bluuebunny/crossref_metadata_2025 huggingface dataset:
RING finger ubiquitin E3 ligase gene TaSDIR1-4A contributes to determination of grain size in common wheat
Authors: Wang Jingyi , Wang Ruitong , Mao Xinguo , Zhang Jialing , Liu Yanna , Xie Qi , Yang Xiaoyuan , Chang Xiaoping , Li Chaonan , Zhang Xueyong , Jing Ruilian
Published: May 2020

Salt and drought-induced RING finger1 (SDIR1) is a RING-type E3 ubiquitin ligase that plays a key role in ABA-mediated responses to salinity and drought stress via the ubiquitination pathway in some plant species. However, its function in wheat (Triticum aestivum) is unknown. Here, we isolated a SDIR1 member in wheat, TaSDIR1-4A, and characterized its E3 ubiquitin ligase activity. DNA polymorphism assays showed the presence of two nucleotide variation sites in the promoter region of TaSDIR1-4A, leading to the detection of the haplotypes Hap-4A-1 and Hap-4A-2 in wheat populations. Association analysis showed that TaSDIR1-4A haplotypes were associated with 1000-grain weight (TGW) across a variety of different environments, including well-watered and heat-stress conditions. Genotypes with Hap-4A-2 had higher TGW than those with Hap-4A-1. Phenotypes in both gene-silenced wheat and transgenic Arabidopsis showed that TaSDIR1-4A was a negative regulator of grain size. Gene expression assays indicated that TaSDIR1-4A was most highly expressed in flag leaves, and expression was higher in Hap-4A-1 accessions than in Hap-4A-2 accessions. The difference might be attributable to the fact that TaERF3 (ethylene response factor) can act as a transcriptional repressor of TaSDIR1-4A in Hap-4A-2 but not in Hap-4A-1. Examination of modern wheat varieties shows that the favorable haplotype has been positively selected in breeding programs in China. The functional marker for TaSDIR1-4A developed in this study should be helpful for future wheat breeding.
Public perception of COVID-19’s global health crisis on Twitter until 14 weeks after the outbreak
Authors: Abdo Muhammad S , Alghonaim Ali S , Essam Bacem A
Published: May 2020

Because language represents advanced aspects of human cognition, studying linguistic styles and figurative meaning have proven effective in measuring embodied cognition about the external world. This article defines the most worrisome topics people discussed from Weeks 1 to 14 after the outbreak and compares the message delivered by the literal use of words to the figurative use of metaphoric expressions. We bootstrapped representative data from Twitter over 14 weeks since the inception of the outbreak to be analyzed thematically using the Linguistic Inquiry and Word Count (LIWC) 2015 software as well as corpus tools. The MetaNet database, corpus tools, and manual annotation were used to detect expressions that can be linguistically mapped to the formalized list of conceptual metaphors. The most frequently tagged themes included ‘the outbreak of the pandemic, its epidemiology, its prophylaxis measures, national and world economies, media’, as well as the ‘signs and symptoms of COVID-19’. Although LIWC-based analysis showed English-speaking tweeters maintained high levels of analytical thinking, elevated levels of anger, anxiety, and doubtfulness, there were discrepancies and improper conceptualization of the clinical picture of the pandemic.
5′ modifications to CRISPR–Cas9 gRNA can change the dynamics and size of R-loops and inhibit DNA cleavage
Authors: Mullally Grace , van Aelst Kara , Naqvi Mohsin M , Diffin Fiona M , Karvelis Tautvydas , Gasiunas Giedrius , Siksnys Virginijus , Szczelkun Mark D
Published: May 2020

A key aim in exploiting CRISPR–Cas is gRNA engineering to introduce additional functionalities, ranging from individual nucleotide changes that increase efficiency of on-target binding to the inclusion of larger functional RNA aptamers or ribonucleoproteins (RNPs). Cas9–gRNA interactions are crucial for complex assembly, but several distinct regions of the gRNA are amenable to modification. We used in vitro ensemble and single-molecule assays to assess the impact of gRNA structural alterations on RNP complex formation, R-loop dynamics, and endonuclease activity. Our results indicate that RNP formation was unaffected by any of our modifications. R-loop formation and DNA cleavage activity were also essentially unaffected by modification of the Upper Stem, first Hairpin and 3′ end. In contrast, we found that 5′ additions of only two or three nucleotides could reduce R-loop formation and cleavage activity of the RuvC domain relative to a single nucleotide addition. Such modifications are a common by-product of in vitro transcribed gRNA. We also observed that addition of a 20 nt RNA hairpin to the 5′ end of a gRNA still supported RNP formation but produced a stable ∼9 bp R-loop that could not activate DNA cleavage. Consideration of these observations will assist in successful gRNA design.
InMeRF: prediction of pathogenicity of missense variants by individual modeling for each amino acid substitution
Authors: Takeda Jun-ichi , Nanatsue Kentaro , Yamagishi Ryosuke , Ito Mikako , Haga Nobuhiko , Hirata Hiromi , Ogi Tomoo , Ohno Kinji
Published: May 2020

In predicting the pathogenicity of a nonsynonymous single-nucleotide variant (nsSNV), a radical change in amino acid properties is prone to be classified as being pathogenic. However, not all such nsSNVs are associated with human diseases. We generated random forest (RF) models individually for each amino acid substitution to differentiate pathogenic nsSNVs in the Human Gene Mutation Database and common nsSNVs in dbSNP. We named a set of our models ‘Individual Meta RF’ (InMeRF). Ten-fold cross-validation of InMeRF showed that the areas under the curves (AUCs) of receiver operating characteristic (ROC) and precision–recall curves were on average 0.941 and 0.957, respectively. To compare InMeRF with seven other tools, the eight tools were generated using the same training dataset, and were compared using the same three testing datasets. ROC-AUCs of InMeRF were ranked first in the eight tools. We applied InMeRF to 155 pathogenic and 125 common nsSNVs in seven major genes causing congenital myasthenic syndromes, as well as in VANGL1 causing spina bifida, and found that the sensitivity and specificity of InMeRF were 0.942 and 0.848, respectively. We made the InMeRF web service, and also made genome-wide InMeRF scores available online (https://www.med.nagoya-u.ac.jp/neurogenetics/InMeRF/).
Hierarchically porous monoliths based on low-valence transition metal (Cu, Co, Mn) oxides: gelation and phase separation
Authors: Lu Xuanming , Kanamori Kazuyoshi , Nakanishi Kazuki
Published: May 2020

Hierarchically porous monoliths based on copper (Cu), cobalt (Co) and manganese (Mn) oxides with three-dimensionally (3D) interconnected macropores and open nanopores were prepared using metal bromides as precursors via a sol–gel process accompanied by phase separation. The difficulty of gelation for low-valence metal cation was overcome by introducing a highly electronegative Br atom near to the metal atom to control the rates of hydrolysis and polycondensation. The 3D interconnected macropores were obtained using appropriate polymers to induce phase separation. The domain sizes of macropores and skeletons can be controlled by reaction parameters such as concentration and/or average molecular weight of polymers, and the amount of hydrochloric acid. The crystalline metal oxide monoliths with their 3D interconnected macroporous structure preserved were obtained after heat treatment in air.
Quantum simulation of particle pair creation near the event horizon
Authors: Wang Yao , Sheng Chong , Lu Yong-Heng , Gao Jun , Chang Yi-Jun , Pang Xiao-Ling , Yang Tian-Huai , Zhu Shi-Ning , Liu Hui , Jin Xian-Min
Published: May 2020

Though it is still a big challenge to unify general relativity and quantum mechanics in modern physics, the theory of quantum field related with the gravitational effect has been well developed and some striking phenomena are predicted, such as Hawking radiation. However, the direct measurement of these quantum effects under general relativity is far beyond present experiment techniques. Fortunately, the emulation of general relativity phenomena in the laboratory has become accessible in recent years. However, up to now, these simulations are limited either in classical regime or in flat space whereas quantum simulation related with general relativity is rarely involved. Here we propose and experimentally demonstrate a quantum evolution of fermions in close proximity to an artificial black hole on a photonic chip. We successfully observe the acceleration behavior, quantum creation, and evolution of a fermion pair near the event horizon: a single-photon wave packet with positive energy escapes from the black hole while negative energy is captured. Our extensible platform not only provides a route to access quantum effects related with general relativity, but also has the potentiality to investigate quantum gravity in future.
Improving photosensitization for photochemical CO2-to-CO conversion
Authors: Wang Ping , Dong Ru , Guo Song , Zhao Jianzhang , Zhang Zhi-Ming , Lu Tong-Bu
Published: May 2020

Inspired by nature, improving photosensitization represents a vital direction for the development of artificial photosynthesis. The sensitization ability of photosensitizers (PSs) reflects in their electron-transfer ability, which highly depends on their excited-state lifetime and redox potential. Herein, for the first time, we put forward a facile strategy to improve sensitizing ability via finely tuning the excited state of Ru(II)-PSs (Ru-1–Ru-4) for efficient CO2 reduction. Remarkably, [Ru(Phen)2(3-pyrenylPhen)]2+ (Ru-3) exhibits the best sensitizing ability among Ru-1–Ru-4, over 17 times higher than that of typical Ru(Phen)32+. It can efficiently sensitize a dinuclear cobalt catalyst for CO2-to-CO conversion with a maximum turnover number of 66 480. Systematic investigations demonstrate that its long-lived excited state and suitable redox driving force greatly contributed to this superior sensitizing ability. This work provides a new insight into dramatically boosting photocatalytic CO2 reduction via improving photosensitization.
Preliminary evidence from a multicenter prospective observational study of the safety and efficacy of chloroquine for the treatment of COVID-19
Authors: Huang Mingxing , Li Man , Xiao Fei , Pang Pengfei , Liang Jiabi , Tang Tiantian , Liu Shaoxuan , Chen Binghui , Shu Jingxian , You Yingying , Li Yang , Tang Meiwen , Zhou Jianhui , Jiang Guanmin , Xiang Jingfen , Hong Wenxin , He Songmei , Wang Zhaoqin , Feng Jianhua , Lin Changqing , Ye Yinong , Wu Zhilong , Li Yaocai , Zhong Bei , Sun Ruilin , Hong Zhongsi , Liu Jing , Chen Huili , Wang Xiaohua , Li Zhonghe , Pei Duanqing , Tian Lin , Xia Jinyu , Jiang Shanping , Zhong Nanshan , Shan Hong
Published: May 2020

Effective therapies are urgently needed for the SARS-CoV-2 pandemic. Chloroquine has been proved to have antiviral effect against coronavirus in vitro. In this study, we aimed to assess the efficacy and safety of chloroquine with different doses in COVID-19. In this multicenter prospective observational study, we enrolled patients older than 18 years old with confirmed SARS-CoV-2 infection excluding critical cases from 12 hospitals in Guangdong and Hubei Provinces. Eligible patients received chloroquine phosphate 500 mg, orally, once (half dose) or twice (full dose) daily. Patients treated with non-chloroquine therapy were included as historical controls. The primary endpoint is the time to undetectable viral RNA. Secondary outcomes include the proportion of patients with undetectable viral RNA by day 10 and 14, hospitalization time, duration of fever, and adverse events. A total of 197 patients completed chloroquine treatment, and 176 patients were included as historical controls. The median time to achieve an undetectable viral RNA was shorter in chloroquine than in non-chloroquine (absolute difference in medians −6.0 days; 95% CI −6.0 to −4.0). The duration of fever is shorter in chloroquine (geometric mean ratio 0.6; 95% CI 0.5 to 0.8). No serious adverse events were observed in the chloroquine group. Patients treated with half dose experienced lower rate of adverse events than with full dose. Although randomized trials are needed for further evaluation, this study provides evidence for safety and efficacy of chloroquine in COVID-19 and suggests that chloroquine can be a cost-effective therapy for combating the COVID-19 pandemic.
Previously Derived Host Gene Expression Classifiers Identify Bacterial and Viral Etiologies of Acute Febrile Respiratory Illness in a South Asian Population
Authors: Tillekeratne L Gayani , Suchindran Sunil , Ko Emily R , Petzold Elizabeth A , Bodinayake Champica K , Nagahawatte Ajith , Devasiri Vasantha , Kurukulasooriya Ruvini , Nicholson Bradly P , McClain Micah T , Burke Thomas W , Tsalik Ephraim L , Henao Ricardo , Ginsburg Geoffrey S , Reller Megan E , Woods Christopher W
Published: May 2020

Background

Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability to detect etiology of illness. We previously showed that peripheral blood-based host gene expression classifiers accurately identify bacterial and viral ARI in cohorts of European and African descent. We determined classifier performance in a South Asian cohort.

Methods

Patients ≥15 years with fever and respiratory symptoms were enrolled in Sri Lanka. Comprehensive pathogen-based testing was performed. Peripheral blood ribonucleic acid was sequenced and previously developed signatures were applied: a pan-viral classifier (viral vs nonviral) and an ARI classifier (bacterial vs viral vs noninfectious).

Results

Ribonucleic acid sequencing was performed in 79 subjects: 58 viral infections (36 influenza, 22 dengue) and 21 bacterial infections (10 leptospirosis, 11 scrub typhus). The pan-viral classifier had an overall classification accuracy of 95%. The ARI classifier had an overall classification accuracy of 94%, with sensitivity and specificity of 91% and 95%, respectively, for bacterial infection. The sensitivity and specificity of C-reactive protein (>10 mg/L) and procalcitonin (>0.25 ng/mL) for bacterial infection were 100% and 34%, and 100% and 41%, respectively.

Conclusions

Previously derived gene expression classifiers had high predictive accuracy at distinguishing viral and bacterial infection in South Asian patients with ARI caused by typical and atypical pathogens.
Deep Sequencing of Varicella-Zoster Virus in Aqueous Humor From a Patient With Acute Retinal Necrosis Presenting With Acute Glaucoma
Authors: von Hofsten Joanna , Ringlander Johan , Norberg Peter , Zetterberg Madeleine , Andersson Maria , Lindh Magnus , Bergström Tomas
Published: May 2020

We report a case of acute retinal necrosis presenting with acute glaucoma preceding inflammatory signs by several days. High-throughput sequencing on aqueous humor revealed a low-level diversity in the viral genome comparable to diversity seen in cutaneous vesicles in contrast to high diversity in encephalitis.
Hospital Associated Respiratory Virus Infection in Children and Adults: It Does Not Just Occur During Cold and Flu Season
Authors: Petrie Joshua G , Lauring Adam S , Martin Emily T , Kaye Keith S
Published: May 2020

Hospital-associated respiratory virus infections (HARVI) are an underappreciated source of morbidity and mortality. We examined HARVI incidence and clinical respiratory virus testing practices in a cohort of hospitalized patients with acute respiratory illness. HARVI were identified in patients of all ages, both during and outside of the influenza season.
The HAL QCD potential in the I = 1 π π system with the ρ meson bound state
Authors: Akahoshi Yutaro , Aoki Sinya , Aoyama Tatsumi , Doi Takumi , Miyamoto Takaya , Sasaki Kenji
Published: May 2020

We investigate the HAL QCD potential in $I=1$$\pi \pi$ scattering using the hybrid method for all-to-all propagators, in which a propagator is approximated by low eigenmodes, and the remaining high-eigenmode part is stochastically estimated. To verify the applicability of the hybrid method to systems containing quark creation$/$annihilation contributions such as the $\rho$ meson, we calculate the $I=1$$\pi\pi$ potential with the $(2+1)$-flavor gauge configurations on a $16^3 \times 32$ lattice with lattice spacing $a \approx 0.12$ fm and $(m_{\pi},m_{\rho}) \approx (870, 1230)$ MeV, in which the $\rho$ meson appears as a deeply bound state. While we find that the naive stochastic evaluations for quark creation$/$annihilation contributions lead to extremely large statistical fluctuations, additional noise reduction methods enable us to obtain a sufficiently precise potential, which shows a strong attractive force. We also confirm that the binding energy and $k^3 \cot \delta$ obtained from our potential are roughly consistent with an existing $\rho$ meson bound state, within the large systematic error associated with our calculation, whose possible origin is also discussed.
Three months of informational trends in COVID-19 across New York City
Authors: Lieberman-Cribbin Wil , Alpert Naomi , Gonzalez Adam , Schwartz Rebecca M , Taioli Emanuela
Published: May 2020

In the midst of widespread community transmission of coronavirus disease 2019 (COVID-19) in New York, residents have sought information about COVID-19. We analyzed trends in New York State (NYS) and New York City (NYC) data to quantify the extent of COVID-19-related queries. Data on the number of 311 calls in NYC, Google Trend data on the search term ‘Coronavirus’ and information about trends in COVID-19 cases in NYS and the USA were compiled from multiple sources. There were 1228 994 total calls to 311 between 22 January 2020 and 22 April 2020, with 50 845 calls specific to COVID-19 in the study period. The proportion of 311 calls related to COVID-19 increased over time, while the ‘interest over time’ of the search term ‘Coronavirus’ has exponentially increased since the end of February 2020. It is vital that public health officials provide clear and up-to-date information about protective measures and crucial communications to respond to information-seeking behavior across NYC.
Women Receiving Massive Transfusion Due to Postpartum Hemorrhage: A Comparison Over Time Between 2 Nationwide Cohort Studies
Authors: Ramler P.I. , van den Akker T. , Henriquez D.D.C.A. , Zwart J.J. , van Roosmalen J. , van Lith J.M.M. , van der Bom J. , Paul I.
Published: May 2020

(Acta Obstet Gynecol Scand. 2019;98:795–804)

Postpartum hemorrhage (PPH) is on the rise in high-income countries. When PPH requires massive transfusion there is an increased risk of maternal morbidity and the need for hysterectomy. The aim of this study was to evaluate the incidence of PPH requiring massive transfusion in the Netherlands between 2011 and 2012 and compare this to previous data from 2004 to 2006. The study also assessed the causes of PPH and the management and outcome of women who received massive transfusions.
Distribution of Extreme Vital Signs and Complete Blood Count Values of Healthy Parturients: A Retrospective Database Analysis and Review of the Literature
Authors: Gat R. , Hadar E. , Orbach-Zinger S. , Shochat T. , Kushnir S. , Einav S.
Published: May 2020

(Anesth Analg. 2019;129:1595–1606)

Maternal near-miss events and excess mortality remain problematic throughout the world, and as such, scoring methods intended to identify early maternal deterioration have become a standard of care in many delivery suites and maternity wards. However, all of these rely on predefined ranges of “normal” laboratory values and vital signs (VSs), but the effect of normal physiological adjustments on maternal VSs has yet to be fully established. The objective of this study was to determine the extremes of VS and blood count values in healthy pregnant women in the peripartum time period who had single offspring. It was a retrospective analysis of data collected during real-time deliveries (from July 2012 to June 2016) at a labor and delivery (L&D) ward in Israel.
Racial Disparities in Postpartum Pain Management
Authors: Badreldin N. , Grobman W. , Yee L. , Lynn M.
Published: May 2020

(Obstet Gynecol. 2019;134:1147–1153)

There has been a rising trend of opioid misuse among non-Hispanic white communities in recent years, and researchers have noted that adults from predominantly white communities were more likely to receive a prescription for opioids than adults from more diverse areas. Previous studies have indicated that there are disparities between minority patients and non-Hispanic white patients in regards to pain treatment, where minority individuals with similar conditions and pain levels are being prescribed less opioid medications. Not much analysis has been performed in the postpartum pain management arena, but these investigators hypothesized that a similar imbalance is present for postpartum patients in minority communities. They conducted this study to assess racial and ethnic differences in patients’ postpartum pain levels, inpatient opioid disbursement, and number of opioid prescriptions upon discharge from the hospital.
Obstetric Intraoperative Cell Salvage: A Review of an Established Cell Salvage Service With 1170 Reinfused Cases
Authors: Sullivan I.J. , Ralph C.J.
Published: May 2020

(Anaesthesia. 2019;74:976–983)

Over the last 20 years, obstetric hemorrhage has remained a dominant cause of maternal death; this trend shows no sign of changing in the near future. A standard treatment for obstetric hemorrhage is allogeneic (donor) blood transfusion, but autologous (cell salvaged) blood transfusion is becoming a more viable alternative to allogeneic blood transfusion. On the basis of a recent multicenter randomized trial that concluded the routine use of cell salvage during cesarean section was not cost-effective, updated guidelines from the Association of Anaesthetists no longer recommend routine cell salvage during cesarean section. They do encourage autologous blood transfusion when significant blood loss is expected. The authors of this article reported on their use of cell salvage during cesarean section and based on their results argued that cell salvage can be a safe and economically feasible option for patients undergoing cesarean section.
Electronic Fetal Monitoring to Prevent Fetal Brain Injury: A Ubiquitous Yet Flawed Tool
Authors: Hirsch E.
Published: May 2020

(JAMA. 2019;322:611–612)

The practice of fetal cardiac rate monitoring began in the 1830s or earlier, and guidelines for intermittent auscultation came out in the 1920s and remained largely unchanged until the 1970s, when continuous electronic fetal monitoring (EFM) appeared. EFM generates a visual recording of fetal heart rate using either Doppler wave technology or a contact electrode on the fetal scalp. Fetal acidosis is associated with abnormal heart rhythms, including tachycardia, bradycardia and transient decreases in pulse rate, as well as diminished variability. Variability cannot practically be detected with auscultation.
Disseminated Intravascular Coagulation and Hemorrhage After Dilation and Evacuation Abortion for Fetal Death
Authors: Kerns J.L. , Ti A. , Aksel S. , Lederle L. , Sokoloff A , Steinauer J.
Published: May 2020

(Obstet Gynecol. 2019;134:708–713)

Second-trimester surgical abortion, or dilation and evacuation (D&E) complications are rare. At a mere 0.7% to 3%, these complications can include cervical laceration, uterine perforation, infection, and hemorrhage [including hemorrhage related to disseminated intravascular coagulation (DIC)]. The possibility of excessive blood loss associated with DIC can even lead to the need for transfusion, or in extreme cases, maternal death. A dearth of well-controlled, large sample size studies evaluating the association of fetal death and abortion-related hemorrhage or DIC makes it difficult to create guidelines for appropriate preoperative preparation and anticipation of needed interventions. This study aimed to determine postabortion risk of hemorrhage for patients with a second trimester fetal death. It sources data from a large cohort at a public, urban abortion clinic.
Shock Index Thresholds to Predict Adverse Outcomes in Maternal Hemorrhage and Sepsis: A Prospective Cohort Study
Authors: Nathan H.L. , Seed P.T. , Hezelgrave N.L. , De Greeff A. , Lawley E. , Anthony J. , Steyn W. , Hall D.R. , Chappell L.C. , Shennan A.H.
Published: May 2020

(Acta Obstet Gynecol Scand. 2019;98:1178–1186)

Almost half of annual maternal deaths can be attributed to postpartum hemorrhage (PPH), maternal sepsis, and abortion complications. Most of these deaths are avoidable with early identification of hemodynamic compromise, but many care providers lack the adequate training to respond properly to abnormal blood pressure (BP) and heart rate (HR) measurements. The ratio of HR to systolic BP, called the shock index (SI), is believed to be an early indicator of life-threatening adverse outcomes; SI has predicted medical events more consistently than other vital signs in PPH retrospective cohorts. While experts have proposed the use of SI measurement thresholds as early warning signs, more research is needed in PPH and maternal sepsis populations. These investigators conducted their study to determine whether SI can consistently predict adverse outcomes in PPH and maternal sepsis cases, and also observe if previously determined SI thresholds are adequate.
Anesthesia for Nonobstetric Surgery During Pregnancy in a Tertiary Referral Center: A 16-Year Retrospective, Matched Case-Control, Cohort Study
Authors: Devroe S. , Bleeset T. , Van de Velde M. , Verbrugge L. , De Buck F. , Deprest J. , Devlieger R. , Rexa S.
Published: May 2020

(Int J Obstet Anesth. 2019;39:74–81)

Nonobstetric operative interventions during pregnancy are fairly uncommon, but can increase the risk of preterm delivery, low birth weight, and cesarean delivery. There has been limited research conducted on the pregnancy outcomes of women who undergo nonobstetric surgical procedures. These investigators, therefore, conducted this retrospective analysis to compare pregnancy outcomes in parturients who underwent nonobstetric surgical procedures to their hospital’s entire obstetric patient population as well as to a matched case-control cohort based on similar demographics.
Assessment of Gastric Emptying of Maltodextrin, Coffee With Milk, and Orange Juice During Labour at Term Using Point of Care Ultrasound: A Noninferiority Randomized Clinical Trial
Authors: Nascimento A.C. , Goveia C.S. , Guimaraes G.M.N. , Filho R.P.L. , Ladeira L.C.A. , Silva H.G.B.
Published: May 2020

(Anaesthesia. 2019;74:856–861)

Although patients have commonly been advised to fast for 8 hours before any surgery, some research has shown benefits associated with shorter fasting periods. Pregnant women have generally been considered to have a “full stomach” due to delayed gastric emptying and reduced lower esophageal sphincter tone. However, recent studies have shown normal gastric emptying in nonlaboring parturients after drinking water. Studies in nonpregnant volunteers have found that milk and other drinks with similar caloric content are cleared from the stomach at similar rates. This noninferiority, parallel group study was undertaken to compare gastric emptying rates in laboring women for maltodextrin, coffee with milk, and pulp-free orange juice.
Certification Process of Fetal Centers in Texas and Developing National Guidelines
Authors: Moise K.J. , Johnson A. , Tsao K.
Published: May 2020

(Obstet Gynecol. 2020;135:141–147)

In the early 1980s, the Fetal Treatment Center at the University of California at San Francisco was established, but since this time, little guidance has been given to define what constitutes a fetal center. Even the American College of Obstetricians and Gynecologists’ (ACOG) Committee on Ethics and the American Academy of Pediatrics’ (AAP) Committee on Bioethics jointly noted in 2011 that fetal centers “exist in many forms.” A majority of fetal centers are multidisciplinary clinics intended for pregnant women with fetal anomalies to consult with various specialists to coordinate plans for delivery and postdelivery neonatal care. The ACOG and AAP also determined that establishing centers prepared for challenging and rarely performed maternal-fetal intervention procedures could optimize fetal and maternal outcomes. A more recent statement coinciding with this determination was made by the International Fetal Medicine and Surgery Society and the North American Fetal Therapy Network when they proposed the reasonable goal of formalizing credentialing programs for fetal centers.
Readability, Content, Quality, and Accuracy Assessment of Internet-based Patient Education Materials Relating to Labor Analgesia
Authors: Murphy J. , Vaughn J. , Gelber K. , Geller K. , Zakowski M.
Published: May 2020

(Int J Obstet Anesth. 2019;39:82–87)

It has been reported that >90% of pregnant women in the United States and Western Europe conduct internet searches for health information related to pregnancy. However, 66% of these women believed that information they obtained from a Web site may have been inaccurate or misleading; this potentially wrong content caused them worry about their pregnancy and/or delivery. With pregnancy information widely available online, it is important for health care professionals to monitor the quality and accuracy of the information their patients are receiving from internet sources. In this study, the investigators compared patient education materials (PEMs) provided by national and international medical societies to PEMs found via a Google search, assessing the readability, content, quality, and accuracy of the information.
The economics of drug allergy
Authors: Mattingly T. Joseph
Published: May 2020

Purpose of review

As drug allergy research aims to inform clinical practice, implementation of best practices may be influenced by financial resources required to incorporate new interventions and the resulting clinical and economic returns on those resource investments. The present review summarizes new insights into the economics of drug allergy over the past year.

Recent findings

While considering economic implications of recent drug allergy research, many studies have addressed different contextual factors related to the setting, provider, or outcomes. Advances in technology have enabled specialized allergists to support remote settings through telemedicine consultation. Training opportunities and interdisciplinary approaches to address drug allergy challenges have enabled multiple provider types to play a role in screening, diagnosis, and management. Penicillin allergy testing has been a major focus for many institutions, with several studies focused on de-labeling strategies including confirmatory skin testing and direct oral challenges.

Studies over the past year provide new opportunities for the field of drug allergy research. The focus of current research to capture direct health costs or savings associated with drug allergy interventions demonstrates opportunity for more cost-effective care delivery and opportunity to explore greater benefits to society.
Low Barrier Tele-Buprenorphine in the Time of COVID-19: A Case Report
Authors: Harris Miriam , Johnson Samantha , Mackin Sarah , Saitz Richard , Walley Alexander Y. , Taylor Jessica L.
Published: May 2020

Background:

To reduce the spread of coronavirus disease 2019 (COVID-19), many substance use disorder treatment programs have transitioned to telemedicine. Emergency regulatory changes allow buprenorphine initiation without an in-person visit. We describe the use of videoconferencing for buprenorphine initiation combined with street outreach to engage 2 patients experiencing homelessness with severe opioid use disorder (OUD).

Case Presentation:

Patient 1 was a 30-year-old man with severe OUD who had relapsed to injection heroin/fentanyl after incarceration. A community drop-in center outreach harm reduction specialist facilitated a videoconference with an addiction specialist at an OUD bridge clinic. The patient completed a community buprenorphine/naloxone initiation and self-titrated to his prior dose, 8/2 mg twice daily. One week later, he reconnected with the outreach team for a follow-up videoconference visit. Patient 2, a 36-year-old man with severe OUD, connected to the addiction specialist via a syringe service program harm reduction specialist. He had been trying to connect to a community buprenorphine/naloxone provider, but access was limited due to COVID-19, so he was using diverted buprenorphine/naloxone to reduce opioid use. He was restarted on his previous dose of 12/3 mg daily which was continued via phone follow-up 16 days later.

Conclusions:

COVID-19-related regulatory changes allow buprenorphine initiation via telemedicine. We describe 2 cases where telemedicine was combined with street outreach to connect patients experiencing homelessness with OUD to treatment. These cases highlight an important opportunity to provide access to life-saving OUD treatment for vulnerable patients in the setting of a pandemic that mandates reduced face-to-face clinical interactions.
Isoflurane Exposure in Juvenile Caenorhabditis elegans Causes Persistent Changes in Neuron Dynamics
Authors: Wirak Gregory S. , Gabel Christopher V. , Connor Christopher W.
Published: May 2020

Background

Animal studies demonstrate that anesthetic exposure during neurodevelopment can lead to persistent behavioral impairment. The changes in neuronal function underlying these effects are incompletely understood. Caenorhabditis elegans is well suited for functional imaging of postanesthetic effects on neuronal activity. This study aimed to examine such effects within the neurocircuitry underlying C. elegans locomotion.

Methods

C. elegans were exposed to 8% isoflurane for 3 h during the neurodevelopmentally critical L1 larval stage. Locomotion was assessed during early and late adulthood. Spontaneous activity was measured within the locomotion command interneuron circuitry using confocal and light-sheet microscopy of the calcium-sensitive fluorophore GCaMP6s.

Results

C. elegans exposed to isoflurane demonstrated attenuation in spontaneous reversal behavior, persisting throughout the animal’s lifespan (reversals/min: untreated early adulthood, 1.14 ± 0.42, vs. isoflurane-exposed early adulthood, 0.83 ± 0.55; untreated late adulthood, 1.75 ± 0.64, vs. isoflurane-exposed late adulthood, 1.14 ± 0.68; P = 0.001 and 0.006, respectively; n > 50 animal tracks/condition). Likewise, isoflurane exposure altered activity dynamics in the command interneuron AVA, which mediates crawling reversals. The rate at which AVA transitions between activity states was found to be increased. These anesthetic-induced effects were more pronounced with age (off-to-on activity state transition time (s): untreated early adulthood, 2.5 ± 1.2, vs. isoflurane-exposed early adulthood, 1.9 ± 1.3; untreated late adulthood, 4.6 ± 3.0, vs. isoflurane-exposed late adulthood, 3.0 ± 2.4; P = 0.028 and 0.008, respectively; n > 35 traces acquired from more than 15 animals/condition). Comparable effects were observed throughout the command interneuron circuitry, indicating that isoflurane exposure alters transition rates between behavioral crawling states of the system overall. These effects were modulated by loss-of-function mutations within the FoxO transcription factor daf-16 and by rapamycin-mediated mechanistic Target of Rapamycin (mTOR) inhibition.

Conclusions

Altered locomotive behavior and activity dynamics indicate a persistent effect on interneuron dynamics and circuit function in C. elegansafter developmental exposure to isoflurane. These effects are modulated by a loss of daf-16 or mTOR activity, consistent with a pathologic activation of stress-response pathways.

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What This Article Tells Us That Is New
Feasibility of Full Neuromuscular Blockade During Transcranial Motor Evoked Potential Monitoring of Neurosurgical Procedures
Authors: Selner Ashley N. , Ivanov Alexander A. , Esfahani Darian R. , Bhimani Abhiraj D. , Waseem Faisal , Behbahani Mandana , Edelman Guy , Stone James L. , Slavin Konstantin V. , Mehta Ankit I.
Published: May 2020

Background:

Transcranial motor evoked potential (TcMEP) monitoring is conventionally performed during surgical procedures without or with minimal neuromuscular blockade (NMB) because of its potential interference with signal interpretation. However, full blockade offers increased anesthetic management options and facilitates surgery. Here, the feasibility of TcMEP interpretation was assessed during full NMB in adult neurosurgical patients.

Methods:

Patients undergoing cervical or lumbar decompression received a rocuronium bolus producing 95% or greater blockade by qualitative train-of-four at the ulnar nerve. TcMEPs were recorded in bilateral thenar-hypothenar and abductor hallucis muscles. Adequacy of response for reliable signal interpretation was determined on the basis of repeatability and clarity, assessed by coefficient of variation and signal-to-noise ratio, respectively.

Results:

All patients had at least 3 of 4 measurable TcMEP limb responses present during full NMB, and 70.8% of patients had measurable responses in all 4 limbs. In total, 82.2% of thenar-hypothenar responses and 62.8% of abductor hallucis responses were robust enough for reliable signal interpretation on the basis of clarity. In addition, 97.8% of thenar-hypothenar responses and 79.1% of abductor hallucis responses met the criteria for reliable signal interpretation on the basis of consistency. Patient demographics, medical comorbidities, and preoperative weakness were not predictive of absent responses during full NMB.

Conclusions:

TcMEP interpretation may be feasible under greater levels of NMB than previously considered, allowing for monitoring with greater degrees of muscle relaxation. Consideration for monitoring TcMEP during full NMB should be made on a case-by-case basis, and baseline responses without blockade may predict which patients will have adequate responses for interpretation.
Effect of rocker-sole footwear on knee joint biomechanics while walking in people with ACL-reconstructed knees: a cross-sectional biomechanical study
Authors: Bagheri Azam , Saeedi Hassan , Jalali Maryam , Forghany Saeed
Published: May 2020

Background:

Reinjury has occurred at a high rate after anterior cruciate ligament (ACL) reconstruction. Low knee flexion angles and high peak posterior ground reaction forces in landing tasks increase ACL loading. Some studies reported that rocker-sole shoes increased knee flexion angle in the early stance phase of the gait. The aim of this study was to investigate the biomechanics of walking with a custom-made heel-to-toe rocker shoe design, with special attention to the sagittal knee joint kinematics of patients after ACL reconstruction.

Methods:

This study examined 10 male participants with ACL-reconstruction participants. Three-dimensional gait analysis was performed under two conditions of level walking that were tested in random order using either modified footwear adapted with a heel-to-toe rocker sole or baseline footwear with a flat sole. The knee flexion angle at initial foot contact with the ground, average knee flexion angle from heel strike to 25% stance phase, and first peak knee flexion angle were compared across footwear conditions.

Results:

Walking with the heel-to-toe rocker shoes increased the knee flexion angle at the early stance phase of the gait cycle when compared with the baseline footwear.

Conclusions:

Rocker-shoe intervention was found to have potential as a rehabilitation tool to modify gait patterns in the sagittal plane of people with ACL-reconstructed knees and may protect against high reinjury rates. Further research is required to evaluate whether prolonged wear of rocker-sole shoes can modify lower extremity biomechanics of participants who have undergone ACL reconstruction.

Level of Evidence:

Level II.
Anterolateral ligament in pediatric knees: A radiographic study
Authors: Hegaze Adel , Khashoggi Khalid , Alqrache Abdulraof , Ashour Abdullah , Mustafa Hesham N.
Published: May 2020

Background:

The anterolateral ligament (ALL) is a true well-defined ligament in the knee first described in 1879 by Segond. After the work of Claes et al., several studies were conducted about biomechanics and its role in stability of the knee. The anatomical existence of the ALL has been studied by and various radiographic diagnostic modalities and in cadavers. It originates from lateral femoral epicondyle and is inserted between Gerdy’s tubercle and the fibular head. There has been controversy about the existence of ALL in pediatric patients. The aim of this work was to confirm the presence of ALL in pediatric patients by using MRI.

Materials and Methods:

We reviewed the knee MRI scans of 100 pediatric patients (ages between one and 12 yr) who had no knee injury or congenital deformity and had been evaluated by an expert radiologist.

Results:

The ALL was detected in 90% of the pediatric patients with the use of MRI.

Conclusions:

The main finding of this study was that ALL can be seen in pediatric patients using MRI. Despite numerous studies, additional research is needed to further define the role of the ALL in knee function.

Level of Evidence:

Level IV.
Physical therapy in axial spondyloarthritis: guidelines, evidence and clinical practice
Authors: Martey Christopher , Sengupta Raj
Published: May 2020

Purpose of review

Physical therapy is recommended for the management of axial spondyloarthritis (axSpA) with the focus of promoting physical activity and prescribing exercise within four domains, outlined recently by the European League against Rheumatism (EULAR): aerobic, resistance, flexibility and neuro-motor exercise. There is an increasing evidence base to support physical therapy interventions in axSpA.

Recent findings

We present evidence supporting the use of exercise as treatment for patients with axSpA, recent updates among different exercise modalities, and make clear its critical place in the management of this condition. Recent large, multicentre data have shown that high-intensity exercise can improve disease activity and also positively impact cardiovascular risk factors in these patients. Although international treatment guidelines advocate the inclusion of physical activity and exercise for the optimal management of axSpA, specific guidance about the amount of exercise required to produce a beneficial effect is lacking.

Exercise must be used in the management of axSpA, and whilst hydrotherapy and flexibility exercises are traditionally the main focus, other applications, such as strength training, may be underutilized domains. Further studies are needed to determine the dose–response relationship between exercise and axSpA patient subsets.
MRI of the sacroiliac joints: what is and what is not sacroiliitis?
Authors: Østergaard Mikkel
Published: May 2020

Purpose of review

MRI has, as the only imaging modality, the ability to visualize both the inflammatory and destructive aspects of sacroiliitis and is a crucial element in the diagnosis and classification of axial spondyloarthritis (axSpA). However, the MRI appearance of several potential differential diagnoses may resemble axSpA sacroiliitis.

Recent findings

The appearances of sacroiliac joint (SIJ) MRIs of various diseased and healthy populations have recently been intensively studied. BME, the key requirement in the Assessment of Spondyloarthritis international Society (ASAS) definition of a ‘MRI positive of sacroiliitis’ may also be found in degenerative disease, athletes and healthy persons, and, particularly, postpartum women. Certain pattern of BME (high extent, large depth from articular surface, close relation to other lesion types) as well as the presence of structural lesions, particularly bone erosion, backfill or ankylosis increase the likelihood/specificity of being axSpA. Furthermore, old and novel MRI approaches to best distinguish the sacroiliitis of early axSpA from differential diagnoses have recently been tested and compared.

Significant new and clinically relevant knowledge has been gained, but further research is still needed to optimally distinguish what is and what isn’t sacroiliitis.
Increasing Fusion Rate Between 1 and 2 Years After Instrumented Posterolateral Spinal Fusion and the Role of Bone Grafting
Authors: Lehr A. Mechteld , Oner F. Cumhur , Delawi Diyar , Stellato Rebecca K. , Hoebink Eric A. , Kempen Diederik H.R. , van Susante Job L.C. , Castelein René M. , Kruyt Moyo C.
Published: May 2020

Study Design.

Two-year clinical and radiographic follow-up of a double-blind, multicenter, randomized, intra-patient controlled, non-inferiority trial comparing a bone graft substitute (AttraX® Putty) with autograft in instrumented posterolateral fusion (PLF) surgery.

Objectives.

The aim of this study was to compare PLF rates between 1 and 2 years of follow-up and between graft types, and to explore the role of bone grafting based on the location of the PLF mass.

Summary of Background Data.

There are indications that bony fusion proceeds over time, but it is unknown to what extent this can be related to bone grafting.

Methods.

A total of 100 adult patients underwent a primary, single- or multilevel, thoracolumbar PLF. After instrumentation and preparation for grafting, the randomized allocation side of AttraX® Putty was disclosed. The contralateral posterolateral gutters were grafted with autograft. At 1-year follow-up, and in case of no fusion at 2 years, the fusion status of both sides of each segment was blindly assessed on CT scans. Intertransverse and facet fusion were scored separately. Difference in fusion rates after 1 and 2 years and between grafts were analyzed with a Generalized Estimating Equations (GEE) model (P < 0.05).

Results.

The 2-year PLF rate (66 patients) was 70% at the AttraX® Putty and 68% at the autograft side, compared to 55% and 52% after 1 year (87 patients). GEE analysis demonstrated a significant increase for both conditions (odds ratio 2.0, 95% confidence interval 1.5–2.7, P < 0.001), but no difference between the grafts (P = 0.595). Ongoing bone formation was only observed between the facet joints.

Conclusion.

This intra-patient controlled trial demonstrated a significant increase in PLF rate between 1 and 2 years after instrumented thoracolumbar fusion, but no difference between AttraX® Putty and autograft. Based on the location of the PLF mass, this increase is most likely the result of immobilization instead of grafting.

Level of Evidence: 1