bluuebunny/crossref_metadata_2025 huggingface dataset:
Early outcomes of hybrid type II arch repair versus total arch replacement with frozen elephant trunk in acute DeBakey type I aortic dissection: a propensity score-matched analysis
Authors: Liu Yanxiang , Liang Shenghua , Zhang Bowen , Li Yunfeng , Wang Lucheng , Dun Yaojun , Chen Zujun , Shi Yi , Guo Hongwei , Sun Xiaogang
Published: June 2020

OBJECTIVES

The aim was to evaluate the short-term outcomes of hybrid type II arch repair (HAR) and total arch replacement with frozen elephant trunk (TAR with FET) for acute DeBakey type I aortic dissection patients.

METHODS

From January 2017 to June 2019, the clinical data of acute DeBakey type I aortic dissection patients in a single centre were retrospectively reviewed; there were 92 cases of HAR and 268 cases of TAR with FET, with 56 pairs by propensity score matching.

RESULTS

After matching, the composite end points including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome were comparable (21.4%, 12/56 in the HAR group vs 21.4%, 12/56 in the TAR with FET group, P = 1.000). The rate of acute kidney injury (AKI) was significantly lower in the HAR group (58.9%, 33/56 vs 80.4%, 45/56, P = 0.031). The distribution of AKI stage according to the Kidney Disease Improving Global Outcomes criteria was different (P = 0.039), with more patients suffering from high-grade AKI in the TAR with FET group. Multivariable logistic analysis showed that the procedure type (HAR or TAR with FET) was not an independent predictor of composite adverse events or stroke. HAR was identified as a protective factor against AKI (odds ratio 0.485, 95% confidence interval 0.287–0.822; P = 0.007).

CONCLUSIONS

In the treatment of acute DeBakey type I aortic dissection, no significant differences were found in early outcomes between the 2 groups, but HAR was associated with a significantly lower incidence of AKI.
Pulmonary Arterial Enlargement in Well-Treated Persons With Human Immunodeficiency Virus
Authors: Knudsen Andreas D , Ronit Andreas , Kristensen Thomas , Thomsen Magda Teresa , Lebech Anne-Mette , Cuong Michael Huy , Sigvardsen Per Ejlstrup , Kühl Jørgen Tobias , Fuchs Andreas , Køber Lars , Lundgren Jens , Vestbo Jørgen , Kofoed Klaus F , Nielsen Susanne D
Published: June 2020

Background

Pulmonary artery enlargement is a marker of pulmonary hypertension. We aimed to determine the proportion with pulmonary artery enlargement among well-treated persons with human immunodeficiency virus HIV (PWH) and uninfected controls.

Methods

PWH with a chest computed tomography were included from the ongoing Copenhagen Comorbidity in HIV Infection (COCOMO) study. Age and sex-matched uninfected controls were recruited from the Copenhagen General Population Study. Pulmonary artery enlargement was defined as a ratio of >1 between the diameter of the main pulmonary artery (at the level of its bifurcation) and the diameter of the ascending aorta.

Results

In total, 900 PWH were included, and 44 (5%) had a pulmonary artery–aorta ratio (PA:A) >1. After adjustment for age, sex, and body mass index, obesity (adjusted odds ratio, 4.33; 95% confidence interval, 1.76–10.65; P = .001) and injection drug use (IDU) (4.90; 1.00–18.46; P = .03) were associated with higher odds of having a PA:A >1, and pulmonary indices and smoking status were not. HIV seropositivity was borderline associated with a PA:A >1 (adjusted odds ratio, 1.89; 95% confidence interval, .92–3.85; P = .08).

Conclusions

A PA:A >1 was common in PWH. Obesity and IDU were independently associated with this finding and HIV serostatus was borderline associated with it, but HIV-related factors were not. Increased awareness may be appropriate in obese PWH and those with IDU.
Challenges of Discrepant HIV Tests in Pregnant Women in the PrEP era—to Treat or Not to Treat?
Authors: Wagner Anjuli D , Kinuthia John , Dettinger Julia , Mwongeli Nancy , Gómez Laurén , Watoyi Salphine , Drake Alison L , Abuna Felix , Pintye Jillian , Ochieng Ben , Odinga Daniel , John-Stewart Grace , Baeten Jared M
Published: June 2020

Background

During HIV retesting in antenatal and preexposure prophylaxis (PrEP) care, discrepant results occur, but guidelines are lacking.

Methods

In a Kenyan trial implementing antenatal PrEP, if 1 test is reactive, a second is performed; if discrepant, both are repeated; if persistently discrepant, DNA polymerase chain reaction (PCR) is performed.

Results

Among 4451 women, 23 265 HIV retesting sessions were performed; 14 (0.06%, 95% confidence interval, 0.03%–0.10%) had discrepant results among 10 individuals; in all 10 initial cases, PCR was negative.

Conclusions

Discrepant rapid tests are an expected, rare, and important challenge for antenatal care HIV retesting, with and without PrEP.

Clinical Trials Registration

NCT03070600.
The Remains of the Day: The International Economic Order in the Era of Disintegration*
Authors: Montanaro Francesco , Violi Federica
Published: June 2020

The last two decades of the XX century have been marked by a vigorous acceleration of international economic integration both at a global and regional level. States accepted pervasive constraints on their national decision-making in the hope that stability and predictability would favor economic growth. This model of international economic integration, however, has recently shown worrying signs of ‘disintegration’. Disintegration manifests itself both as disintegration of the international legal regimes which compose the international economic order; and disintegration through law, namely the social, economic and environmental disintegration phenomena, triggered or at least facilitated by these regimes. Relying on the paradox integration/disintegration as an analytical framework, this article draws a blueprint of the various disintegration phenomena, which are further analyzed in the individual contributions to this Special Issue. It seeks to identify a relationship between the two dimensions of disintegration and detect possible correlation patterns. Last, after engaging with the different normative alternatives put forward by the contributors, it concludes by calling for a rethinking of the traditional approach to international economic integration. This reconceptualization should be premised on the full realization that the current model entails a great deal of environmental and social ‘hidden costs’.
Between a rock and a hard place: retained appendicolith causing a mechanical small bowel obstruction
Authors: Sagkriotis Ioannis , Habib Zain , Zardab Mohammed
Published: June 2020

Here we report an unusual case of small bowel obstruction, preluded by an unremarkable presentation of appendicitis. The small bowel obstruction subsequently diagnosed involved deposition of an appendicolith within the small bowel. Radiographic features of this incident are discussed along with its pathomechanics. Surgical management was carried out and is detailed along with advice for the management of retained appendicolith.
Masses of the components of SB2 binaries observed with Gaia – V. Accurate SB2 orbits for 10 binaries and masses of the components of 5 binaries
Authors: Halbwachs J-L , Kiefer F , Lebreton Y , Boffin H M J , Arenou F , Le Bouquin J-B , Famaey B , Pourbaix D , Guillout P , Salomon J-B , Mazeh T
Published: June 2020

Double-lined spectroscopic binaries (SB2s) are one of the main sources of stellar masses, as additional observations are only needed to give the inclinations of the orbital planes in order to obtain the individual masses of the components. For this reason, we are observing a selection of SB2s using the SOPHIE spectrograph at the Haute-Provence observatory in order to precisely determine their orbital elements. Our objective is to finally obtain masses with an accuracy of the order of one per cent by combining our radial velocity (RV) measurements and the astrometric measurements that will come from the Gaia satellite. We present here the RVs and the re-determined orbits of 10 SB2s. In order to verify the masses, we will derive from Gaia, we obtained interferometric measurements of the ESO VLTI for one of these SB2s. Adding the interferometric or speckle measurements already published by us or by others for four other stars, we finally obtain the masses of the components of five binary stars, with masses ranging from 0.51 to 2.2 solar masses, including main-sequence dwarfs and some more evolved stars whose location in the HR diagram has been estimated.
Blue straggler populations of seven open clusters with Gaia DR2
Authors: Vaidya Kaushar , Rao Khushboo K , Agarwal Manan , Bhattacharya Souradeep
Published: June 2020

Blue straggler stars (BSS) are well studied in globular clusters but their systematic study with secure membership determination is lacking in open clusters. We use Gaia DR2 data to determine accurate stellar membership for four intermediate-age open clusters, namely Melotte 66, NGC 2158, NGC 2506, and NGC 6819, and three old open clusters, namely, Berkeley 39, NGC 188, and NGC 6791, to subsequently study their BSS populations. The BSS radial distributions of five clusters, namely Melotte 66, NGC 188, NGC 2158, NGC 2506, and NGC 6791, show bimodal distributions, placing them with Family II globular clusters that are of intermediate dynamical ages. The location of minima, rmin, in the bimodal BSS radial distributions, varies from 1.5rc to 4.0rc, where rc is the core radius of the clusters. We find a positive correlation between rmin and Nrelax, the ratio of cluster age to the current central relaxation time of the cluster. We further report that this correlation is consistent in its slope, within the errors, with the slope of the globular cluster correlation between the same quantities, but with a slightly higher intercept. This is the first example in open clusters that shows BSS radial distributions as efficient probes of dynamical age. The BSS radial distributions of the remaining two clusters, Berkeley 39 and NGC 6819, are flat. The estimated Nrelax values of these two clusters, however, indicate that they are dynamically evolved. Berkeley 39 especially has its entire BSS population completely segregated to the inner regions of the cluster.
The advection-dominated accretion flow for the anticorrelation between the X-ray photon index and the X-ray luminosity in neutron star low-mass X-ray binaries
Authors: Qiao Erlin , Liu B F
Published: June 2020

Observationally, an anticorrelation between the X-ray photon index Γ (obtained by fitting the X-ray spectrum between 0.5 and 10 keV with a single power law) and the X-ray luminosity L0.5-10 keV, i.e. a softening of the X-ray spectrum with decreasing L0.5-10 keV, is found in neutron star low-mass X-ray binaries (NS-LMXBs) in the range of $L_{\rm 0.5\!-\!10\,keV}\sim 10^{34}\!-\!10^{36}\ \rm erg\ s^{-1}$. In this paper, we explain the observed anticorrelation between Γ and L0.5–10 keV within the framework of the self-similar solution of the advection-dominated accretion flow (ADAF) around a weakly magnetized NS. The ADAF model intrinsically predicts an anticorrelation between Γ and L0.5–10 keV. In the ADAF model, there is a key parameter, fth, which describes the fraction of the ADAF energy released at the surface of the NS as thermal emission to be scattered in the ADAF. We test the effect of fth on the anticorrelation between Γ and L0.5–10 keV. It is found that the value of fth can significantly affect the anticorrelation between Γ and L0.5–10 keV. Specifically, the anticorrelation between Γ and L0.5–10 keV becomes flatter with decreasing fth as taking fth = 0.1, 0.03, 0.01, 0.005, 0.003, and 0, respectively. By comparing with a sample of non-pulsating NS-LMXBs with well measured Γ and L0.5–10 keV, we find that indeed only a small value of 0.003 ≲ fth ≲ 0.1 is needed to match the observed anticorrelation between Γ and L0.5–10 keV. Finally, we argue that the small value of fth ≲ 0.1 derived in this paper further confirms our previous conclusion that the radiative efficiency of NSs with an ADAF accretion may not be as high as $\epsilon \sim {\dot{M} GM\over R_{*}}/{\dot{M} c^2}\sim 0.2$.
Predicting the time variation of radio emission from MHD simulations of a flaring T-Tauri star
Authors: Waterfall C O G , Browning P K , Fuller G A , Gordovskyy M , Orlando S , Reale F
Published: June 2020

We model the time-dependent radio emission from a disc accretion event in a T-Tauri star using 3D, ideal magnetohydrodynamic simulations combined with a gyrosynchrotron emission and radiative transfer model. We predict for the first time, the multifrequency (1–1000 GHz) intensity and circular polarization from a flaring T-Tauri star. A flux tube, connecting the star with its circumstellar disc, is populated with a distribution of non-thermal electrons that is allowed to decay exponentially after a heating event in the disc and the system is allowed to evolve. The energy distribution of the electrons, as well as the non-thermal power-law index and loss rate, are varied to see their effect on the overall flux. Spectra are generated from different lines of sight, giving different views of the flux tube and disc. The peak flux typically occurs around 20–30 GHz and the radio luminosity is consistent with that observed from T-Tauri stars. For all simulations, the peak flux is found to decrease and move to lower frequencies with elapsing time. The frequency-dependent circular polarization can reach 10$-30{{\ \rm per\ cent}}$ but has a complex structure that evolves as the flare evolves. Our models show that observations of the evolution of the spectrum and its polarization can provide important constraints on physical properties of the flaring environment and associated accretion event.
The Bardeen–Petterson effect in accreting supermassive black hole binaries: a systematic approach
Authors: Gerosa Davide , Rosotti Giovanni , Barbieri Riccardo
Published: June 2020

Disc-driven migration is a key evolutionary stage of supermassive black hole binaries hosted in gas-rich galaxies. Besides promoting the inspiral, viscous interactions tend to align the spins of the black holes with the orbital angular momentum of the disc. We present a critical and systematic investigation of this problem, also known as the Bardeen–Petterson effect. We design a new iterative scheme to solve the non-linear dynamics of warped accretion discs under the influence of both relativistic frame dragging and binary companion. We characterize the impact of the disc ‘critical obliquity’, which marks regions of the parameter space where stationary solutions do not exist. We find that black hole spins reach either complete alignment or a critical configuration. Reaching the critical obliquity might imply that the disc breaks as observed in hydrodynamical simulations. Our findings are important to predict the spin configurations with which supermassive black hole binaries enter their gravitational-wave driven regime and become detectable by LISA.
Consequences of Stability-Induced Epistasis for Substitution Rates
Authors: Youssef Noor , Susko Edward , Bielawski Joseph P
Published: June 2020

Do interactions between residues in a protein (i.e., epistasis) significantly alter evolutionary dynamics? If so, what consequences might they have on inference from traditional codon substitution models which assume site-independence for the sake of computational tractability? To investigate the effects of epistasis on substitution rates, we employed a mechanistic mutation-selection model in conjunction with a fitness framework derived from protein stability. We refer to this as the stability-informed site-dependent (S-SD) model and developed a new stability-informed site-independent (S-SI) model that captures the average effect of stability constraints on individual sites of a protein. Comparison of S-SI and S-SD offers a novel and direct method for investigating the consequences of stability-induced epistasis on protein evolution. We developed S-SI and S-SD models for three natural proteins and showed that they generate sequences consistent with real alignments. Our analyses revealed that epistasis tends to increase substitution rates compared with the rates under site-independent evolution. We then assessed the epistatic sensitivity of individual site and discovered a counterintuitive effect: Highly connected sites were less influenced by epistasis relative to exposed sites. Lastly, we show that, despite the unrealistic assumptions, traditional models perform comparably well in the presence and absence of epistasis and provide reasonable summaries of average selection intensities. We conclude that epistatic models are critical to understanding protein evolutionary dynamics, but epistasis might not be required for reasonable inference of selection pressure when averaging over time and sites.
ENSO and Southeast Asian biomass burning modulate subtropical trans-Pacific ozone transport
Authors: Xue Lian , Ding Aijun , Cooper Owen , Huang Xin , Wang Wuke , Zhou Derong , Wu Zhaohua , McClure-Begley Audra , Petropavlovskikh Irina , Andreae Meinrat O , Fu Congbin
Published: June 2020

Trans-Pacific transport of enhanced ozone plumes has been mainly attributed to fossil fuel combustion in Asia in spring, but less attention has been paid to vegetation fires in Asia. Here we show that the El Niño-Southern Oscillation (ENSO)-modulated fires in Southeast Asia, rather than Asian fossil fuel plumes, dominate the interannual variability of springtime trans-Pacific transport of ozone across the entire North Pacific Ocean. During El Niño springs, the intensified fires from both the Indochinese Peninsula and Indonesia, together with large-scale circulation anomalies, result in enhanced ozone plumes that stretch over 15 000 km in both the lower-middle and upper troposphere. This enhancement is also observed in the in situ measurements of ozone concentration, with an almost 10% increase at Mauna Loa Observatory, Hawaii, a unique site to monitor the long-distance transport over the North Pacific. This study reports an unexpectedly strong influence of vegetation fires, linked with climate variability, on global tropospheric chemistry and proves once more how complex the interactions in the climate system are.
Endovascular Management of Intracranial Vertebral Artery Dissection: Technical Nuances for the Preservation of Posterior Inferior Cerebellar Artery and Basilar Artery
Authors: Gupta Gaurav , Eckstein Donna A , Narayan Vinayak , Jumah Fareed , DePalma Anthony A , Sozio Stephen J , Prendergast Nancy , Schonfeld Steven , Keller Irwin , Al-Mufti Fawaz , Nosko Michael , Nanda Anil , Roychowdhury Sudipta
Published: June 2020

BACKGROUND

The treatment of intracranial vertebral artery dissection (VAD) can be challenging.

OBJECTIVE

To evaluate the clinical presentation, endovascular treatment techniques, and prognostic outcome of patients diagnosed with intracranial VAD at our institution.

METHODS

A retrospective analysis of 35 patients who were diagnosed with VAD at our institution over 17-yr period (2001-2017) is presented. A total of 27 patients with a total of 30 affected arteries underwent endovascular treatment, and their outcome was evaluated.

RESULTS

Of the 35 total patients with VAD, 15 presented with headache, 12 with focal neurological deficits, 2 with neck pain, 2 with dizziness, 1 with syncope, and 3 after trauma. Of the 30 dissected arteries, 18 were treated with deconstruction and 12 were treated with stent reconstruction. Treatment method was determined by the dominance of the affected artery and location relative to the ipsilateral posterior inferior cerebellar artery (PICA) and the basilar artery. Deconstructive techniques were utilized in all cases of hypoplastic artery dissection and the majority of codominant artery dissections, whereas reconstruction was performed on the majority of dominant artery dissections. Rupture did not impact treatment technique. Four patients demonstrated post-treatment infarcts, and another 1 patient died because of intraparenchymal bleed. The remaining 22 patients demonstrated favorable clinical outcome. None of the patients developed recanalization or needed retreatment till the last follow-up.

CONCLUSION

This study suggests that endovascular treatment of intracranial VAD with deconstruction or stent reconstruction based on the patients anatomy, particularly vessel dominance and location with respect to PICA, is feasible and effective though the revascularization procedures still has its role in selected cases.
Reduction of Postoperative Opioid Use After Elective Spine and Peripheral Nerve Surgery Using an Enhanced Recovery After Surgery Program
Authors: Flanders Tracy M , Ifrach Joseph , Sinha Saurabh , Joshi Disha S , Ozturk Ali K , Malhotra Neil R , Pessoa Rachel , Kallan Michael J , Fleisher Lee A , Ashburn Michael A , Maloney Eileen , Welch William C , Ali Zarina S
Published: June 2020

Objective

Enhanced recovery after surgery (ERAS) pathways have previously been shown to be feasible and safe in elective spinal procedures. As publications on ERAS pathways have recently emerged in elective neurosurgery, long-term outcomes are limited. We report on our 18-month experience with an ERAS pathway in elective spinal surgery.

Methods

A historical cohort of 149 consecutive patients was identified as the control group, and 1,141 patients were prospectively enrolled in an ERAS protocol. The primary outcome was the need for opioid use one month postoperation. Secondary outcomes were opioid and nonopioid consumption on postoperative day (POD) 1, opioid use at three and six months postoperation, inpatient pain scores, patient satisfaction scores, postoperative Foley catheter use, mobilization/ambulation on POD0–1, length of stay, complications, and intensive care unit admissions.

Results

There was significant reduction in use of opioids at one, three, and six months postoperation (38.6% vs 70.5%, P < 0.001, 36.5% vs 70.9%, P < 0.001, and 23.6% vs 51.9%, P = 0.008) respectively. Both groups had similar surgical procedures and demographics. PCA use was nearly eliminated in the ERAS group (1.4% vs 61.6%, P < 0.001). ERAS patients mobilized faster on POD0 compared with control (63.5% vs 20.7%, P < 0.001). Fewer patients in the ERAS group required postoperative catheterization (40.7% vs 32.7%, P < 0.001). The ERAS group also had decreased length of stay (3.4 vs 3.9 days, P = 0.020).

Conclusions

ERAS protocols for all elective spine and peripheral nerve procedures are both possible and effective. This standardized approach to patient care decreases opioid usage, eliminates the use of PCAs, mobilizes patients faster, and reduces length of stay.
Perceptual Experience and Degrees of Belief
Authors: Raleigh Thomas , Vindrola Filippo
Published: June 2020

According to the recent Perceptual Confidence view, perceptual experiences possess not only a representational content, but also a degree of confidence in that content. The motivations for this view are partly phenomenological and partly epistemic. We discuss both the phenomenological and epistemic motivations for the view, and the resulting account of the interface between perceptual experiences and degrees of belief. We conclude that, in their present state of development, orthodox accounts of perceptual experience are still to be favoured over the perceptual confidence view.
The Effect of Institutional Affiliation and Career Patterns on (De)centralization Preferences in Advanced Multi-Level States: Parliamentarians’ Support for (De)Centralization in Belgium
Authors: Dodeigne Jeremy , Niessen Christoph , Reuchamps Min , Sinardet Dave
Published: June 2020

The decentralization of political power towards subnational entities is one of the major contemporary processes of territorial transformation in European democracies. Traditionally, research has focused on arguments related to nationalism and identities. Later, the strategic agency of political parties has been integrated as they typically play a major role in negotiating constitutional reforms. We investigate two institutionalist factors to explain why political Parliamentarians (MPs) favour decentralization while others oppose it: their parliamentary institutional affiliation and their career pattern (as well as the interaction between both). The importance of these factors is studied based on a large-scale survey among Belgian MPs from all federal and regional parliaments. Our results indicate that MPs’ preferences for decentralization significantly differ depending on their institutional affiliation (regional MPs being more decentralist than national MPs). This difference is moderated by MPs’ career pattern, but only for national MPs (who are more decentralist when they have a regional career pattern).
Phenotypic Characterization of Targeted Knockdown of Cyclin-Dependent Kinases in the Intestinal Epithelial Cells
Authors: Lu Shuyan , Sung Tae , Amaro Marina , Hirakawa Brad , Jessen Bart , Hu Wenyue
Published: June 2020

Cyclin-dependent kinases (CDKs) are serine/threonine kinases that regulate cell cycle and have been vigorously pursued as druggable targets for cancer. There are over 20 members of the CDK family. Given their structural similarity, selective inhibition by small molecules has been elusive. In addition, collateral damage to highly proliferative normal cells by CDK inhibitors remains a safety concern. Intestinal epithelial cells are highly proliferative and the impact of individual CDK inhibition on intestinal cell proliferation has not been well studied. Using the rat intestinal epithelial (IEC6) cells as an in vitro model, we found that the selective CDK4/6 inhibitor palbociclib lacked potent anti-proliferative activity in IEC6 relative to the breast cancer cell line MCF7, indicating the absence of intestinal cell reliance on CDK4/6 for cell cycle progression. To further illustrate the role of CDKs in intestinal cells, we chose common targets of CDK inhibitors (CDK 1, 2, 4, 6, and 9) for targeted gene knockdown to evaluate phenotypes. Surprisingly, only CDK1 and CDK9 knockdown demonstrated profound cell death or had moderate growth effects, respectively. CDK2, 4, or 6 knockdowns, whether single, double, or triple combinations, did not have substantial impact. Studies evaluating CDK1 knockdown under various cell seeding densities indicate direct effects on viability independent of proliferation state and imply a potential noncanonical role for CDK1 in intestinal epithelial biology. This research supports the concept that CDK1 and CDK9, but not CDKs 2, 4, or 6, are essential for intestinal cell cycle progression and provides safety confidence for interphase CDK inhibition.
Monitoring of Peronospora destructor Primary and Secondary Inoculum by Real-Time qPCR
Authors: Van der Heyden Hervé , Bilodeau Guillaume J. , Carisse Odile , Charron Jean-Benoit
Published: June 2020

Onion downy mildew (ODM), caused by Peronospora destructor, is a serious threat for onion growers worldwide. In southwestern Québec, Canada, a steady increase in occurrence of ODM has been observed since the mid-2000s. On onion, P. destructor can develop local and systemic infections producing numerous sporangia which act as initial inoculum locally and also for neighboring areas. It also produces oospores capable of surviving in soils and tissues for a prolonged period of time. A recent study showed that ODM epidemics are strongly associated with weather conditions related to production and survival of overwintering inoculum, stressing the need to understand the role of primary (initial) and secondary inoculum. However, P. destructor is an obligate biotrophic pathogen, which complicates the study of inoculum sources. This study aimed at developing a molecular assay specific to P. destructor, allowing its quantification in environmental samples. In this study, a reliable and sensitive hydrolysis probe-based assay multiplexed with an internal control was developed on the internal transcribed spacer (ITS) region to quantify soil- and airborne inoculum of P. destructor. The assay specificity was tested against 17 isolates of P. destructor obtained from different locations worldwide, other members of the order Peronosporales, and various onion pathogens. Validation with artificially inoculated soil and air samples suggested a sensitivity of less than 10 sporangia g−1 of dry soil and 1 sporangium m−3 of air. Validation with environmental air samples shows a linear relationship between microscopic and real-time quantitative PCR counts. In naturally infested soils, inoculum ranged from 0 to 162 sporangia equivalent g−1 of dry soil, which supported the hypothesis of overwintering under northern climates. This assay will be useful for primary and secondary inoculum monitoring to help characterize ODM epidemiology and could be used for daily tactical and short-term strategic decision-making.
Soft drugs in anesthesia: remifentanil as prototype to modern anesthetic drug development
Authors: Birgenheier Nathaniel M. , Stuart Ami R. , Egan Talmage D.
Published: June 2020

Purpose of review

The unique demands of modern anesthesia practice require that medications be effective, well tolerated, and efficient. These attributes are increasingly achieved with the soft drug approach, wherein novel active compounds are specifically designed to be susceptible to rapid biotransformation to inactive metabolites. The present review summarizes the historical background and recent trends in soft drug development in anesthesiology.

Recent findings

Soft drug development programs for propranadid, etomidate, and benzodiazepine analogues have been undertaken in recent years. Although all three drugs advanced into human trials, neuro-excitatory adverse effects hampered the propranadid and etomidate analogue projects. Remimazolam, the soft benzodiazepine analogue, is at an advanced stage of development, having already received regulatory approval or review in several countries.

With succinylcholine as the historical forerunner and remifentanil as the modern prototype, the soft drug paradigm continues to hold promise for the future of anesthesia drug development.
The role of pharmacokinetics and pharmacodynamics in clinical anaesthesia practice
Authors: Hannivoort Laura N. , Absalom Anthony R. , Struys Michel M.R.F.
Published: June 2020

Purpose of review

Growing concerns about the environmental effects of volatile anaesthetics are likely to lead to increased use of intravenous anaesthetic drugs. Pharmacokinetic/pharmacodynamic (PKPD) models can increase the accuracy of intravenous drug titration, especially in populations that differ from the ‘average.’ However, with a growing number of PKPD models, and other technology available to date, it can be hard to see the wood for the trees. This review attempts to guide the reader through the PKPD jungle.

Recent findings

General purpose PKPD models for propofol and remifentanil designed to apply to a broader population, including children, the elderly and the obese, reduce the need for population-specific models. PKPD models for drugs such as dexmedetomidine and antimicrobial agents may be useful for procedural sedation or in the ICU. Technological advances such as Bayesian model adjustment based on point-of-care plasma concentration measurements, closed-loop drug delivery and artificial intelligence may improve the ease of use of the anaesthetic drugs and increase the accuracy of titration.

Newer and more complex modelling techniques and technological advancements can help to deliver anaesthetic drugs, sedatives and other drugs in a more stable and thereby safer way.
Prevalence of Covid-19 Infection and Subsequent Cohorting in a Residential Substance Use Treatment Program in Boston, MA
Authors: Barocas Joshua A. , Blackstone Elizabeth , Bouton Tara C. , Kimmel Simeon D. , Caputo Andrea , Porter Sarah J. , Walley Alexander Y.
Published: June 2020

Objectives:

The global pandemic of coronavirus disease 2019 (Covid-19) may disproportionately affect persons in congregate settings, including those in residential substance use treatment facilities. To limit the spread of SARS-CoV-2 through congregate settings, universal testing may be necessary. We aimed to determine the point prevalence of SARS-CoV-2 in a residential treatment program setting and to understand the unique challenges of Covid-19 transmission in this setting.

Methods:

We performed a case series of SARS-CoV-2 rT-PCR testing via nasopharyngeal in a residential substance use treatment program for women in Boston. Staff and residents of the treatment program were tested for SARS-CoV-2. The primary outcome was SARS-CoV-2 test result.

Results:

A total of 31 residents and staff were tested. Twenty-seven percent (6/22) of the residents and 44% (4/9) of staff tested positive for SARS-CoV-2. All of the SARS-CoV-2 positive residents resided in the same residential unit. Two positive cases resided together with 2 negative cases in a 4-person room. Two other positive cases resided together in a 2-person room. One positive case resided with 2 negative cases in a 3-person room. One positive case resided with a negative case in a 2-person room. Based on test results, residents were cohorted by infection status and continued to participate in addiction treatment on-site.

Conclusions:

SARS-CoV-2 infection was common among staff and residents within a residential substance use treatment program for women in Boston. Universal SARS-CoV-2 testing in residential substance use programs can be instituted to reduce the risk of further transmission and continue addiction treatment programming when accompanied by adequate space, supplies, and staffing.
Trial of Labor After Two Prior Cesarean Deliveries
Authors: Dombrowski Michael , Illuzzi Jessica L. , Reddy Uma M. , Lipkind Heather S. , Lee Henry C. , Lin Haiqun , Lundsberg Lisbet S. , Xu Xiao
Published: June 2020

OBJECTIVE:

Trial of labor after cesarean delivery has been mostly studied in the setting of one prior cesarean delivery; controversy remains regarding the risks and benefits of trial of labor for women with two prior cesarean deliveries. This study aimed to examine utilization, success rate, and maternal and neonatal outcomes of trial of labor in this population.

METHODS:

Using linked hospital discharge and birth certificate data, we retrospectively analyzed a cohort of mothers with nonanomalous, term, singleton live births in California between 2010–2012 and had two prior cesarean deliveries and no clear contraindications for trial of labor. We measured whether they attempted labor and, if so, whether they delivered vaginally. Association of patient and hospital characteristics with the likelihood of attempting labor and successful vaginal birth was examined using multivariable regressions. We compared composite severe maternal morbidities and composite severe newborn complications in those who underwent trial of labor as opposed to planned cesarean delivery using a propensity score–matching approach.

RESULTS:

Among 42,771 women who met sample eligibility criteria, 1,228 (2.9%) attempted labor, of whom 484 (39.4%) delivered vaginally. There was no significant difference in the risk of composite severe maternal morbidities, but there was a modest increase in the risk of composite severe newborn complications among women who attempted labor compared with those who did not (2.0% vs 1.4%, P=.04). After accounting for differences in patient and hospital characteristics, propensity score–matched analysis showed no significant association between trial of labor and the risk of composite severe maternal morbidities (odds ratio [OR] 1.16, 95% CI 0.70–1.91), but trial of labor was associated with a higher risk for the composite of severe newborn complications (OR 1.78, 95% CI 1.04–3.04).

CONCLUSION:

Among women with two prior cesarean deliveries, trial of labor was rarely attempted and was successful in 39.4% of attempts. Trial of labor in this population was associated with a modest increase in severe neonatal morbidity.
Maternal and Neonatal Hospitalization Costs Associated With Elective Induction of Labor at Term in California, 2007–2011
Authors: Hersh Alyssa R. , Greiner Karen S. , Garg Bharti , Skeith Ashley E. , Caughey Aaron B.
Published: June 2020

OBJECTIVE:

To compare hospitalization costs of pregnancies managed by elective induction of labor to those with spontaneous labor in a large cohort of pregnant women.

METHODS:

We conducted a retrospective cohort study of women with singleton, nonanomalous births in California from 2007 to 2011. We excluded women with placenta previa, breech presentation, prior cesarean delivery, planned cesarean delivery, medically indicated induction of labor, gestational age less than 37 weeks or at or greater than 41 weeks, and stillbirths. We adjusted hospital charges using a cost-to-charge ratio and costs included hospitalization costs for admission for delivery only. We estimated the difference in costs between elective induction of labor (resulting in a vaginal or cesarean delivery) and spontaneous labor for both women and neonates, stratified by mode of delivery, parity, gestational age at delivery and geographic location. We conducted analyses using Kruskal-Wallis equality-of-populations rank tests with a significance level of 0.05.

RESULTS:

In a California cohort of 1,278,151 women, 190,409 (15%) had an elective induction of labor. Median maternal hospitalization costs were $10,175 (interquartile range: $7,284–$14,144) with induction of labor and $9,462 (interquartile range: $6,667–$13,251) with spontaneous labor (P<.01) for women who had a vaginal delivery, and $20,294 (interquartile range: $15,367–$26,920) with induction of labor and $18,812 (interquartile range: $13,580–$25,197) with spontaneous labor (P<.01) for women who had a cesarean delivery. Maternal median hospitalization costs were significantly higher in the setting of elective induction of labor regardless of parity, mode of delivery, and gestational age at delivery. Alternatively, median hospitalization costs for neonates of women who had an elective induction of labor were significantly lower.

CONCLUSION:

Further research regarding approaches to induction of labor is necessary to determine whether strategies to reduce health care costs without affecting or even improving outcomes could help curb costs associated with induction of labor.
Maternal Obesity and the Risk of Early-Onset and Late-Onset Hypertensive Disorders of Pregnancy
Authors: Bicocca Matthew J. , Mendez-Figueroa Hector , Chauhan Suneet P. , Sibai Baha M.
Published: June 2020

OBJECTIVE:

To evaluate the relationship between maternal body mass index (BMI) at delivery and rates of early-onset and late-onset hypertensive disorders of pregnancy.

METHODS:

We performed a population-based, retrospective cohort study using U.S. Vital Statistics period-linked birth and infant death certificates from 2014 to 2017. Women who delivered a nonanomalous singleton live neonate from 24 to 41 completed weeks of gestation were included. We excluded women with chronic hypertension and those with BMIs less than 18.5. The primary exposure was maternal BMI, defined as nonobese (BMI 18.5–29.9; referent group), class 1 obesity (BMI 30.0–34.9), class 2 obesity (BMI 35.0–39.9), and class 3 obesity (BMI 40.0 or greater). The primary outcome was delivery with hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia) at less than 34 weeks of gestation or at 34 weeks or more. Multivariable Poisson regression was used to estimate relate risk and adjust for confounding variables. Results are presented as adjusted relative risk (aRR) and 95% CIs.

RESULTS:

Of the 15.8 million women with live births during the study period, 14.0 million (88.6%) met inclusion criteria, and 825,722 (5.9%) had hypertensive disorders of pregnancy. The risk of early-onset hypertensive disorders of pregnancy was significantly higher in women with class 1 obesity (aRR 1.13; 95% CI 1.10–1.16), class 2 obesity (aRR 1.57; 95% CI 1.53–1.62), and class 3 obesity (aRR 2.18; 95% CI 2.12–2.24), compared with nonobese women. The risk of late-onset hypertensive disorders of pregnancy was also significantly increased in women with class 1 obesity (aRR 1.71; 95% CI 1.70–1.73), class 2 obesity (aRR 2.60; 95% CI 2.58–2.62), and class 3 obesity (aRR 3.93; 95% CI 3.91–3.96) compared with nonobese women.

CONCLUSION:

Compared with nonobese women, the risk of early-onset and late-onset hypertensive disorders of pregnancy is significantly and progressively increased among women with increased class of obesity.
Operative Vaginal Birth of a Critically Endangered Gorilla With Forceps Assistance
Authors: Monseur Brent , McCurdy Rebekah , Ialeggio Donna , Hinshaw Keith , Georoff Timothy , Weiner Stuart
Published: June 2020

BACKGROUND:

An obstetrician on standby assessed an 18-year-old primiparous captive gorilla with a term singleton fetus with a protracted labor course.

CASE:

After it was determined that an arrest of descent had occurred, a viable, 2,280 g male neonate was delivered through an operative vaginal birth with forceps assistance without major complications.

CONCLUSION:

Given the numerous anatomic and biochemical similarities of humans and other great apes, it is possible that the high maternal mortality and stillbirth rates of gorillas could be reduced by using the same principles of obstetric management in a multidisciplinary fashion.
Cochrane Review Summaries—July 2020
Authors: Jahanfar Shayesteh , Hill Matthew , Kariyawasam Diluma , Kumar Nimisha , Haas David M.
Published: June 2020

This feature highlights recently published Cochrane Reviews of interest to the readers of Obstetrics & Gynecology. The brief summaries are published below, and the complete references, along with a hyperlink, are listed in Box 1.
Effect of phenylephrine versus norepinephrine on 28-day mortality and SICU length of stay in septic shock
Authors: Santoriello Lisa , Schweiger Krislyn , Aronowitz Danielle , Maisch Nicole , Smith Candace , Wu Wenchen , Patel Vihas , Coppa Gene , Barrera Rafael
Published: June 2020

Background:

According to the Surviving Sepsis Campaign (SSC) guidelines, norepinephrine is the preferred vasopressor over phenylephrine when treating hemodynamically unstable septic patients. However, few studies have directly compared the use of these 2 vasopressors in septic shock patients.

Objective:

To compare 28-day mortality and surgical intensive care unit (SICU) length of stay in septic shock patients treated with phenylephrine and norepinephrine.

Methods:

Retrospective chart review of septic shock patients admitted from January 2012 through June 2017, who were treated with either phenylephrine or norepinephrine. The primary endpoint was assessment of 28-day mortality, secondary endpoint was SICU length of stay. The same endpoints were also evaluated specifically in patients with known cardiac disease.

Results:

Of the 30 patients included, 15 had been treated with norepinephrine and 15 with phenylephrine. Patients in either group had similar demographics and SOFA scores. No statistically significant difference was observed in either 28-day mortality (P=0.200) or SICU length of stay (P=0.544) between the 2 vasopressor groups. There was still no significant difference in the primary or secondary endpoints when compared among patients with baseline cardiac disease.

Conclusion:

Phenylephrine use in patients with septic shock does not appear to increase risk of 28-day mortality or prolong SICU length of stay when compared with using norepinephrine. However, its use also does not improve outcomes, even in patients with significant cardiac history.
The Effect of Foot Reflexology Applied Before Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty on Anxiety, Stress, and Cortisol Levels of Individuals
Authors: Vural Doğru Birgül , ŞenuzunAykar Fisun , Yıldırım Yasemin , Yavuzgil Oğuz , Sözmen Eser , Memmedov Hikmet
Published: June 2020

Background

Coronary angiography and percutaneous transluminal coronary angioplasty procedures cause anxiety and stress in individuals.

Objective

The aim of this study was to determine the effect of foot reflexology applied before coronary angiography and percutaneous transluminal coronary angioplasty on the anxiety, stress, and cortisol levels of individuals.

Methods

A simple randomized trial design was used. The patients who met the inclusion criteria were divided into 4 groups including experimental and control groups of coronary angiography patients (30 patients in each group) and percutaneous transluminal coronary angioplasty (26 patients in each group) by randomization method. Data were collected with the State-Trait Anxiety Inventory and Distress Thermometer 90 minutes before coronary angiography and percutaneous transluminal coronary angioplasty and the laboratory samples were taken. After these procedures, foot reflexology was applied to both feet of the patients in the experimental group for 30 minutes, and the control group received only standard care. The inventories were reapplied 30 minutes after the reflexology application and after coronary angiography and percutaneous transluminal coronary angioplasty.

Results

Whereas there was no statistically significant difference (P > .05) between the coronary angiography and percutaneous transluminal coronary angioplasty experimental and control groups in Anxiety Inventory and stress median scores before reflexology, a significant difference was found (P < .001) 30 minutes after reflexology application and after coronary angiography and percutaneous transluminal coronary angioplasty. After the reflexology, anxiety and stress scores were significantly lower in the experimental group compared with the control group (P < .001). Whereas there was a significant difference (P < .001) in the within-group cortisol values of both reflexology groups, no significant difference was found in the control groups (P > .05).

Conclusions

The application of reflexology before coronary angiography and percutaneous transluminal coronary angioplasty reduces the levels of anxiety, stress, and cortisol without any side effects.
Activin B signaling may promote the conversion of normal fibroblasts to scar fibroblasts
Authors: Deng Shi-Kang , Tang Jian-Zhong , Jin Yan , Hu Ping-Hai , Wang Jun-Feng , Zhang Xiao-Wen
Published: June 2020

This study is to explore the molecular mechanism of benign bile duct hypertrophic scar formation.

Differential proteins between the normal fibroblast (NFB) and scar fibroblast (SCFB) were screened by protein chip assay, and analyzed by pathway-enrichment analysis and function-enrichment analysis. The differential proteins were further tested by ELISA. SiRNA-Act B was transfected to SCFB to down-regulate the expression of Act B. NFB was incubated with rh-Act B. The cell apoptosis and cell cycle were determined by flow cytometry. The expression of Act B, Smad2/3, transforming growth factor-β1 (TGF-β1), endothelin-1 (ET-1), thrombospondin-1 (Tsp-1), and Oncostatin M (OSM) were detected by Western blot.

A total of 37 differential proteins were identified in SCFBs by microarray (P < .05), including 27 up-regulated proteins and 10 down-regulated proteins (P < .05). Their function were associated with Activin signaling, synthesis and degradation of extracellular matrix, formation and activation of cytokine, inflammatory reaction, immunoreaction, tissue damage reaction, cell cycle, migration, apoptosis, and secretion, etc. ELISA results showed that the expression of Act B, TGF-β1, ET-1 were higher in SCFBs, while the expression of Tsp-1 and OSM were lower in SCFBs (P < .05). After interfered by siRNA-Act B, the expression of Act B mRNA decreased (P < .05). The percentage of early apoptosis increased (P < .05). The expression of Act B, Smad2/3, TGF-β1 were decreased and Tsp-1, OSM were increased (P < .05). After treatment with rh-Act B, the percentage of G0/G1 phase of NFBs was decreased and that of S phase was increased without significance (P > .05). The expression of Act B, Smad2/3, TGF-β1 were increased (P < .05) and Tsp-1, OSM were decreased (P < .01).

There are differentially expressed proteins between SCFBs and NFBs. Activin B signal plays an important role in the process of NFB transforming to SCFB, and TGF-β1, Smad2/3, Tsp-1, and OSM are important participants.