetto Francesca , Crispi Fàtima , Casas Rosa , Martín-Asuero Andrés , Borràs Roger , Vieta Eduard , Estruch Ramon , Gratacós Eduard
Published: June 2022

(Abstracted from JAMA 2021;326:2150–2160)

Babies with birth weights below the 10th percentile, or small for gestational age infants (SGA), are at risk of poor neurodevelopment or perinatal mortality. Although there is currently no effective prevention therapy for SGA, this study aimed to evaluate the value of structured lifestyle interventions such as a Mediterranean diet or stress reduction therapy in terms of reducing incidence of birth weight <10th percentile and adverse pregnancy outcomes.
Changing Gender Gap and Practice Patterns in Reproductive Endocrinology and Infertility Subspecialists in the United States: A Society for Reproductive Endocrinology and Infertility Report
Authors: Stadtmauer Laurel , Sadek Seifeldin , Richter Kevin S. , Amato Paula , Hurst Bradley S.
Published: June 2022

(Abstracted from Fertil Steril 2022;117:421–430)

After the implementation of the Equal Pay Act of 1963, the pay gap between men and women for equal work has decreased from 62% to 80%. In the field of medicine, women make up greater than 50% of all students graduating medical school and approximately 40% of faculty members; yet, compared with male counterparts, women continue to be underpaid, obtain less funding, and are promoted at slower and lower rates.
Ciliary Gland Adenocarcinoma of the Eyelid Arising in Hidrocystoma: Case Report and Review of Previously Reported Cases
Authors: Malkova Kseniia , Tschen Jaime
Published: June 2022

Moll gland is a modified tubular-shaped apocrine sweat gland, which is located on the margin of the eyelid. Moll glands are also known as ciliary glands. The function of these glands was not well known for a long time. However, based on the different studies, it was proved that Moll glands are active from birth and have local immunologic function producing immunoglobulin A. We present a case of Moll adenocarcinoma, a type of apocrine carcinoma, arising from the right upper eyelid of a 57-year-old man. Although Moll gland cysts are frequently seen, this type of adnexal malignancy is extremely uncommon. These tumors can have variable presentation and behavior from less invasive forms to highly malignant metastatic recurrent lesions.
Eccrine Squamous Syringometaplasia Associated With Lichen Sclerosus et Atrophicus
Authors: Mishlab Salih , Cohen Itzhak , Bergman Reuven
Published: June 2022

Eccrine squamous syringometaplasia (ESS) has been associated with several conditions including morphea, linear scleroderma, and burns. It is yet to be reported in lichen sclerosus et atrophicus (LSA). We describe a bullous LSA plaque on the forearm of a woman with pre-existing genital LSA and vitiligo. Besides the histopathological findings of bullous LSA, numerous small irregular squamoid structures were present in the mid and upper dermis always above the normal eccrine glands. The histopathology, periodic acid–Schiff stain, and positive immunostains for P63, low molecular weight keratins 8&18, epithelial membrane antigen, and carcinoembryonic antigen supported the diagnosis of ESS. The pathogenesis of ESS in LSA may be related to ischemia, inflammation, and fibrosis.
ANOMALIES OF CHOROIDAL VENOUS STRUCTURE IN HIGHLY MYOPIC EYES
Authors: Lu Hongshuang , Du Ran , Xie Shiqi , Xiong Jianping , Chen Changyu , Moriyama Muka , Igarashi-Yokoi Tae , Takahashi Hiroyuki , Kamoi Koju , Uramoto Kengo , Nakao Noriko , Ohno-Matsui Kyoko
Published: June 2022

Purpose:

To identify anomalies of choroidal venous structure in highly myopic (HM) eyes.

Methods:

Widefield indocyanine green angiographic images of 175 HM eyes (refractive error ≤ –6.0D diopters or axial length >26.5 mm) and 100 control eyes taken between January 2014 and December 2018 were reviewed.

Results:

There were no significant differences in age and gender between HM patients and controls. Three types of changes of large choroidal veins were found in 103 HM eyes (58.86%): Asymmetry of vortex veins in 44 eyes (25.14%), isolated long vein across the macula in 58 eyes (33.14%), and intervortex anastomoses in 25 eyes (14.29%). Similar changes in controls were found in 12 eyes (12%), 0 eye (0%), and 2 eyes (2%), respectively, which were significantly lower than those in the HM group (all P < 0.05). The patterns of asymmetry were affected by steeper staphyloma edges and anastomoses were observed through large trunks and terminal venules. In two eyes with large trunk anastomosis, attenuation of the less dominant vortex vein was observed afterward.

Conclusion:

Choroidal venous anomalies are more common in HM eyes than controls. Choroidal venous structure in HM eyes may be altering continuously, and such changes may underlie the development of myopic maculopathy.
CLINICAL FEATURES AND PROGNOSIS IN IDIOPATHIC EPIRETINAL MEMBRANES WITH DIFFERENT TYPES OF INTRARETINAL CYSTOID SPACES
Authors: Yang Xiaohan , Wang Zengyi , Yu Yanping , Wu Xijin , Qi Biying , Liu Lingzi , Zhang Ke , Wang Xinbo , Liu Wu
Published: June 2022

Purpose:

To observe the characteristics and prognosis of different types of intraretinal cystoid spaces in idiopathic epiretinal membranes (iERMs).

Methods:

Two hundred and seven consecutive patients with symptomatic iERM who underwent vitrectomy between September 2016 and December 2019 were included. According to spectral-domain optical coherence tomography images, intraretinal cystoid spaces were classified into cystoid macular edema (CME) and microcystic macular edema (MME). Other optical coherence tomography characteristics, including ectopic inner foveal layers, central foveal thickness, and interdigitation zone integrity, were also evaluated.

Results:

Intraretinal cystoid spaces were presented in 30.1% of the iERMs, 21.5% were CME-type, 66.2% were MME-type, and 12.3% were combined-type. Compared with CME, eyes with MME-type and combined-type showed a significantly lower best-corrected visual acuity (BCVA) preoperatively and postoperatively. Cystoid macular edema is always presented in earlier stages (92.9%) and has no significant effects on BCVA (P

Stage I
= 0.927, P

Stage II
= 0.985). Conversely, MME is the primary type in advanced stages associated with a longer duration of symptoms (P = 0.037) and lower preoperative BCVA (P = 0.008). After surgery, cystoid spaces were newly occurred in 33 eyes (21.6%), with no effects on BCVA (P = 0.668). In the multiple regression analysis, the presence of MME was a risk factor for preoperative BCVA (P = 0.001). However, it is not an independent predictor for the postoperative VA.

Conclusion:

Our research further proved that MME is an adverse factor for preoperative and postoperative VA in iERMs. Moreover, we underlined the importance of distinguishing between CME and MME, which may affect prognosis differently.
Surgical Advancement of Tenon’s Layer During Trabeculectomy Improves Bleb Morphology
Authors: Roddy Gavin W. , Sit Arthur J.
Published: June 2022

Trabeculectomy surgery remains the gold standard incisional glaucoma surgical procedure in many practices, particularly for patients requiring intraocular pressure (IOP) in the low teens or below. However, trabeculectomy surgery is associated with complications including leakage, over filtration, or fibrosis of the surgical bleb. Morphology of the surgical bleb is an important predictor of surgical success defined as long-term IOP reduction with minimal to no complications. There have been many, often subtle, variations in the surgical technique in hopes of improving long-term IOP reduction. However, fewer changes have been implemented specifically to modify bleb morphology. In our surgical practice, we began performing a thorough dissection and advancement of Tenon’s layer with incorporation into the conjunctival closure in a 2-layered manner. This technique allowed flow of aqueous to a delineated potential space between sclera and Tenon’s layer. Our clinical observations were improved bleb morphology characterized by diffuse, low-lying blebs with nonischemic overlying conjunctiva compared with those performed with a more traditional trabeculectomy technique. Since we incorporated this change into our practice at a defined time, we have a small number of patients in our practice that had a more traditional trabeculectomy technique in the fellow eye. Therefore, in our surgical practice, a small number of patients had trabeculectomy in 1 eye before implementation of this new technique, and then had trabeculectomy in the fellow eye after this technique was adopted, providing opportunity for comparison of bleb morphology with and without Tenon advancement. In series we present two representative, index cases and describe our surgical technique.
Prophylactic Clipping to Prevent Delayed Bleeding and Perforation After Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection
Authors: Jiang Wenxi , Cen Li , Dong Caijuan , Zhu Shefeng , Shen Zhe , Li Dong
Published: June 2022

Background and Aims:

To help prevent delayed adverse events after endoscopic surgery, endoscopists often place clips at the site. This meta-analysis aimed to assess the efficacy and safety of prophylactic clipping in the prevention of delayed bleeding and perforation after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR).

Methods:

Multiple databases were searched from the inception dates to April 2021. And we included all relevant studies. Pooled odds ratio comparing the prophylactic clipped group versus nonprophylactic clipped group were calculated using the random effects model.

Results:

Twenty-seven articles fulfilled the inclusion criteria, with a total size of 8693 participants. There was statistically significant difference in prophylactic clipping versus no prophylactic clipping for delayed bleeding and perforation found in all studies (odds ratio: 0.35, 95% confidence interval: 0.25-0.49, P<0.01; odds ratio: 0.42, 95% confidence interval: 0.21-0.83, P<0.05; respectively). Besides, statistically significant difference was also found in subgroup analyses based on patients with lesions larger than 20 mm. Prophylactic clipping was more protective for duodenal delayed adverse events than colorectum. The use of clip closure was more protective to ESD-related delayed adverse events than EMR.

Conclusions:

Prophylactic clipping after ESD and EMR was beneficial in preventing delayed bleeding and perforation.
Do Chargemaster Prices Matter?
Authors: Linde Sebastian , Egede Leonard E.
Published: June 2022

Background:

It remains widely debated whether chargemaster price markups are tied to hospital profitability.

Objective:

To evaluate the effect of chargemaster markups on hospital profitability in the presence of unobserved hospital-specific (time-invariant) confounders, and cross-sectional dependence due to latent (common) policy shocks.

Design:

We use interactive fixed effects methods to address concerns of unobserved hospital-specific (time-invariant) confounders, and cross-sectional dependence.

Setting:

US acute care hospitals, 1996 through 2017 (ie, 22 y).

Participants:

Using primarily Medicare cost report data, we construct an unbalanced panel of 3499 acute care hospitals per year, or a total of 76,972 hospital-year observations.

Measurements:

Chargemaster markups (above cost), profits per hospital inpatient discharge.

Results:

Between 1996 and 2017, chargemaster markups increased (on average) by 155%, and the SD of the chargemaster markup distribution increased by 324%—indicating growing variability in the average markup strategies pursued by hospitals. Our preferred model specification implies that a unit increase of the hospital chargemaster markup is associated with a $261 (P<0.01; 95% confidence interval: $232–$291) increase in profits per hospital inpatient discharge. These results are robust to a wide set of model specifications, the use of alternative profitability measurements, and the use of an alternative instrumental variable identification strategy. Additional subsample analysis that controls for a rich set of hospital quality measures and system affiliation information also yields similar results.

Conclusion:

We show that higher chargemaster markups are associated with higher hospital profitability. Additional research is needed to understand how chargemaster pricing impact health outcomes and health care disparities.
Managing pulmonary arterial hypertension: how to select and facilitate successful transplantation
Authors: Khangoora Vikramjit S. , King Christopher S. , Shlobin Oksana A.
Published: June 2022

Purpose of review

Despite improvements in available medical therapies, pulmonary arterial hypertension (PAH) remains a progressive, ultimately fatal disorder. Lung transplantation is a viable treatment option for PAH patients with advanced disease.

Recent findings

Recent guidelines from the International Society of Heart and Lung Transplantation (ISHLT) have updated recommendations regarding time of referral and listing for lung transplantation in PAH. The new guidelines emphasize earlier referral for transplant evaluation to ensure adequate time for proper evaluation and listing. They also incorporate objective risk stratification criteria to assist in decision-making regarding timing of referral and listing. With regards to the transplant procedure, bilateral lung transplantation has largely supplanted heart–lung transplantation as the procedure of choice for transplantation for advanced PAH. Exceptions to this include patients with PAH because of congenital heart disease and those with concurrent LV dysfunction. Use of mechanical support via venoarterial ECMO initiated before transplantation and continued into the early postoperative period is emerging as a standard of care and may help to reduce early posttransplant mortality in this population. There has been increased recognition of the importance of WHO Group 3 pulmonary hypertension. Many of the lessons learned from PAH may be applied when transplanting patients with severe WHO Group 3 pulmonary hypertension.

Patients with PAH present unique challenges with regards to transplantation that require a therapeutic approach distinct from other lung disorders. Lung transplantations for PAH are high-risk endeavors best performed at centers with expertise in management of both PAH and extracorporeal support.
Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications: A Systematic Review
Authors: Doyle Paula Jaye , Grimes Cara L. , Balk Ethan M. , Wieslander Cecilia , Richardson Monica , Mamik Mamta M. , Sleemi Ambereen , Alas Alexandriah , Kudish Bela , Walter Andrew J. , Aschkenazi Sarit , Mama Saifuddin , Foda Mohamed , Meriwether Kate V.
Published: June 2022

(Abstracted from Obstet Gynecol 2022;139:277–286)

Because the US Food and Drug administration gave approval for mesh midurethral slings for surgical treatment of female stress incontinence (SUI) in 1996, these synthetic midurethral slings have become procedure of choice for this diagnosis. A systematic review of evidence-based practice guidelines for partial and total removal of these slings after complications was performed by the Society of Gynecologic Surgeons Systematic Review Group.
Sudden Unexpected Death in Epilepsy
Authors: Jordan Richard D. , Coscia Matthew , Lantz Patrick , Harrison William
Published: June 2022

Sudden unexplained death in epilepsy (SUDEP) is the most common cause of death in children and young adults with epilepsy with epileptic patients harboring a 27 times increased risk of death from SUDEP. Structural brain lesions are encountered in up to 50% of autopsy cases. In this case series, we report 3 previously undiagnosed structural causes of SUDEP discovered at autopsy at our institution including schizencephaly, ganglioglioma, and focal cortical dysplasia. Our major recommendation is in cases with suspected SUDEP, formal neuropathological examination and tissue sampling should be employed to identify and characterize specific potential anatomic etiologies.
Vascular Safe Zones for Facial Soft Tissue Filler Injections
Authors: Cotofana Sebastian , Lowrey Nicola , Frank Konstantin , Ziebart Rachel , Guertler Anne , Freytag Lysander , Helm Sabrina , Alfertshofer Michael G. , Moellhoff Nicholas
Published: June 2022

The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones.
Is the Systematic Sponge Count an Impediment to Patient Care During Plastic Surgical Procedures?
Authors: Geeroms Maxim , Pai Ashwin , Ceuterick Brecht , Kapila Ayush
Published: June 2022

Nurses and surgeons collaborate to conduct safe surgery. We follow time-consuming and labor-intensive protocols, such as the systematic counting and verifying of surgical sponges. However, the counting process may be distracting from other patient-centered tasks. To understand the perception of plastic surgery professionals about the intraoperative sponge count, we designed an online questionnaire. One hundred plastic surgeons and residents from 32 different countries completed the survey. The results showed that most often (70%) the scrub person determines when sponges will be counted, and 34.3% of the time, a sponge count is incorrect at the first count and then corrected. The main reason for an incorrect sponge count appears to be a change in personnel (53%). Radiological imaging is required during an average of 8.7% of surgeries to rule out a retained sponge in the patient. Notably, missing sponges are most frequently found elsewhere in the operating room. Younger surgeons prefer to pause during the surgical procedure until the sponge count is completed and noted to be correct. This approach appears to be associated with fewer counting errors, a shorter counting time, and a significant reduction in distraction of the whole surgical team. Performing a cavity sweep before beginning wound closure and using large surgical sponges are also suggested as alternatives to counting sponges. A sponge count can become an impediment to patient care because it has limited reliability and causes distraction among the team. A surgical pause can be implemented until the sponge count is completed or until any discrepancy is resolved.
Beautiful Unique Faces—Be the Change—Make It Your Legacy
Authors: East Anita
Published: June 2022

Due to increasing pressure from social media, influencers, friends, society, and even our own self-expectations to look beautiful, women and girls are in the stranglehold of a sickening mental health crisis. As practitioners of nonsurgical aesthetic medicine, we can help our patients to navigate and overcome the common belief that happiness comes from inside an injectable syringe.
Ultrasound for the Aesthetic Injector
Authors: Weiner Steven F.
Published: June 2022

The use of ultrasound has become ubiquitous in the health care industry. Several ultrasound applications may be beneficial for aesthetic injectors. Aesthetic injectors can use ultrasound to visualize needles or cannulas and confirm the exact location of the tip. Using ultrasound guidance can improve nodule management. Perhaps, the most beneficial aspect of ultrasound guidance is its ability to identify and assist with vascular occlusions. The available ultrasound systems appropriate for aesthetic injectors are handheld or cart systems. When purchasing ultrasound systems, practitioners must weigh the advantages and disadvantages of a cart system (i.e., better resolution, higher cost, greater space requirements) compared with the advantages and disadvantages of a handheld system (i.e., increased portability, lower costs, less resolution). High-frequency ultrasound is rapidly being adopted by aesthetic injectors. It is time to consider adding an ultrasound system to your practice to increase safety and provide better outcomes for your patients.
Effect of Time of Year on Surgical Outcomes in Patients Undergoing Minimally Invasive Sacral Colpopexy or Uterosacral Ligament Suspension
Authors: Renkosiak Kaitlin , Bradley Megan , Dubinskaya Alexandra , Shepherd Jonathan P.
Published: June 2022

Importance

Academic urogynecologists incorporating fellows/residents into operative cases must ensure safety and quality outcomes throughout the learning curve of the academic year.

Objectives

We evaluated if the month of year relative to fellow/resident promotions in July affects operating time, complications, and prolapse recurrence for minimally invasive sacral colpopexy (MISC) or uterosacral ligament suspension (USLS).

Study Design

This was a retrospective study comprising MISC and USLS from January 2009 to August 2015. Patient demographics, clinical, and surgical data were compared between months with July as month 1. Linear regression assessed operating time. Logistic regression assessed prolapse recurrence (composite of any POP-Q point beyond the hymen, pessary use, or reoperation) and complications.

Results

One thousand seven participants had a mean age of 59.9 ± 9.4, body mass index of 27.6 ± 4.2, gravity of 3.0 ± 1.5, and parity of 2.6 ± 1.1. Most had stage III (67.7%) or II prolapse (25.6%). Minimally invasive sacral colpopexy represented 81.0% (58.8% laparoscopic, 41.2% robotic). Uterosacral ligament suspensions were 68.1% vaginal versus laparoscopic/robotic. Median follow-up was 34 weeks (interquartile range, 11–82). Mean operating time was 199.8 ± 66.4 minutes with no impact by month (P = 0.26). Minimally invasive sacral colpopexy (vs USLS, β = 36.4 minutes), conversion to laparotomy (β = 112.9 minutes), and concomitant hysterectomy (β = 33.4 minutes) increased operating time (P < 0.001). Complications ranged 7.9% (January) to 23.8% (March) with mean of 17.1%. Complications were unaffected by month (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95–1.04), but USLS had more complications than MISC (OR, 1.55; 95% CI, 1.05–2.28). Prolapse recurred in 9.4% with no impact by month (OR, 0.95; 95% CI, 0.88–1.02). Minimally invasive sacral colpopexy had less recurrence than USLS (OR, 0.33; 95% CI, 0.18–0.60).

Conclusions

Month of year relative to resident/fellow promotion did not affect operating time, complications, or recurrence, debunking the myth of worse outcomes earlier in the academic year.
Unicellular–multicellular evolutionary branching driven by resource limitations
Authors: Bonforti Adriano , Solé Ricard
Published: June 2022

Multicellular life forms have evolved many times on our planet, suggesting that this is a common evolutionary innovation. Multiple advantages have been proposed for the emergence of multicellularity (MC). In this paper, we address the problem of how the first precondition for MC, namely ‘stay together’, might have occurred under spatially limited resources exploited by a population of unicellular agents. Using a minimal model of evolved cell–cell adhesion among growing and dividing cells that exploit a localized resource with a given size, we show that a transition occurs at a critical resource size separating a phase of evolved multicellular aggregates from a phase where unicellularity (UC) is favoured. The two phases are separated by an intermediate domain where both UC and MC can be selected by evolution. This model provides a minimal approach to the early stages that were required to transition from individuality to cohesive groups of cells associated with a physical cooperative effect: when resources are present only in a localized portion of the habitat, MC is a desirable property as it helps cells to keep close to the available local nutrients.
Sensitivity analysis on a network model of glymphatic flow
Authors: Boster Kimberly A. S. , Tithof Jeffrey , Cook Douglas D. , Thomas John H. , Kelley Douglas H.
Published: June 2022

Intracranial cerebrospinal and interstitial fluid (ISF) flow and solute transport have important clinical implications, but limited
in vivo
access to the brain interior leaves gaping holes in human understanding of the nature of these neurophysiological phenomena. Models can address some gaps, but only insofar as model inputs are accurate. We perform a sensitivity analysis using a Monte Carlo approach on a lumped-parameter network model of cerebrospinal and ISF in perivascular and extracellular spaces in the murine brain. We place bounds on model predictions given the uncertainty in input parameters. Péclet numbers for transport in penetrating perivascular spaces (PVSs) and within the parenchyma are separated by at least two orders of magnitude. Low permeability in penetrating PVSs requires unrealistically large driving pressure and/or results in poor perfusion and are deemed unlikely. The model is most sensitive to the permeability of penetrating PVSs, a parameter whose value is largely unknown, highlighting an important direction for future experiments. Until the value of the permeability of penetrating PVSs is more accurately measured, the uncertainty of any model that includes flow in penetrating PVSs is so large that absolute numbers have little meaning and practical application is limited.
The ‘sustainability gap’ of US broiler chicken production: trade-offs between welfare, land use and consumption
Authors: Chan Iris , Franks Becca , Hayek Matthew N.
Published: June 2022

In 2018, over nine billion chickens were slaughtered in the United States. As the demand for chickens increases, so too have concerns regarding the welfare of the chickens in these systems and the damage such practices cause to the surrounding ecosystems. To address welfare concerns, there is large-scale interest in raising chickens on pasture and switching to slower-growing, higher-welfare breeds as soon as 2024. We created a box model of US chicken demographics to characterize aggregate broiler chicken welfare and land-use consequences at the country scale for US shifts to slower-growing chickens, housing with outdoor access, and pasture management. The US produces roughly 20 million metric tons of chicken meat annually. Maintaining this level of consumption entirely with a slower-growing breed would require a 44.6%–86.8% larger population of chickens and a 19.2%–27.2% higher annual slaughter rate, relative to the current demographics of primarily ‘Ross 308’ chickens that are slaughtered at a rate of 9.25 billion per year. Generating this quantity of slower-growing breeds in conventional concentrated animal feeding operations (CAFO) would require 90 582–98 687 km
2
, an increase of 19.9–30.6% over the 75 577 km
2
of land used for current production of Ross 308. Housing slower-growing breeds on pasture, the more individually welfare-friendly option, would require 108 642–121 019 km
2
, a 43.8–60.1% increase over current land use. Allowing slower-growing breeds occasional outdoor access is an intermediate approach that would require 90 691–98 811 km
2
, an increase of 20–30.7% of the current land use, a very minor increase of land relative to managing slower-growing breeds in CAFOs. In sum, without a drastic reduction in consumption, switching to alternative breeds will lead to a substantial increase in the number of individuals killed each year, an untenable increase in land use, and a possible decrease in aggregate chicken welfare at the country-level scale. Pasture-based management requires substantial additional land use. These results demonstrate constraints and trade-offs in animal welfare, environmental conservation and food animal consumption, while highlighting opportunities for policies to mitigate impacts in an integrated manner using a One Health approach.
Robustness of subwavelength devices: a case study of cochlea-inspired rainbow sensors
Authors: Davies Bryn , Herren Laura
Published: June 2022

We derive asymptotic formulae describing how the properties of subwavelength devices are changed by the introduction of errors and imperfections. As a demonstrative example, we study a class of cochlea-inspired rainbow sensors. These are graded metamaterials which have been designed to mimic the frequency separation performed by the cochlea. The device considered here has similar dimensions to the cochlea and has a resonant spectrum that falls within the range of audible frequencies. We show that the device’s properties (including its role as a signal filtering device) are stable with respect to small imperfections in the positions and sizes of the resonators. Additionally, under suitable assumptions, if the number of resonators is sufficiently large, then the device’s properties are stable under the removal of a resonator.
Surviving environmental change: when increasing population size can increase extinction risk
Authors: Tanaka Mark M. , Wahl Lindi M.
Published: June 2022

Populations threatened by an abrupt environmental change—due to rapid climate change, pathogens or invasive competitors—may survive if they possess or generate genetic combinations adapted to the novel, challenging condition. If these genotypes are initially rare or non-existent, the emergence of lineages that allow a declining population to survive is known as ‘evolutionary rescue’. By contrast, the genotypes required for survival could, by chance, be common before the environmental change. Here, considering both of these possibilities, we find that the risk of extinction can be lower in very small or very large populations, but peaks at intermediate population sizes. This pattern occurs when the survival genotype has a small deleterious effect before the environmental change. Since mildly deleterious mutations constitute a large fraction of empirically measured fitness effects, we suggest that this unexpected result—an intermediate size that puts a population at a greater risk of extinction—may not be unusual in the face of environmental change.
The exploitation of sexual signals by predators: a meta-analysis
Authors: White Thomas E. , Latty Tanya , Umbers Kate D. L.
Published: June 2022

Sexual signals are often central to reproduction, and their expression is thought to strike a balance between advertising to mates and avoiding detection by predatory eavesdroppers. Tests of the predicted predation costs have produced mixed results, however. Here we synthesized 187 effects from 78 experimental studies in a meta-analytic test of two questions; namely, whether predators, parasites and parasitoids express preferences for the sexual signals of prey, and whether sexual signals increase realized predation risk in the wild. We found that predators and parasitoids express strong and consistent preferences for signals in forced-choice contexts. We found a similarly strong overall increase in predation on sexual signallers in the wild, though here it was modality specific. Olfactory and acoustic signals increased the incidence of eavesdropping relative to visual signals, which experienced no greater risk than controls on average. Variation in outcome measures was universally high, suggesting that contexts in which sexual signalling may incur no cost, or even reduce the incidence of predation, are common. Our results reveal unexpected complexity in a central viability cost to sexual signalling, while also speaking to applied problems in invasion biology and pest management where signal exploitation holds promise for bio-inspired solutions.
Vocal babbling in a wild parrot shows life history and endocrine affinities with human infants
Authors: Eggleston Rory , Viloria Nurialby , Delgado Soraya , Mata Astolfo , Guerrero Hilda Y. , Kline Richard J. , Beissinger Steven R. , Berg Karl S.
Published: June 2022

Prelinguistic babbling is a critical phase in infant language development and is best understood in temperate songbirds where it occurs primarily in males at reproductive maturity and is modulated by sex steroids. Parrots of both sexes are icons of tropical vocal plasticity, but vocal babbling is unreported in this group and whether the endocrine system is involved is unknown. Here we show that vocal babbling is widespread in a wild parrot population in Venezuela, ensues in both sexes during the nestling stage, occurs amidst a captive audience of mixed-aged siblings, and is modulated by corticosteroids. Spectrographic analysis and machine learning found phoneme diversity and combinatorial capacity increased precipitously for the first week, thereafter, crystalizing into a smaller repertoire, consistent with the selective attrition model of language development. Corticosterone-treated nestlings differed from unmanipulated birds and sham controls in several acoustic properties and crystallized a larger repertoire post-treatment. Our findings indicate babbling occurs during an early life-history stage in which corticosteroids help catalyse the transition from a universal learning programme to one finely tuned for the prevailing ecological environment, a potentially convergent scenario in human prelinguistic development.
Environment, animal hosts and human activity on predicting space-time variations of Lyme Borreliosis incidence in France: a Bayesian two-part model
Authors: Fu Wen , Bonnet Camille , Septfons Alexandra , Figoni Julie , Durand Jonas , Frey-Klett Pascale , Rustand Denis , Jaulhac Benoît , Métras Raphaëlle
Published: June 2022

Background

Lyme Borreliosis (LB) is the most widespread hard tick-borne zoonosis in the Northern Hemisphere and shows a seasonal pattern. Existing studies in Europe mainly focused on acarological risk assessment, with very limited investigations exploring human LB occurrence. We aimed to highlight areas and seasons of higher risk for LB occurrence in mainland France, integrating information on meteorological, environmental, animal hosts and human exposure to quantify the associated spatial and temporal risk factors.

Methods

We fitted 2016–19 French LB surveillance data to a two-part spatiotemporal statistical model, defined with binomial and gamma distributions, to explore the factors associated with the presence and increased LB incidence. Shared spatial and temporal random effects were specified using a Besag-York-Mollie model and a seasonal model, respectively. Coefficients were estimated in a Bayesian framework using integrated nested Laplace approximation. Projections and data for 2020 were used for model validation.

Findings

LB presence was associated with a high vegetation index (≥0·6). LB incidence increased in areas highly suitable for deer (≥80% cover per area), with mild soil temperatures (10–15°C) in the season preceding the onset, moderate air saturation deficits (3–5 mmHg), and higher proportion of tick bite reports. Prediction maps showed a higher risk of LB in spring and summer (April-September). Substantial geographical variation in LB incidence was found. Higher incidence was reported in parts of eastern, midwestern, and southwestern France.

Interpretation

This is the first national-level assessment of seasonal human LB occurrence in Europe allowing to disentangle factors associated with LB presence and increased incidence. This model illustrates a spatial integrated analysis of meteorological, hosts, and anthropogenic factors for a zoonotic and vector-borne infection of major public health concern, and can be used as a reference model to be calibrated in other LB-affected areas.

Funding

WF is funded by a Sorbonne University PhD fellowship, JD is supported by a grant overseen by the French National Research Agency (ANR) as part of the «Investissements d’Avenir» program (ANR-11-LABX-0002-01, Lab of Excellence ARBRE).
Effectiveness of a telenursing intervention program in reducing exacerbations in patients with chronic respiratory failure receiving noninvasive positive pressure ventilation: A randomized controlled trial
Authors: Shimoyama Makoto , Sato Fumiko , Sato Naoko , Yoshida Shiori , Takahashi Chikako , Inoue Mizue
Published: June 2022

Telenursing for patients with chronic respiratory failure receiving noninvasive positive pressure ventilation (NPPV) is an important aid in reducing exacerbations; however, there is insufficient evidence. This randomized controlled trial aimed to investigate the effectiveness of a telenursing intervention program in reducing exacerbations in patients with chronic respiratory failure receiving NPPV at home. This study included patients who were receiving NPPV at home and could handle a tablet device. The intervention group (n = 15) was exposed to an information and communications technology-based telenursing intervention program, in addition to usual care; the control group (n = 16) received the usual care only. The telenursing intervention program comprised telemonitoring and health counseling sessions via videophone. The intervention was evaluated once at enrollment and after 3 months. The primary endpoints were the number of unscheduled outpatient visits, hospitalizations, and hospital days. The secondary endpoints included the St. George’s Respiratory Questionnaire (SGRQ), Euro QOL 5 Dimension, Self-Care Agency Questionnaire (SCAQ), pulmonary function tests, and 6-minute walking distance. We found no significant differences between the intervention and control groups at enrollment. At follow-up, the number of routine outpatient visits for acute exacerbations (r = .36; p = .045), the number of hospitalizations (r = .38; p = .037), the number of hospital days (r = .39; p = .031), SGRQ (r = .36; p = .016), SCAQ (r = .41; p = .019), and 6-minute walking distance (r = .54; p = .030) were significantly different. The increase in the number of unscheduled outpatient visits in the intervention group during follow-up was attributed to acute exacerbations and a significant decrease in the number of hospitalizations and hospital days. Hence, the telenursing intervention program may be effective in reducing exacerbations in patients with chronic respiratory failure receiving NPPV at home.

Trial Registration

UMIN Clinical Trials Registry (UMIN-CTR) UMIN000027657
Persistent Orofacial Pain Attendances at General Medical Practitioners
Authors: Currie CC , Palmer J , Stone SJ , Brocklehurst P , Aggarwal VR , Dorman PJ , Pearce MS , Durham J
Published: June 2022

Patients with persistent orofacial pain (OFP) can go through complex care pathways to receive a diagnosis and management, which can negatively impact their pain. This study aimed to describe 44-year trends in attendances at Welsh medical practices for persistent OFP and establish the number of attendances per patient and referrals associated with OFP and factors which may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analysed using descriptive statistics, univariate, and multivariable logistic regression. Over the 44-year period there were 468,827 persistent OFP and migraine Read codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1000 patient-years (95% CI 4.21-4.23). The attendance rate increased over the study period. Almost one-third of patients (n=92,192, 30.54%) attended more than once over the study period and 15.83% attended more than once within a 12-month period. There were 20,103 referral Read codes which were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (OR 1.23; 95% CI 1.17-1.29), in those living in rural locations (OR 1.17; 95% CI 1.12-1.22) and in the least deprived quintile (OR 1.39; 95% CI 1.29-1.48). Odds also increased with increasing age (OR 1.03; 95% CI 1.03-1.03). The increasing attendance may be explained by the increasing incidence of persistent OFP within the population. Current care pathways when these patients do seek care from their GMP could be improved. Referrals could be encouraged at an earlier point and made to the most appropriate place to streamline care pathways which could result in improved patient outcomes.
Lineage BA.2 dominated the Omicron SARS-CoV-2 epidemic wave in the Philippines
Authors: Li Yao-Tsun , Polotan Francisco Gerardo M. , Sotelo Gerald Ivan S. , Alpino Anne Pauline A. , Dolor Ardiane Ysabelle M. , Tujan Ma. Angelica A. , Gomez Ma. Ricci R. , Onza Othoniel Jan T. , Chang Angela Kae T. , Bautista Criselda T. , Carandang June C. , Lim Dodge R. , Dancel Lei Lanna M. , Uy-Lumandas Mayan , Dizon Timothy John R. , Hampson Katie , Daldry Simon , Hughes Joseph , Brunker Kirstyn
Published: June 2022

The Omicron SARS-CoV-2 variant led to a dramatic global epidemic wave following detection in South Africa in November, 2021. The Omicron lineage BA.1 was dominant and responsible for most domestic outbreaks during December 2021-January 2022, whilst other Omicron lineages including BA.2 accounted for the minority of global isolates. Here, we describe the Omicron wave in the Philippines by analysing genomic data. Our results identify the presence of both BA.1 and BA.2 lineages in the Philippines in December 2021, before cases surged in January 2022. We infer that only lineage BA.2 underwent sustained transmission in the country, with an estimated emergence around November 18th, 2021 [95% highest posterior density: November 6-28th], whilst despite multiple introductions BA.1 transmission remained limited. These results suggest the Philippines was one of the earliest areas affected by BA.2, and reiterate the importance of whole-genome sequencing for monitoring outbreaks.