bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical versus biological valve prosthesis for surgical aortic valve replacement in patients with infective endocarditis
Authors: Kytö Ville , Ahtela Elina , Sipilä Jussi , Rautava Päivi , Gunn Jarmo
Published: May 2019

OBJECTIVES

The optimal choice of valve prosthesis in surgical aortic valve replacement for infective endocarditis (IE) is controversial. We studied outcomes after mechanical versus biological prosthetic valve surgical aortic valve replacement in IE patients.

METHODS

All patients with native-valve IE aged 16–70 years undergoing mechanical or biological surgical aortic valve replacement in Finland, between 2004 and 2014, were retrospectively studied (n = 213). Outcomes were all-cause mortality, ischaemic stroke, major bleeding and aortic valve reoperation at 1 year and 5 years. Results were adjusted for baseline features (age, sex, comorbidity burden, atrial fibrillation, valvular stenosis, concomitant coronary artery bypass grafting, extension, urgency, year and centre of operation). Median follow-up was 5 years.

RESULTS

The 5-year mortality rate was 19.0% with mechanical prostheses and 34.8% with biological prostheses [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.23–0.92; P = 0.03]. Ischaemic stroke rates were 8.3% with mechanical prostheses and 16.8% with biological prostheses at 5 years (HR 0.21, CI 0.06–0.79; P = 0.01). Results were comparable in patients aged 16–59 and 60–70 years (interaction P = 0.84). Major bleeding within 5 years was similar between mechanical (11.3%) and biological valve (13.4%) groups (P = 0.95) with comparable rates of both gastrointestinal and intracranial bleeds. Reoperation rates at 5 years were 5.0% for mechanical prostheses and 9.2% for biological prostheses (P = 0.14). The 1-year ischaemic stroke rate was lower with mechanical prostheses (3.6% vs 11.6%, P =0.03), whereas mortality, major bleeding and reoperation rates were similar between groups.

CONCLUSIONS

The use of mechanical aortic valve is associated with lower mid-term mortality compared to biological prosthesis in patients with native-valve IE aged ≤70 years. Our results do not support the routine choice of a biological aortic valve prosthesis in this patient group.
Causes and predictors of mortality among Ghanaians hospitalised with endocrine disorders
Authors: Sarfo-Kantanka Osei , Ansah Eunice Oparebea , Kyei Ishmael , Barnes Nana Ama
Published: May 2019

Background

Endocrine disorders have been noted to be on the increase in the developing world, but little is known about their outcomes on the African continent.

Methods

We conducted a retrospective longitudinal study to evaluate the demographic characteristics and determinants of endocrine-related mortality among adult patients over 9 y in a leading tertiary hospital in Ghana. We determined the predictors of inpatient mortality using Kaplan–Meier survival curves and Cox proportional hazard regression analysis.

Results

Overall, 6265 patients (9.7% of all medical admissions) were admitted with various endocrine disorders during the period. The most common endocrine cause of hospitalisation was diabetes mellitus (86.0%), followed in order of decreasing frequency by thyroid disorders (7.7%) and miscellaneous disorders (1.4%). The overall crude mortality rate of endocrine admissions was 16.7%. Death was predicted by increasing age with an adjusted hazard ratio of 1.25 (95% confidence interval 1.15 to 1.65) for every 10-y increase in age.

Conclusions

Almost one in six adults admitted with an endocrine disorder to a tertiary care centre in Ghana died in hospital, and many of the deaths were due to non-communicable disease complications. Enhanced public health disease prevention strategies and endocrine inpatient care processes are warranted.
Impact of prolonged maraviroc treatment on non-AIDS-related comorbidities in HIV-positive patients: a retrospective cohort study
Authors: Piconi Stefania , Foschi Antonella , Malagoli Andrea , Carli Federica , Zona Stefano , Milic Jovana , Ricci Elena Delfina , Rizzardini Giuliano , Guaraldi Giovanni
Published: May 2019

Objectives

This retrospective study evaluates the effect of maraviroc, the first CCR5 receptor antagonist, on non-AIDS-related comorbidity incidence and its impact on inflammatory and lipid parameters.

Methods

Seventy-four HIV patients on maraviroc treatment were compared with 312 patients never exposed to maraviroc (matched for sex, age and CD4 nadir).

Results

At baseline (T0), maraviroc patients presented a longer duration of HIV infection, a higher prevalence of comorbidities and a greater frequency of polypharmacy. Non-AIDS-defining disease incidence was lower in the maraviroc group than in the non-maraviroc group (without achieving statistical significance). Except triglycerides (TGL), which dropped only in the maraviroc group, inflammatory and immunological parameters did not significantly change in either group by the end of the study period (T3). At T3, high-sensitivity C-reactive protein (hsCRP) and high-density lipoprotein were inversely correlated in both groups (Spearman’s rho: maraviroc −0.30, P = 0.05; non-maraviroc −0.23, P = 0.0003). Only in the non-maraviroc group was the positive correlation between hsCRP and lipids observed both at T0 (hsCRP/low-density lipoprotein (LDL) +0.17, P = 0.004; hsCRP/total cholesterol +0.20, P = 0.0007; hsCRP/TGL +0.12, P = 0.04) and T3 (hsCRP/LDL +0.26, P < 0.0001; hsCRP/total cholesterol +0.24, P = 0.0001; hsCRP/TGL +0.15, P = 0.02). These correlations were not found in the maraviroc group. A significant positive correlation was found at T0 and at T3 between hsCRP and D-dimer in both groups (maraviroc: T0 +0.46, P = 0.0007; T3 +0.41, P = 0.006; non-maraviroc: T0 +0.17, P = 0.02; T3: +0.17, P = 0.017).

Conclusions

These data suggest a possible protective role of maraviroc in the incidence of non-AIDS-related comorbidities in a population with longer-lasting infection and allow us to hypothesize its role in the modulation of lipid-dependent inflammation.
Potential exists to change, through breeding, the yield of individual primal carcass cuts in cattle without increasing overall carcass weight1
Authors: Judge Michelle M , Pabiou Thierry , Murphy Jessica , Conroy Stephen B , Hegarty P J , Berry Donagh P
Published: May 2019

The ability to alter the morphology of cattle towards greater yields of higher value primal cuts has the potential to increase the value of animals at slaughter. Using weight records of 14 primal cuts from 31,827 cattle, the objective of the present study was to quantify the extent of genetic variability in these primal cuts; also of interest was the degree of genetic variability in the primal cuts adjusted to a common carcass weight. Variance components were estimated for each primal cut using animal linear mixed models. The coefficient of genetic variation in the different primal cuts ranged from 0.05 (bavette) to 0.10 (eye of round) with a mean coefficient of genetic variation of 0.07. When phenotypically adjusted to a common carcass weight, the coefficient of genetic variation of the primal cuts was lesser ranging from 0.02 to 0.07 with a mean of 0.04. The heritability of the 14 primal cuts ranged from 0.14 (bavette) to 0.75 (topside) with a mean heritability across all cuts of 0.48; the heritability estimates reduced, and ranged from 0.12 (bavette) to 0.56 (topside), when differences in carcass weight were accounted for in the statistical model. Genetic correlations between each primal cut and carcass weight were all ≥0.77; genetic correlations between each primal cut and carcass conformation score were, on average, 0.59 but when adjusted to a common carcass weight, the correlations weakened to, on average, 0.27. The genetic correlations among all 14 primal cut weights was, on average, strong (mean correlation of 0.72 with all correlations being ≥0.37); when adjusted to a common carcass weight, the mean of the genetic correlations among all primal cuts was 0.10. The ability of estimated breeding values for a selection of primal cuts to stratify animals phenotypically on the respective cut weight was demonstrated; the weight of the rump, striploin, and fillet of animals estimated to be in the top 25% genetically for the respective cut, were 10 to 24%, 12 to 24%, and 7 to 17% heavier than the weight of cuts from animals predicted to be in the worst 25% genetically for that cut. Significant exploitable genetic variability in primal carcass cuts was clearly evident even when adjusted to a common carcass weight. The high heritability of many of the primal cuts infers that large datasets are not actually required to achieve high accuracy of selection once the structure of the data and the number of progeny per sire is adequate.
If the Chair Fits: Sexism in American Office Furniture Design
Authors: Kaufmann-Buhler Jennifer
Published: May 2019

This article examines the ways in which gendered bodies and gendered ideas about labour were built into American office furniture by way of human factors from the 1960s through the early 1990s. Using an analysis of chairs and desks, including their forms and technical dimensions, the author argues that executive and secretarial furniture, in particular, encoded exaggerated and idealized gendered bodies in their design and excluded bodies that did not fit the expected gendered norms. The persistence of this convention, even in the design of ergonomic chairs which first appeared in the 1970s, reproduced sexism in organizational hierarchy and inscribed in furniture gendered assumptions of labour and gendered ideals of leadership.
A review of head and neck cancer staging system in the TNM classification of malignant tumors (eighth edition)
Authors:   Head and Neck Cancer Study Group (HNCSG), Monden Nobuya , Asakage Takahiro , Kiyota Naomi , Homma Akihiro , Matsuura Kazuto , Hanai Nobuhiro , Kodaira Takeshi , Zenda Sadamoto , Fujii Hirofumi , Tahara Makoto , Yokota Tomoya , Akimoto Tetsuo , Iwae Shigemichi , Onitsuka Tetsuro , Ogawa Takenori , Okano Susumu , Takahashi Shunji , Shimizu Yasushi , Yonezawa Koichiro , Hayashi Ryuichi
Published: May 2019

A number of major modifications were made to the classification of head and neck carcinomas in the eighth edition of the American Joint Committee on Cancer, Cancer Staging Manual and Union for International Cancer Control TNM classification of Malignant Tumors. These modifications were aimed at improving the prognosis prediction accuracy of the system. In this article, we review the new edition of the TNM classification system. Among the several changes in the new system, a separate algorithm for p16-positive oropharyngeal carcinoma was included, as were new chapters on ‘Head and Neck Skin Carcinoma’ and ‘Unknown Primary Carcinoma—Cervical Nodes.’ Changes to Tumor (T) classification were made by introducing the depth of invasion of oral carcinoma, whereas changes to Node (N) classification were made by adding extra-nodal extension. It is believed that these changes will help improve the accuracy of the system in the prediction of prognosis. However, it is necessary to verify their validity through further clinical research.
Deep convolutional neural network for reduction of contrast-enhanced region on CT images
Authors: Sumida Iori , Magome Taiki , Kitamori Hideki , Das Indra J , Yamaguchi Hajime , Kizaki Hisao , Aboshi Keiko , Yamashita Kyohei , Yamada Yuji , Seo Yuji , Isohashi Fumiaki , Ogawa Kazuhiko
Published: May 2019

This study aims to produce non-contrast computed tomography (CT) images using a deep convolutional neural network (CNN) for imaging. Twenty-nine patients were selected. CT images were acquired without and with a contrast enhancement medium. The transverse images were divided into 64 × 64 pixels. This resulted in 14 723 patches in total for both non-contrast and contrast-enhanced CT image pairs. The proposed CNN model comprises five two-dimensional (2D) convolution layers with one shortcut path. For comparison, the U-net model, which comprises five 2D convolution layers interleaved with pooling and unpooling layers, was used. Training was performed in 24 patients and, for testing of trained models, another 5 patients were used. For quantitative evaluation, 50 regions of interest (ROIs) were selected on the reference contrast-enhanced image of the test data, and the mean pixel value of the ROIs was calculated. The mean pixel values of the ROIs at the same location on the reference non-contrast image and the predicted non-contrast image were calculated and those values were compared. Regarding the quantitative analysis, the difference in mean pixel value between the reference contrast-enhanced image and the predicted non-contrast image was significant (P < 0.0001) for both models. Significant differences in pixels (P < 0.0001) were found using the U-net model; in contrast, there was no significant difference using the proposed CNN model when comparing the reference non-contrast images and the predicted non-contrast images. Using the proposed CNN model, the contrast-enhanced region was satisfactorily reduced.
Maternal nesting behaviour in city dragons: a species with temperature-dependent sex determination
Authors: Jackson Nicola , Cristescu Romane H , Piza-Roca Carme , Littleford-Colquhoun Bethan L , Strickland Kasha , Frère Céline H
Published: May 2019

Urban environments present some of the greatest challenges to species survival. This is particularly true for species that exhibit thermally sensitive traits, such as temperature-dependent sex determination (TSD). This is because urban environments not only present species with entirely novel ecosystems, but species will also experience increased temperatures. These temperature increases may result not only in offspring mortality, but also skewed population sex ratios. To persist in cities, urban dwellers with TSD will therefore need to adjust the temperature of the nesting environment, either through phenotypic plasticity or rapid evolution through natural selection. Here, we investigate the nesting ecology of a long-lived, urban dwelling reptile, the eastern water dragon (Intellagama lesueurii), to understand how a TSD species may respond to urban environments. Based on data collected from 72 nests over 2 nesting seasons, we show that city dragons not only dug significantly deeper nests than previously observed across their natural riparian habitat, but also nested in novel substrates. Furthermore, we observed a behaviour not previously described in this species, where mothers travel outside of their core home range to nest. This excursion behaviour potentially represents a greater maternal investment and is linked to the selection of specific microhabitats.
Probing G-quadruplex topologies and recognition concurrently in real time and 3D using a dual-app nucleoside probe
Authors: Nuthanakanti Ashok , Ahmed Ishtiyaq , Khatik Saddam Y , Saikrishnan Kayarat , Srivatsan Seergazhi G
Published: May 2019

Comprehensive understanding of structure and recognition properties of regulatory nucleic acid elements in real time and atomic level is highly important to devise efficient therapeutic strategies. Here, we report the establishment of an innovative biophysical platform using a dual-app nucleoside analog, which serves as a common probe to detect and correlate different GQ structures and ligand binding under equilibrium conditions and in 3D by fluorescence and X-ray crystallography techniques. The probe (SedU) is composed of a microenvironment-sensitive fluorophore and an excellent anomalous X-ray scatterer (Se), which is assembled by attaching a selenophene ring at 5-position of 2′-deoxyuridine. SedU incorporated into the loop region of human telomeric DNA repeat fluorescently distinguished subtle differences in GQ topologies and enabled quantify ligand binding to different topologies. Importantly, anomalous X-ray dispersion signal from Se could be used to determine the structure of GQs. As the probe is minimally perturbing, a direct comparison of fluorescence data and crystal structures provided structural insights on how the probe senses different GQ conformations without affecting the native fold. Taken together, our dual-app probe represents a new class of tool that opens up new experimental strategies to concurrently investigate nucleic acid structure and recognition in real time and 3D.
Smokers’ Perceptions of Cigarette Packaging With Audio Warning Messages: A Focus Group Study in Scotland
Authors: Mitchell Danielle , Moodie Crawford , Bauld Linda
Published: May 2019

Aims

The use of audio pack cues or messages is a recent trend in packaging design. There is scope to use audio technology to communicate health and cessation messages via cigarette packaging. We explored how smokers responded to cigarette packs which played audio health messages.

Methods

Twenty focus groups were conducted in Scotland in 2015 with smokers (n = 120) segmented by age (16–17, 18–24, 25–35, 36–50, >50), gender and social grade. Perceptions of cigarette packs which played audio warnings were explored, with four messages used: (1) a cessation message with a quitline number, (2) mortality message, (3) fertility message, and (4) message about ageing skin.

Results

Audio warnings were thought to increase message impact, particularly among younger smokers, as they would be hard to ignore or avoid, and repetition may lead to the messages being memorized. The warnings were considered annoying or embarrassing, and participants suggested they may discard the packs and use alternative storage. Some participants suggested that the audio warnings were off-putting and may alter their smoking behavior, with the mortality message deemed most effective and was considered relatable and felt personal. Older smokers were least likely to believe that audio warnings would affect their smoking behavior, although some thought that they may enhance cessation attempts among smokers seeking to quit, and could deter new or potential smokers, for example, young people.

Conclusions

Cigarette packs with audio messaging may have a role to play, now or in the future, as a novel way of communicating health and cessation information.

Implications

There is a lack of research exploring smokers’ perceptions of cigarette packs which play audio health messages. This focus group study provides an understanding of smokers’ immediate responses to cigarette packs which played a short health message when opened. Smokers generally viewed them as annoying or embarrassing, and some suggested the use of alternative storage. Audio warnings were thought to increase message salience, memorability, and impact, for younger smokers in particular, and some suggested that they be off-putting for themselves or others.
Live-Attenuated Respiratory Syncytial Virus Vaccine With Deletion of RNA Synthesis Regulatory Protein M2-2 and Cold Passage Mutations Is Overattenuated
Authors: Cunningham Coleen K , Karron Ruth , Muresan Petronella , McFarland Elizabeth J , Perlowski Charlotte , Libous Jennifer , Thumar Bhagvanji , Gnanashanmugam Devasena , Moye Jack , Schappell Elizabeth , Barr Emily , Rexroad Vivian , Aziz Mariam , Deville Jaime , Rutstein Richard , Yang Lijuan , Luongo Cindy , Collins Peter , Buchholz Ursula ,   International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) 2012 Study Team
Published: May 2019

Background

The live respiratory syncytial virus (RSV) candidate vaccine LIDcpΔM2-2 is attenuated through deletion of M2-2 and 5 cold-passage mutations.

Methods

RSV-seronegative children aged 6–24 months received a single intranasal dose of 105 plaque-forming units (PFU) of LIDcpΔM2-2 or placebo. RSV serum antibodies, vaccine infectivity, and reactogenicity were assessed.

Results

Four of 11 (36%) vaccinees shed vaccine virus with median peak titers of 1.6 log10 PFU/mL by quantitative culture and 4.5 log10 copies/mL by polymerase chain reaction; 45% had ≥4-fold rise in serum-neutralizing antibodies. Respiratory symptoms or fever were common in vaccinees (64%) and placebo recipients (6/6, 100%).

Conclusions

RSV LIDcpΔM2-2 is overattenuated.

Clinical Trial Numbers. NCT02890381, NCT02948127.
Gene Expression and DNA Methylation Alterations in the Glycine N-Methyltransferase Gene in Diet-Induced Nonalcoholic Fatty Liver Disease-Associated Carcinogenesis
Authors: Borowa-Mazgaj Barbara , de Conti Aline , Tryndyak Volodymyr , Steward Colleen R , Jimenez Leandro , Melnyk Stepan , Seneshaw Mulugeta , Mirshahi Faridodin , Rusyn Ivan , Beland Frederick A , Sanyal Arun J , Pogribny Igor P
Published: May 2019

Nonalcoholic fatty liver disease (NAFLD) is becoming a major etiological risk factor for hepatocellular carcinoma (HCC) in the United States and other Western countries. In this study, we investigated the role of gene-specific promoter cytosine DNA methylation and gene expression alterations in the development of NAFLD-associated HCC in mice using (1) a diet-induced animal model of NAFLD, (2) a Stelic Animal Model of nonalcoholic steatohepatitis-derived HCC, and (3) a choline- and folate-deficient (CFD) diet (CFD model). We found that the development of NAFLD and its progression to HCC was characterized by down-regulation of glycine N-methyltransferase (Gnmt) and this was mediated by progressive Gnmt promoter cytosine DNA hypermethylation. Using a panel of genetically diverse inbred mice, we observed that Gnmt down-regulation was an early event in the pathogenesis of NAFLD and correlated with the extent of the NAFLD-like liver injury. Reduced GNMT expression was also found in human HCC tissue and liver cancer cell lines. In in vitro experiments, we demonstrated that one of the consequences of GNMT inhibition was an increase in genome methylation facilitated by an elevated level of S-adenosyl-L-methionine. Overall, our findings suggest that reduced Gnmt expression caused by promoter hypermethylation is one of the key molecular events in the development of NAFLD-derived HCC and that assessing Gnmt methylation level may be useful for disease stratification.
Novel morphological structures in frogs: vocal sac diversity and evolution in Microhylidae (Amphibia: Anura)
Authors: Targino Mariane , Elias-Costa Agustín J , Taboada Carlos , Faivovich Julián
Published: May 2019

Vocal sacs are present in most species of frogs and are the product of the interaction of three elements: the gular skin, the superficial submandibular musculature and an internal mucosa derived from the buccal floor. In this paper, we surveyed the structural diversity in the vocal sac of microhylids and related families in 109 exemplar species, including 11 of the 13 currently recognized subfamilies. We defined five characters related to anatomical and histological properties of the m. interhyoideus, as well as the relationship of this muscle and the vocal sac internal mucosa. We describe a vocal sac configuration characterized by highly abundant elastic fibres in association with muscle fibres, a very unusual structure in animal tissues. We discuss the evolution of novel structures in a phylogenetic context and identify new synapomorphies for Microhylidae and internal clades. Furthermore, we comment on the functional implications that these features have in vocal sac inflation.
A Descriptive Analysis of Abortion Clinics’ Aftercare Instructions Following Surgical Abortion [4G]
Authors: Robin Tucker Ann , Tang Michelle , Askew Amy Liao , Truong Tracy , Deans Elizabeth Innes
Published: May 2019

INTRODUCTION:

Providing patient expectations after a planned procedure is an important component of the preoperative visit. However, recommendations after surgical abortion are often neither standardized nor evidence-based.

METHODS:

The aftercare instructions of 73 National Abortion Federation (NAF) clinics providing surgical abortion were reviewed by three different authors for consistency. Clinics were chosen that provided comprehensive written instructions. The answers to common patient questions were examined.

RESULTS:

Of the clinics, 7 (10%) were academic university affiliated. A follow-up appointment was recommended at 3 weeks by 45% of clinics. The most common behavioral recommendations were to abstain from sex, douching, and tampons for 2 weeks. The majority of clinics did not have recommendations regarding exercise, baths, or swimming. Recommendations for pain included Tylenol™ (60%), NSAIDs (78%), narcotics (22%), and a heating pad (49%). Emergency care was recommended for fever (88%) and excessive pain (81%). Majority (52%) of clinics described abnormal bleeding as soaking 1 pad/hr for 2 hours compared to 2 pads/hr for 2 hours (36%). Normal post-abortion bleeding was defined as irregular (86%) or spotting (44%) with return to menses by 8 weeks as the most common time frame. About half (53%) of clinics counseled regarding breast symptoms, of which 93% described discomfort and 66% described leaking. 77% of clinics mentioned post-abortion emotional reactions, of which 77% used normalizing language and 82% provided specific resources.

CONCLUSION:

While many recommendations will likely remain unsupported by formal evidence, a review of frequent recommendations by expert providers may help formalize surgical abortion aftercare instructions.
Access to Postpartum Sterilization: Are We Underestimating the Risk of Regret? [5G]
Authors: Urbina Josephine P. , Baum Jonathan D.
Published: May 2019

INTRODUCTION:

To identify barriers to postpartum sterilization at a suburban community teaching hospital.

METHODS:

Retrospective cohort study of pregnant women ages 21-44 who expressed desire for postpartum sterilization by the 28th week of gestation. The study period was from January 2012 to December 2013. Patient demographics and outcomes were analyzed.

RESULTS:

In the study period, 154 women desired postpartum sterilization, 88 (57.1%) underwent the procedure and 66 (42.9%) did not. Change of heart occurred in 38 women (57.5%), medical reasons were given in 14 women (21.2%), and lack of Medicaid sterilization form was noted in 5 women (7.5%). There was lack of a documented reason for not performing the procedure in 9 (13.6%) women.

CONCLUSION:

We found that almost 60% of women experienced a change of heart regarding sterilization which is significantly higher than other reports. The high rate of change of heart and low rate of lack of government consent in our study suggest that women can exercise autonomy and opt out of sterilization even after consenting and completing the required consent form by 28 weeks gestation. While risk of regret appears to vary inversely with age, the relationship between change of heart and sterilization regret warrants further study.
Management of Complex Myometrial Cyst in Pregnancy: Case Report [12G]
Authors: Mama Saifuddin Taiyeb , Fischer Richard L. , Kovacs James
Published: May 2019

INTRODUCTION:

Acquired myometrial cysts have been associated occasionally with endometriosis, adenomyosis, endosalpingiosis or degenerative leiomyomas. These conditions do not usually pose a danger to the mother or fetus if conception occurs. There are two reports in the literature of benign cystic myometrial masses unrelated to any of the above conditions.

METHODS:

A 33 y.o. female was found to have a cystic mass on the posterior uterine wall during a first trimester ultrasound. An MRI revealed a mass arising from the endometrial cavity extruding cranially and laterally through a right myometrial wall defect partially contained within the uterine serosa, unconnected with the gestational sac. Diagnostic laparoscopy confirmed a large, reducible cystic structure. Following extensive counseling about the possibility of uterine rupture later in gestation, the patient chose to terminate the pregnancy. A laparoscopic-guided dilation and evacuation was performed. The cyst was separately drained, and clear fluid aspirated. Five months postoperatively, the myometrial defect was repaired with a hysterorrhaphy. Histopathology of the excised cyst revealed benign mesothelium without evidence of adenomyosis, endometriosis or leiomyoma. The patient conceived five months later, delivering by repeat caesarean section without any complications.

CONCLUSION:

There are no prior reported cases of complex cystic myometrial masses or herniations unrelated to endosalpingiosis, endometriosis, adenomyosis or leiomyomas; nor of the effects of such a mass on current pregnancy or future fertility. This desired pregnancy was terminated to avoid the potential risk of uterine rupture and associated hemorrhage. Clinicians should be aware of this rare entity.
A Scoping Review of Climate-Change Related Exposures on Obstetrics Outcomes [18G]
Authors: DeNicola Nathaniel G. , Bekkar Bruce , Pacheco Susan , Basu Rupa
Published: May 2019

INTRODUCTION:

Toxic environmental exposures, specifically climate-change related exposures, pose a unique risk to pregnant women and the developing fetus. Robust evidence analysis is needed to guide clinicians on risk assessment and clinical counseling.

METHODS:

A literature search was conducted by our research team and medical librarian; scope included United States studies from 2007 to 2017. Climate-change related exposures included air pollution components: fine particulate matter (PM 2.5) and ozone, extreme weather, heat and temperature. Exposures ranged throughout all trimesters. Obstetrics outcomes included preterm birth, low birth-weight, and stillbirth. Exposures related to natural disasters were excluded; clinical outcomes related to neurodevelopment, mental illness, gynecology, and fertility were excluded. The Arksey and O'Malley scoping review framework was followed and quality assessment was performed using the Jadad scale.

RESULTS:

A total of 1,842 references were screened. 24 studies related to air pollution and preterm birth met inclusion; 21 found an effect. 27 studies related to air pollution and low birth-weight and met inclusion; 25 found an effect. 4 studies related to air pollution and stillbirth met inclusion; 3 found an effect. 5 studies related to heat and preterm birth met inclusion; 5 found an effect. 3 studies related to heat and low birth-weight met inclusion; 3 found an effect. 2 studies related to heat and stillbirth met inclusion; 2 found an effect.

CONCLUSION:

Climate-change related exposures, specifically air pollution and heat, are associated with an effect on important obstetrics outcomes: preterm birth, low birthweight, and stillbirth. Women's health providers should become familiar with this emerging risk.
Abnormal Screening Echocardiogram in High-Risk Obese Pregnant Women Increases the Risk of Preeclampsia [20G]
Authors: Hopkins Maeve , Levine Lisa D. , Koelper Nathanael , Sammel Mary , Durnwald Celeste
Published: May 2019

INTRODUCTION:

Obese women with comorbidities such as hypertension (HTN) and diabetes (DM) are at increased risk for preeclampsia (PreE) and perinatal morbidity. This study explores whether screening echocardiogram can identify obese women at higher risk for preeclampsia.

METHODS:

IRB-approved retrospective cohort study of women with BMI ≥40 kg/m2 and one or more risk factor for PreE (diabetes, hypertension, rheumatologic disease) undergoing screening echocardiogram. Abnormal findings were defined as diastolic dysfunction, ejection fraction ≤ 40%, or enlargement of any heart cavity including left ventricle hypertrophy. Multinomial and multivariable logistic regression was used to estimate the relative risk (RR) of gestational hypertension (ghtn), PreE, or severe PreE, and preterm delivery <37 weeks when controlling for potential confounders.

RESULTS:

Of 225 eligible women, 158 underwent screening echocardiograms. 39.9% (63/158) had abnormal echocardiograms. Clinical characteristics were similar between groups. Gestational age at time of echocardiogram was later (26.2 vs 21.5 wks P=0.0001) for women with abnormal echocardiograms, and women with abnormal echocardiogram were more likely to have chronic hypertension (79% vs 60%, P=0.02) and history of preeclampsia (28% vs 11%, P=0.03). After controlling for chronic HTN, history PreE, race, age, BMI, and GA at echo, women with abnormal echocardiogram were at increased risk of ghtn/PreE, 13% vs. 9%, aRR 4.87 (95% CI 1.36-17.53, P=0.02), severe PreE 54% vs. 15%, aRR 8.14 (95% CI 3.26-20.28, P=0.0001), and preterm delivery, 38% vs. 20%, aRR 4.87 (95% CI 1.36-17.53, P=0.02).

CONCLUSION:

Among obese pregnant women with vascular comorbidities, screening echocardiogram helps identify women at highest risk for developing preeclampsia.
Age and Body Mass Index as Independent Risk Factors in Different Indications for Scheduled Primary Cesarean Section [22G]
Authors: Elsamadicy Emad A. , Ha Laura , Goldberg Mack , Le Chi
Published: May 2019

INTRODUCTION:

There is a paucity of data identifying maternal risk factors that can contribute to women undergoing a scheduled primary cesarean section. We sought to investigate differences in maternal risk factors including age and body mass index (BMI) with the various indications for scheduled primary cesarean section.

METHODS:

Medical records of 502 consecutive patients that underwent a scheduled primary low-transverse cesarean section (PLTCS) at a major academic institution from 2009 to 2017 were reviewed. Patient age, BMI and the specific indication for the scheduled PLTCS were collected and compared using ANOVA statistical analysis.

RESULTS:

Of the 502 consecutive patients reviewed, the indication for PLTCS were majority for breech presentation (33.8%), followed by fetal anomalies (22%), elective (16.8%), fetal macrosomia (10.6%), placenta and vasa previa (7.4%), prior myomectomy (5.8%), cephalopelvic disproportion (2.4%), and for primary HSV or HIV (1.2%). There was a statistically significant difference in the mean age across all cohorts (p<0.0001). The previous myomectomy cohort had oldest mean age at myomectomy at 34.8±5.2 years while the primary HSV cohort had the youngest mean age at 22.5±2.6 years. There was not a statistically significant difference in the mean BMI across cohorts (P=0.236). The fetal macrosomia cohort trended towards the highest BMI of 36.4±10 kg/m2, while the vasa previa cohort trended towards the lowest BMI of 28.3±4.8 kg/m2.

CONCLUSION:

Our study demonstrated significant differences between age and various primary cesarean indications while there was no significant difference in BMI. Further studies are necessary to help identify risk factors associated with different indications for cesarean section.
Amnioreduction in Cases of Polyhydramnios: Indications and Outcomes in Singleton Pregnancies [23G]
Authors: Diaz-Rodriguez Gian E. , Shamshirsaz Alireza A. , Gandhi Manisha , Sanz-Cortes Magdalena , Belfort Michael A. , Dorado Jimmy Espinoza
Published: May 2019

INTRODUCTION:

There is limited information in regards to complication rates of this procedure in singleton pregnancies, which makes it difficult to counsel patients. Our goal is to evaluate indications, pregnancy outcomes and risk of adverse events following isolated amnioreduction procedures in singleton gestations.

METHODS:

Retrospective cohort of all amnioreduction procedures performed on singleton gestations complicated by polyhydramnios between January 2011 and June 2018 at our referral center. Clinical indications for amnioreduction procedures were categorized as either maternal shortness of breath, maternal sense of abdominal tightness, or preterm uterine contractions. Outcome variables included preterm premature rupture of membranes (PPROM), placental abruption, chorioamnionitis and preterm delivery in isolation or in composite. Data were tested for normality and reported as mean±SD, median [range] and n (%).

RESULTS:

33 patients underwent a median number of 1 [range 1-12] amnioreductions, yielding a total of 66 amnioreduction procedures. Estimated gestational age at delivery in this subgroup was 36 [30-40]. Among the study cohort, there were no instances of PPROM, placental abruption, chorioamnionitis or preterm delivery 12 hrs following the procedure. However, 7/66 (10.6%) of amnioreductions resulted in preterm delivery 12-48 hr post procedure. There were 2 cases of active preterm labor, 2 cases of non-reassuring fetal heart tracing, 1 case of preeclampsia with severe features, and 2 cases with mirror syndrome.

CONCLUSION:

Our data suggests that among singleton gestations, approximately 10% will experience a preterm birth, but none in the immediate procedure interval. This data may be used in counseling of potential candidates of amnioreduction with singleton pregnancies.
Association Between Maternal Glucose Control Intrapartum, Glucose Control Antepartum, and Neonatal Hypoglycemia [35G]
Authors: Zelivianskaia Anna S. , Iqbal Sara Naeem , Mclaughlin Andrew , Kette Bethany , Leibold Aurora
Published: May 2019

INTRODUCTION:

There are recommendations regarding target antepartum and intrapartum blood glucose values, but associations between degree of glucose control and neonatal hypoglycemia are not well-studied. We researched these factors and the rates of neonatal hypoglycemia in women with gestational and pre-gestational diabetes (DM).

METHODS:

This was a retrospective cohort study of all women diagnosed with gestational diabetes and pre-gestational DM at ≥23 weeks gestational age who delivered at an urban institution from 2016 to 2017. Our primary outcome was neonatal hypoglycemia defined as neonatal blood glucose <40 mg/dL. Antepartum glucose control categories were as follows: good (90% fingersticks within target range, compliant with prenatal care (PNC)), moderate (50-90% fingersticks within target range, compliant with PNC), poor (<50% of fingersticks within target range or missed 3+ prenatal visits). Intrapartum glucose control within target range were categorized as either never controlled or controlled the entire labor course.

RESULTS:

Of 191 neonates, 46 had hypoglycemia, resulting in a rate of 24%. Cases with neonatal hypoglycemia compared to cases without neonatal hypoglycemia were less likely to have good antenatal glucose control (17% vs. 29-34%; P=.048). Good intrapartum glucose control was not associated with neonatal hypoglycemia (P=.403).

CONCLUSION:

In our cohort of women with diabetes, we found that good antenatal glucose control, compared to moderate or poor, was associated with a decreased rate of neonatal hypoglycemia. This finding can be used for counseling and encourage women to better control their blood glucose values. More research is needed regarding the effect of intrapartum glucose control on neonatal hypoglycemia.
Contraceptive Quality Measures: Population-Level Protection Using the Contraceptive Protection Index [1H]
Authors: Saleeby Erin , Peacock Karen , Rabinovitz Julie , Khalfani Nomsa , Walsh Terri
Published: May 2019

INTRODUCTION:

National Quality Forum (NQF) endorsed contraception metric is now available to assess the proportion of women with reproductive capacity who are using highly effective contraception. The NQF measure does not assess the protection of the population from pregnancy based on the effectiveness of the methods and the distribution of method choice by age. The Contraceptive Protection Index (CPI) does incorporate these variables and can be calculated using the NQF measure data and may be instructive in monitoring population health over time.

METHODS:

We compare two observational cohorts (2013 and 2017) use of contraceptive methods in 54 agencies with some 200 health centers across the state of California. CPI was calculated using efficacy rates from clinical trials. Changes in CPI were evaluated by age group, race, ethnicity, and type of health center (Federally Qualified Health Centers, Health Departments, Planned Parenthoods, university and community clinics).

RESULTS:

Between 2013 and 2017, CPI increased for all groups. Teens (15-17), young adults (18-20) and women over 44 years old demonstrated the largest shift in CPI (increasing 1.4, 1.3, 1.6 respectively). This due to combination of decreases in condom or no method use with concomitant increases in LARC use. Federally Qualified Health Centers and Health Departments demonstrated the largest increases in CPI (1.4 and 1.9 respectively).

CONCLUSION:

Much of the shift in contraceptive use occurred within the group already using highly effective methods. Larger shifts in CPI are observed when women move from no method or condom use to highly effective methods, especially LARC use.
Debunking the Myth: Do MFM Fellows Negatively Impact Resident Obstetrical Skills [15H]
Authors: Dotters-Katz Sarah , Grace Matthew Ryan , Heine R. Phillips , Propst Katie
Published: May 2019

INTRODUCTION:

Residents often express concern that fellows negatively impact surgical opportunities. We described the impact of MFM fellows on resident surgical opportunities.

METHODS:

After IRB approval, anonymous 27-question e-survey sent to OBGYN residents in US and Puerto Rico in 3/2018. Survey included consent statement, and questions included experience as primary surgeon (PS), for 4th year residents only, comfort performing procedures post-residency (CPPR), and demographics. Residents from programs with MFM fellows (pMFM) were compared to those without (nMFM). Descriptive statistics used as appropriate. Regression performed, controlling for significant variables.

RESULTS:

417 residents completed the survey; 275 (66%) from nMFM and 142 (33%) from pMFM. PMFM residents were more likely to have >7 residents/year, be from an academic residency, and less likely to be planning to practice obstetrics post-residency (all P<0.01). Plan to pursue MFM fellowship did not differ. NMFM residents were more likely to have been PS on a vacuum assisted delivery (VAVD; 77% vs 63%, p<0.01), but equally likely to have been PS at forceps delivery (FAVD; 48% vs 57%, P=0.09). No difference in PS experience was seen for breech deliveries, 3rd or 4th degree repairs, cerclage or cesarean hysterectomy. With regards to CPPR, VAVD was more likely among nMFM trainees, no other differences seen. In regression models, no differences in likelihood of CPPR for any procedures based on the presence of MFM fellows were seen. Among pMFM residents, 94% stated fellows positively impacted their learning.

CONCLUSION:

MFM fellows do not appear to impact residents' competency in obstetric procedures, larger studies are needed to confirm these findings.
Appropriateness of Colposcopy Referrals to a Tertiary Care Center. A Review of Adherence to the 2012 ASCCP Guideline [18H]
Authors: Conrad Sarah , Hylton Jordan , King Elizabeth , Isaacs Christine Robillard
Published: May 2019

INTRODUCTION:

The 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines were developed to identify cervical pathology and minimize overtreatment of lesions that may resolve spontaneously. These guidelines serve to streamline referrals to facilities for colposcopy and further management. Our objective was to evaluate adherence to the 2012 ASCCP guidelines regarding referrals for colposcopy to a large academic center.

METHODS:

A descriptive study was performed using women referred to Virginia Commonwealth University for Colposcopy or Loop Electrosurgical Excision Procedure (LEEP) from January 2015 to December 2016. Data on patient demographics, cervical cytology, HPV status, prior cervical dysplasia, and the recommended intervention were gathered.

RESULTS:

Referral requests for 432 women were reviewed. Of the referrals, 17.6% were discordant with ASCCP guidelines. The most common discordant colposcopy referrals were for low-grade squamous intraepithelial lesion (LSIL, 47.4%) and atypical squamous cell of undetermined significance (ASCUS, 30.3%). Of the discordant LSIL referrals, 63.9% were patients age <25, of which seven received non-indicated colposcopies. Discordant ASCUS referrals were most commonly HPV negative (n = 5), did not have appropriate co-testing or reflex testing (n = 7) or were age < 25 (n=7). Ten patients were referred for cervical cytology collected on vaginal cuffs despite hysterectomies performed for benign reasons.

CONCLUSION:

Effectiveness of the ASCCP guidelines depends on knowledge and adherence. Patients referred outside of the guidelines were most often women age <25 with LSIL. Referrals outside of evidence-based guidelines may lead to unnecessary procedures and added healthcare expense. Our results help identify areas for provider education.
Blood Transfusion in Gynecologic Surgery: Adherence to Guidelines in Academic and Community-Based Practice [19H]
Authors: Vaughan Kristen Ann , Gillispie Veronica , Manayan Olivia
Published: May 2019

INTRODUCTION:

Blood transfusions are commonly administered during gynecological surgery. Traditionally, multiple units of packed red blood cells (pRBC) were transfused simultaneously, with a goal hemoglobin level (Hb) of 10 g/dL. However, research shows that this is associated with worse patient outcomes. In 2015, Ochsner implemented restrictive transfusion guidelines to improve patient outcomes and reduce costs. This protocol recommends transfusing one unit pRBC at a time, with an Hb goal of 7 (8 g/dL in patients with acute coronary syndrome or who are symptomatic). A retrospective study was conducted to assess gynecologists' understanding and adherence to these guidelines in academic versus community practices.

METHODS:

IRB approval was obtained from the Ochsner Clinic Foundation. Gynecologists completed an anonymous survey assessing their knowledge of Ochsner's transfusion guidelines. To evaluate adherence to the guidelines, a retrospective chart review was conducted on gynecologic surgeries that utilized pRBC transfusion in 2017.

RESULTS:

Compared to 2016, awareness of Ochsner's transfusion guidelines amongst practitioners (81.36% vs 72.7%) was increased. Knowledge of the guideline parameters also improved. 175 charts were reviewed from community (n=91), academic (n=53), and oncologic (n=31) sites. Academic sites adhered to guidelines more often than community sites (49% vs 31.8%, P<.017). The most common departure from the guidelines was transfusing multiple units of pRBC at once.

CONCLUSION:

Although most practitioners were aware of Ochsner's transfusion protocol, they violated these guidelines in practice. Despite overall knowledge of the guidelines, there continues to be a lack of adherence amongst providers. Further studies are needed to identify and address reasons for non-adherence.
B-Type Natriuretic Peptide (BNP) and Hypertensive Disorders in Pregnancy [31H]
Authors: Lai Monica , Schachter Aubrey , Heard Asha J. , Grant Joshua , Hagan Joseph , Stafford Irene A.
Published: May 2019

INTRODUCTION:

B type natriuretic peptide (BNP) is a sensitive marker discerning early cardiac dysfunction and has demonstrated correlation with volume expansion and pressure overload in hypertensive disorders in pregnancy. The purpose of this study is to examine variations of BNP values in women with chronic hypertension and severe preeclampsia as indications for delivery.

METHODS:

Pregnant women greater than 20 weeks gestation and women up to 14 days postpartum presenting at Touro Infirmary in New Orleans between April 1, 2015 and May 30, 2017 for hypertension evaluation were eligible for inclusion. After informed consent, BNP values were collected at any evaluation for hypertension during the antepartum period, at admission for delivery and up to 14 days postpartum. 132 women were included. A BNP value above 100 pg/dL was considered elevated. Standards for hypertension and preeclampsia were determined by criteria described by the American College of Obstetrics and Gynecology.

RESULTS:

Of 18 women with chronic hypertension exacerbation as an indication for delivery, none had an elevated BNP, as compared to 24.6% of women without the indication (n =132, p=0.0248). Of 43 women with severe preeclampsia as an indication for delivery, 37.2% had an elevated BNP, as compared to 13.5% of women without the indication (p=0.003).

CONCLUSION:

Women with chronic hypertension exacerbation as an indication for delivery are not likely to have elevated BNP. Women with severe preeclampsia as an indication for delivery are more likely to have elevated BNP, which is congruent with the notion that BNP is a measure of acute stress to the heart.