bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of replacement of Mn by Cr on magnetocaloric properties of quenched NiMn1–xCrxGe alloys
Authors: Zubov E. , Nedelko N. , Sivachenko A. , Dyakonov K. , Tyvanchuk Yu. , Marzec M. , Valkov V. , Bażela W. , Ślawska-Waniewska A. , Dyakonov V. , Szytuɬa A. , Szymczak H.
Published: August 2018

In this paper, the crystallographic, magnetic, thermomagnetic, and magnetocaloric properties of the quenched NiMn1−xCrxGe (x = 0.04, 0.18, and 0.25) half-Heusler alloys have been studied by x-ray diffraction, differential scanning calorimetry and magnetization measurements. An influence of partial substitution of Cr for Mn and quenching of the samples on the character of structural and magnetic phase transitions is presented. Quenching of the alloys results in the formation of two phase (orthorhombic and hexagonal) crystal structure. The magnetic properties were investigated by means of magnetization measurements over a wide temperature (5–400 K) and magnetic field (up to 60 kOe) ranges. The experimental data indicate that at quenching and with increasing Cr content the magnetic order changes from antiferromagnetic to ferromagnetic. Hardened compounds exhibit a thermal hysteresis in the vicinity of the magnetic phase transition, what is characteristic for a first-order magnetic phase transition. The magnetic phase transition temperatures are decreased as a result of quenching of the samples. The magnetic entropy changes were calculated using the field dependences of isothermal magnetization in terms of the thermodynamic Maxwell relation. The magnetic entropy changes, |ΔSMmax|, obtained for the hardened alloys with x = 0.25 have the maximum value equal to 23 J/(kg·K) near the magnetic phase transition for a field change of ΔH = 0–60 kOe.
On a new mechanism of friction in nanoelectromechanical systems
Authors: Ilinskaya O. A.
Published: August 2018

A new friction mechanism in nanoelectromechanical systems is proposed. A model comprising of a movable quantum dot, located in an electric field, and a tunnel connected with an electron reservoir, maintained at a constant temperature, is considered. The method of kinetic equations in the framework of perturbation theory for the parameter of the ratio of the level width to the temperature is used to show that internal friction with non-monotonic temperature dependence arises in the system. The possibility of applying this result to find the instability region in shuttle systems is discussed.
Maturation of buffalo oocytes in vitro with acetyl-L-carnitine improves cryotolerance due to changes in mitochondrial function and the membrane lipid profile
Authors: Xu Hui-Yan , Geng Shuang-Shuang , Li Ting-Ting , Fu Qiang , Lu Sheng-Sheng , Liang Xing-Wei , Lu Yang-Qing , Zhang Ming , Yang Xiao-Gan , Lu Ke-Huan
Published: August 2018

The effects of acetyl-l-carnitine (ALC) supplementation during IVM on subsequently vitrified buffalo oocytes were evaluated, followed by determination of the mitochondrial DNA copy number, measurement of mitochondrial membrane potential (MMP) and identification of the lipid profile of oocyte membranes as markers of oocyte quality after vitrification. Supplementation with ALC during IVM significantly improved the rates of oocyte cleavage and morula and blastocyst formation, and increased MMP after vitrification compared with unsupplemented vitrified oocytes (P<0.05). Using a bidirectional orthogonal projection to latent structures discriminant analysis based on positive ion matrix-assisted laser desorption ionisation time-of-flight mass spectrometry data, five phospholipid ions (m/z 728.7 (phosphatidylcholine (PC) 32:3), 746.9 (PC 32:5), 760.6 (PC 34:1), 768.8 (PC P-36:3) and 782.6 (PC 36:4); P<0.05) were identified as significantly more abundant in fresh oocytes than in unsupplemented vitrified oocytes. Meanwhile, three phospholipid ions (m/z 734.6 (PC 32:0), 760.6 (PC 34:1), and 782.6 (PC 36:4); P<0.05) were more abundant in ALC-supplemented vitrified oocytes than in unsupplemented vitrified oocytes. Therefore, supplementation with ALC during IVM may improve buffalo oocyte quality after vitrification by enhancing mitochondrial function and altering the phospholipid composition of vitrified oocyte membranes.
Dietary resource use and competition between white-tailed deer and introduced sika deer
Authors: Kalb David M. , Bowman Jacob L. , DeYoung Randy W.
Published: August 2018

Content
Native communities of herbivores have evolved fundamental dietary niches that avoid or minimise competition; the introduction of exotic species can change dietary niches, cause overlap in resource use, and result in competition for resources.

Aims
We compared niche breadth, overlap in diet, and quality of diet between introduced sika deer and native white-tailed deer in Maryland, USA. We investigated these changes in free-ranging populations where both species are allopatric as well as when they are sympatric.

Methods
We used microhistological analysis of faecal samples to determine the percentage of resources used by sika deer and white-tailed deer, as measured between geographical areas of similar habitat quality. We compared resource use specifically by controlling for harvest pressure and resource availability, which are known to alter resource use other than the presence of an additional deer species.

Key results
We observed a significant resource overlap (range 63–88%) between species. In the presence of sika deer, white-tailed deer displayed an increased niche breadth (108%) and a lower diet quality (17%). Sika deer consumed the same resources that comprised 78% of white-tailed deer diet. Unlike other native ungulates that have dietary overlap with white-tailed deer, sika deer is neither temporally nor geographically segregated in habitat use.

Conclusions
Resource overlap and changes in niche breadth and diet quality during sympatry strongly denote dietary competition between sika deer and white-tailed deer. This competition results in white-tailed deer altering the dietary selection, thereby consuming lower-quality forage.

Implications
White-tailed deer are concentrate selectors and require higher diet quality than do sika deer, which can tolerate diets higher in fibre, consistent with their classification as intermediate feeders. A decrease in the nutritional quality of resources used by white-tailed deer could contribute to the decline of white-tailed deer over time and allow the continued spread of sika deer.
High aspect ratio nanotubes assembled from macrocyclic iminium salts
Authors: Sun Chao , Shen Meng , Chavez Anton D. , Evans Austin M. , Liu Xiaolong , Harutyunyan Boris , Flanders Nathan C. , Hersam Mark C. , Bedzyk Michael J. , Olvera de la Cruz Monica , Dichtel William R.
Published: August 2018

Significance

The distinct properties of one-dimensional nanomaterials, such as carbon nanotubes and actin filaments, emerge from their high aspect ratios. Stacking macrocycles into nanotubes represents a potentially powerful design strategy to access synthetic nanotubes, but such noncovalent assemblies are typically too weak to support individual, high aspect ratio structures. We report hexagonal macrocycles that exhibit strong electrostatic stacking upon protonation of their imine linkages. The resulting nanotubes form lyotropic phases and align in flow, a hallmark of high aspect ratio structures. The iminium-linked macrocycle assemblies form and disassemble reversibly in the presence of bases and acids, and are stabilized by covalent cross-linking.
Isolation of tyrosinase and melanogenesis inhibitory flavonoids from Juniperus chinensis fruits
Authors: Park Sang-a , Jegal Jonghwan , Chung Ki Wung , Jung Hee Jin , Noh Sang Gyun , Chung Hae Young , Ahn Jongmin , Kim Jinwoong , Yang Min Hye
Published: August 2018

A new biflavonoid, amentoflavone-7-O-β-D-glucoside, and thirteen known flavonoids were isolated from the fruits of Juniperus chinensis using a bioactivity-guided method and their tyrosinase inhibitory effects were tested using a mushroom tyrosinase bioassay. Two isolates, hypolaetin-7-O-β-D-glucoside and quercetin-7-O-α-L-rhamnoside, were found to reduce tyrosinase activity at a concentration of 50 μM. Quercetin-7-O-α-L-rhamnoside attenuated cellular tyrosinase activity and melanogenesis in α-MSH plus IBMX-stimulated B16F10 melanoma cells. Molecular docking simulation revealed that quercetin-7-O-α-L-rhamnoside inhibits tyrosinase activity by hydrogen bonding with residues His85, His244, Thr261, and Gly281 of tyrosinase.

Abbreviations: EtOH, ethanol; CH2Cl2, dichloromethane; EtOAc, ethylacetate; n-BuOH, n-butanol; MeOH, metanol; CHCl3,chloroform; DMSO, dimethylsulfoxide; DMEM, Dulbecco’s modified Eagle’s medium; FBS, fetal bovine serum; α-MSH, α-melanocyte stimulating hormone; L-DOPA, L-3, 4-dihydroxyphenylalanine
Quantification of Hsp90 availability reveals differential coupling to the heat shock response
Authors: Alford Brian D. , Brandman Onn
Published: August 2018

The heat shock response (HSR) is a protective gene expression program that is activated by conditions that cause proteotoxic stress. While it has been suggested that the availability of free chaperones regulates the HSR, chaperone availability and the HSR have never been precisely quantified in tandem under stress conditions. Thus, how the availability of chaperones changes in stress conditions and the extent to which these changes drive the HSR are unknown. In this study, we quantified Hsp90 chaperone availability and the HSR under multiple stressors. We show that Hsp90-dependent and -independent pathways both regulate the HSR, and the contribution of each pathway varies greatly depending on the stressor. Moreover, stressors that regulate the HSR independently of Hsp90 availability do so through the Hsp70 chaperone. Thus, the HSR responds to diverse defects in protein quality by monitoring the state of multiple chaperone systems independently.
An Analysis of Plastic Surgeons’ Social Media Use and Perceptions
Authors: Economides James M , Fan Kenneth L , Pittman Troy A
Published: August 2018

Background

Social media have become ubiquitous in society with an increasing number of active daily users across multiple platforms. Social media use has grown within the field of plastic surgery; many surgeons have created a professional account to gain exposure.

Objectives

This study investigates the patterns of use and perceptions of social media in plastic surgery.

Methods

A 16-item questionnaire was sent electronically to board-certified plastic surgeons to investigate professional social media use and perceptions. A literature review of all studies pertaining to social media and plastic surgery was also undertaken.

Results

An online survey was sent to 6136 ASPS members with 454 responses (7.4%). Of the respondents, 61.9% reported having an active professional social media account. Respondents whose practice primarily consisted of aesthetic/cosmetic surgery were the most likely to have an active professional social media account (79.4%). Nonacademic surgeons were most likely to maintain an active professional social media account (71.9%) compared with university-affiliated community surgeons (41.4%) and academic surgeons (29.5%). Nonacademic surgeons were more likely to believe social media is positive for the field (48.9%) compared with the other 2 cohorts (27.6% and 35.1%, respectively). Academic surgeons are more likely to believe social media worsens the image of the field (49.3%) vs the other cohorts (35.4% and 37.2%).

Conclusions

Professional social media use is rising within plastic surgery. However, a dichotomy exists in acceptance. Private practice, younger surgeons are more likely to view social media as an acceptable method of reaching patients.
SOMANZ Guidelines for the Investigation and Management of Sepsis in Pregnancy
Authors: Bowyer L. , Robinson H.L. , Barrett H. , Crozier T.M. , Giles M. , Idel I. , Lowe S. , Lust K. , Marnoch C.A. , Morton M.R. , Said J. , Wong M. , Makris A.
Published: August 2018

(Aust N Z J Obstet Gynaecol 2017;57:540–551)

Sepsis, caused by Group A beta hemolytic streptococcal (GAS) infection, is an increasing cause of maternal mortality in both Australia and the United Kingdom. Sepsis can lead to insufficiency in maternal circulation, leading to compromised fetal perfusion and fetal distress. The Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) has designed evidence-based guidelines for the effective investigation and management of sepsis in pregnant and postpartum women.
Competency-based Assessment Tools for Regional Anaesthesia: A Narrative Review
Authors: Chuan A. , Wan A.S. , Royse C.F. , Forrest K.
Published: August 2018

(Br J Anaesth. 2018;120:264–273)

Assessment tools play a critical role in the evaluation of trainee performance in competency-based postgraduate medical education programs. Consequently, the authors of the present narrative appraised published regional anesthesia assessment tools and addressed the type and purpose of current tools, relevant psychometric properties, implications for clinical adoption, and priorities in research.
Preeclampsia and Scleroderma: A Prospective Nationwide Analysis
Authors: Kamper-Jørgensen M. , Gammill H.S. , Nelson J.L.
Published: August 2018

(Acta Obstet Gynecol Scand 2018;97:587–590)

Scleroderma is an autoimmune disease that is characterized by skin thickening. Various subtypes exist that are defined by the organ systems affected. A previous retrospective study found that women who ultimately developed scleroderma reported having had a pregnancy with hypertensive complications at twice the rate of that for healthy women. To determine the possible association between preeclampsia and scleroderma, a nationwide prospective cohort analysis was performed.
Reduction of Preterm Birth Rates Starts at Preconception
Authors: Oudijk M.A.
Published: August 2018

(BJOG 2017;124:1717)

The article by Kim et al has found obesity, in the absence of chronic disease, to be associated with preterm birth. Of interest was the association between obesity and extremely preterm birth (birth at <28 wk gestation), both spontaneous and indicated, in nulliparous women. Extremely preterm birth is associated with neonatal morbidity and mortality. Providers should attempt to identify women at risk of preterm birth, such as overweight and obese women, and work to modify these risk factors.
Loss of Resistance: A Randomized Controlled Trial Assessing 4 Low-fidelity Epidural Puncture Simulators
Authors: Pedersen T.H. , Meuli J. , Plazikowski E.J. , Buttenberg M. , Kleine-Brueggeney M. , Seidl C. , Theiler L. , Greif R.
Published: August 2018

(Eur J Anaesthesiol 2017;34:602–608)

Placing an epidural catheter for administration of regional anesthesia is considered to be a difficult skill for anesthesia residents to master. In one study, first-year residents had only an 80% success rate after 90 attempts at epidural catheter placement. With such a steep learning curve, it would be beneficial to have significant simulated experiences before performing the procedure on patients. Several simulators are commercially available for practicing identification of the epidural space using a loss of resistance (LOR) technique. However, these simulators can be quite expensive, ranging in price between €1500 and 3000. The use of various fruits have been studied to simulate the feel of LOR during epidural procedures with the banana found to best simulate the sensation. In this single-blinded, randomized, controlled study the investigators compared 3 commercially available simulators and a banana for their ability to simulate the LOR feel essential to successful epidural placement.
Electron Microscopy of Dural and Arachnoid Disruptions After Subarachnoid Block
Authors: Reina M.A. , Puigdellívol-Sánchez A. , Gatt S.P. , De Andrés J. , Prats-Galino A. , van Zundert A.
Published: August 2018

(Reg Anesth Pain Med 2017;42:709–718)

Postdural puncture headache (PDPH) is commonly explained by intracranial hypotension due to cerebrospinal fluid leakage. An association between larger size dural punctures and an increased incidence of PDPH has been widely accepted. It was generally believed that pencil-point type needles produced smaller dural lesions by allowing separation rather than cutting of the dural fibers, but this has not been supported by morphologic evidence. There has been little investigation on the morphology of dural lesions produced by spinal needles. This study aimed to study human meninges and the morphology of dura-arachnoid lesions produced by 27 G Whitacre and 29 G Quincke spinal needles. The study also sought to determine whether there was a correlation between the diameter of the lesions and the needles used. Finally, authors aimed to determine whether the lesion diameter was altered when the 29 G needle bevel was oriented vertically rather than horizontally.
Preventing Mistransfusions: An Evaluation of Institutional Knowledge and a Response
Authors: MacDougall N. , Dong F. , Broussard L. , Comunale M.E.
Published: August 2018

(Anesth Analg. 2018;126:247–251)

The risk of transfusion of the wrong blood to the wrong patient is 3 times higher than the risk of infectious disease transmission through blood products. In the present study, the authors reported on their experience with a transfusion event, in which a patient with type AB blood type was given type A plasma with no negative sequelae. Following the analysis of the knowledge gap that occurred between the technician and the members of the anesthesia team, the authors evaluated the application of a point of care cognitive aid to bridge potentially lethal knowledge gaps among practitioners in blood product to patient compatibility.
Microparticle Release During Normal Cesarean Delivery
Authors: Hofer J.E. , Scavone B.M.
Published: August 2018

(Anesth Analg. 2018;126:925–927)

Microparticles (MPs) are spherical cytoplasm-free parts of cell membranes released from cells during physiological or pathologic processes; the origin of MPs can be identified based on their membrane proteins. The relationship between coagulability and MP levels surrounding normal delivery has not been characterized. A better understanding of peripartum coagulation may permit better identification of those at risk for postpartum hemorrhage. The authors of this brief report hypothesized that an increase in MP levels in plasma occurs around the time of placental separation and subsides after several hours.
Photoplethysmography and Heart Rate Variability for the Diagnosis of Preeclampsia
Authors: Euliano T.Y. , Michalopoulos K. , Singh S. , Gregg A.R. , Del Rio M. , Vasilopoulos T. , Johnson A.M. , Onkala A. , Darmanjian S. , Euliano N.R. , Ho M.
Published: August 2018

(Anesth Analg. 2018;126:913–919)

Nearly one-third of patients with preeclampsia (PE) do not present clearly, and there currently is no predictive test with adequate discrimination power. Analysis of peripheral pulse waveforms has long been recognized to indicate arterial resistance characteristics. The authors of the present study hypothesized it may be possible to distinguish women with PE with severe features from nonpreeclamptic patients, using parameters of photoplethysmographic (PPG) pulse and electrocardiogram (ECG) alone. To that end, the authors of the present study determined a set of timing, shape, and statistical features available through these noninvasive measures.
Continuous Glucose Monitoring in Pregnant Women With Type 1 Diabetes (CONCEPTT): A Multicentre International Randomized Controlled Trial
Authors: Feig D.S. , Donovan L.E. , Corcoy R. , Murphy K.E. , Amiel S.A.
Published: August 2018

(Lancet 2017;390:2347–2359)

Pregnant women with type 1 diabetes are at increased risk of preeclampsia, cesarean delivery, congenital anomalies, and other adverse pregnancy outcomes. While optimal glycemic control during pregnancy can improve outcomes, it is difficult to accomplish due to the complexity of insulin dose adjustments, changes in insulin sensitivity, and variability of insulin absorption that all occur during pregnancy. Continuous glucose monitoring (CGM) has been successful at improving glycemic control in nonpregnant women but studies in pregnant women have had conflicting results. This study aimed to evaluate the effects of CGM in women with type 1 diabetes who were pregnant or planning to become pregnant.
A Shift in Thinking to Reduce Mother-to-Infant Transmission of Hepatitis B
Authors: Dusheiko G.
Published: August 2018

(N Engl J Med. 2018;378:952–953)

In this editorial, the author discusses a recent study regarding the use of tenofovir disoproxil fumarate (TDF) prophylaxis and vaccination to help alleviate the increasing disease burden of hepatitis B virus (HBV) infection in countries eligible for Global Vaccine Alliance support. In these countries, HBV infection during the neonatal period and childhood remains the leading source of new chronic infections. An estimated 1% of newborns annually (>365,000 newborns) are infected at birth in sub-Saharan Africa. Although the first dose of the vaccine is scheduled to occur at 5 weeks, as per the Expanded Program on Immunization (EPI), only 48% of countries report actually administering the vaccine at birth.
Risk of Adverse Pregnancy Outcomes at Advanced Maternal Age
Authors: Frederiksen L.E. , Ernst A. , Brix N. , Braskhøj Lauridsen L.L. , Roos L. , Ramlau-Hansen C.H. , Ekelund C.K.
Published: August 2018

(Obstet Gynecol 2018;131:457–463)

Previous studies examining associations between advanced maternal age and adverse pregnancy outcomes have conflicting findings, are inadequately powered, or are prone to bias. The authors of the present study thereby examined the possible associations between advanced maternal age (above 35 y of age) and adverse pregnancy outcomes in a large population-based cohort of pregnant women in Denmark, followed from first trimester to delivery or termination of pregnancy. The authors also predicted risk estimates of a composite adverse pregnancy outcome, to identify whether certain groups of parturients are at risk for select adverse pregnancy outcomes.
Rocuronium Versus Suxamethonium for Rapid Sequence Induction of General Anesthesia for Cesarean Section: Influence on Neonatal Outcomes
Authors: Kosinova M. , Stourac P. , Adamus M. , Seidlova D. , Pavlik T. , Janku P. , Krikava I. , Mrozek Z. , Prochazka M. , Klucka J. , Stoudek R. , Bartikova I. , Harazim H. , Robotkova H. , Hejduk K. , Hodicka Z. , Kirchnerova M. , Francakova J. , Pyszkova L. Obare , Hlozkova J. , Sevcik P.
Published: August 2018

(Int J Obstet Anesth 2017;32:4–10)

Rocuronium has been considered for use in rapid-sequence induction of general anesthesia for cesarean delivery as an alternative to succinylcholine. No large, randomized trials have investigated neonatal outcomes associated with maternal administration of rocuronium. A previous trial by the same authors as the present study compared rocuronium and succinylcholine for cesarean delivery and found lower Apgar scores at 1 and 5 minutes for neonates whose mothers were administered rocuronium. However, this was a secondary outcome of the earlier study and was not adequately powered for that outcome. Therefore, the investigators performed this current study with the goal to confirm these findings in a larger sample size.
S100β in Newborns After C-Section With General Versus Epidural Anesthesia: A Prospective Observational Study
Authors: Xu Z. , Liu Z. , Zhang Y. , Jin C. , Shen F. , Yu Y. , Cheek T. , Onuoha O. , Liang G. , Month R. , Atkins J. , Tran K.M. , Wei H.
Published: August 2018

(Acta Anaesthesiol Scand. 2018;62:293–303)

S100β is a sensitive and reliable biomarker that can be used to detect brain damage and hypoxia and ischemia in the fetuses of pregnant patients. In fact, previous studies have demonstrated S100β as a sensitive marker for fetal brain apoptosis, particularly when the fetal brain is exposed to a high concentration of general anesthetic (GA). Although S100β has been well studied in animal models, its effectiveness in human subjects is yet to be confirmed. In the present study, the authors compared the ratio of S100β from umbilical artery to umbilical vein (UA/UV) immediately after delivery of a newborn via cesarean section under either epidural or GA; they hypothesized that S100β would not be increased in cord arterial blood of fetuses exposed briefly to GA when compared with epidural anesthesia (EA).
New Labor Management Guidelines and Changes in Cesarean Delivery Patterns
Authors: Rosenbloom J.I. , Stout M.J. , Tuuli M.G. , Woolfolk C.L. , López J.D. , Macones G.A. , Cahill A.G.
Published: August 2018

(Am J Obstet Gynecol 2017;217:689.e1–e8)

In 2010 the Consortium on Safe Labor published new labor curves based on contemporary parturients which changed the onset of active labor to 6 cm. The American College of Obstetricians and Society for Maternal-Fetal Medicine proposed that the cesarean delivery (CD) rate could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm. However, the efficacy of the new labor curves, the extent of their clinical implementation, and their effect on CD rates is still unclear. This study was aimed at testing the following hypotheses: (1) rates of arrest of dilation disorders have decreased in term, low-risk patients and (2) pushing duration before the diagnosis of arrest of descent has increased. In turn, a decrease in CD rates should be observed. Changes in the maternal and neonatal morbidity were also investigated.
Preoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial
Authors: Zeng Min , Dong Jia , Lin Nan , Zhang Wei , Zhang Kaiying , Peng Kun , Wang Dexiang , Zhao Yan , Peng Yuming , Han Ruquan
Published: August 2018

Background:

Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear.

Methods:

The study was a single-center, randomized, placebo-controlled, and double-blinded trial. A total of 122 patients undergoing elective craniotomy by a suboccipital or subtemporal approach were randomly allocated to a placebo group and gabapentin group. The patients received gabapentin (600 mg, orally) the night before surgery and 2 hours before anesthesia induction in the gabapentin group, and patients received vitamin B in the placebo group. The primary outcome was the postoperative pain score on movement at 24 hours. The secondary outcomes included the pain score at other time points, incidence of nausea and vomiting, sedation, and analgesic consumption.

Results:

Gabapentin significantly decreased the postoperative acute pain scores at rest (P=0.001) and on movement (P=0.000) within 24 hours; however, it did not have an effect at 48 hours. Gabapentin decreased postoperative vomiting (P=0.047) and rescue antiemetic use (P=0.033), whereas it increased the postoperative sedation score at 2 hours (P<0.05). Moreover, gabapentin decreased the mean consumption of intraoperative propofol (0.7 mg/kg/h; P=0.021) and remifentanil (1.3 µg/kg/h; P=0.025); however, it did not influence postoperative opioid consumption.

Conclusions:

Preoperative gabapentin significantly alleviated acute postoperative pain and decreased the incidence of vomiting in patients undergoing suboccipital or subtemporal craniotomy. However, more attention should be paid to early postoperative sedation when multimodal analgesia with gabapentin is administered.
Successful Use of Extracorporeal Membrane Oxygenation for Status Asthmaticus in a Woman With a Periviable Pregnancy
Authors: Clifford Caitlin , Mhatre Mohak , Craigo Sabrina
Published: August 2018

BACKGROUND:

Status asthmaticus is a severe asthma exacerbation with persistent airway obstruction despite standard therapy. Use of extracorporeal membrane oxygenation (ECMO) as rescue therapy in pregnancy is exceedingly rare. We describe a case of ECMO for treatment of status asthmaticus in woman with a periviable pregnancy culminating in a term delivery.

CASE:

The patient was a 33-year-old woman, gravida 3 para 1, admitted at 23 2/7 weeks of gestation with respiratory failure secondary to status asthmaticus. Venovenous ECMO was initiated and continued for 6 days. After hospital discharge, she had no further respiratory issues. She ultimately developed fetal growth restriction and gestational hypertension and underwent a repeat cesarean delivery at 38 weeks of gestation.

CONCLUSION:

Venovenous ECMO can be used successfully for status asthmaticus during a periviable pregnancy and enable delivery at term.
Ulipristal Acetate for Unscheduled Bleeding in Etonogestrel Implant Users
Authors: Zigler Rachel E. , Madden Tessa , Ashby Caitlin , Wan Leping , McNicholas Colleen
Published: August 2018

OBJECTIVE:

To evaluate whether ulipristal acetate reduces the number of bleeding days in etonogestrel implant users in a 30-day period as compared with placebo.

METHODS:

We performed a single-center, randomized, double-blind, placebo-controlled trial. Eligible participants were women aged 18–45 years with an etonogestrel implant in place for greater than 90 days and less than 3 years who reported greater than one bleeding episode in a 24-day period. Enrolled participants were randomized to receive 15 mg ulipristal acetate compared with an identical-appearing placebo daily for 7 days. Participants completed daily bleeding diaries using automated text messaging to evaluate whether ulipristal acetate reduces the number of bleeding days as compared with placebo. Secondary outcomes included participant satisfaction with bleeding and the effect of ulipristal acetate on ovulation status. A sample size of 52 per group (n=104) was planned, calculated with an effect size of a 30% reduction in bleeding days, SD of 10 days, and dropout of 15%. Our study was terminated early (N=65) as a result of a U.S. Food and Drug Administration hold, but power was sufficient for analysis. The effect of ulipristal acetate on ovulatory potential was evaluated in a subset with weekly serum progesterone.

RESULTS:

From May 2017 to January 2018, 65 women were allocated to receive 15 mg ulipristal acetate (n=32) or placebo (n=33) daily for 7 days. Demographic characteristics were similar between groups. Women randomized to ulipristal acetate reported 5 fewer days of bleeding over a 30-day reference period after treatment (P=.002). At the conclusion of the 30-day follow-up period, women in the ulipristal acetate group were more satisfied with their bleeding profile than the placebo group (87.5% vs 60%, respectively; P<.001). Serum progesterone levels were nonovulatory in a subset of each group (placebo group range: less than 0.2–1.3 ng/mL; ulipristal acetate group range: less than 0.2–4.4 ng/mL).

CONCLUSION:

Ulipristal acetate is well-tolerated and reduced the number of bleeding days in etonogestrel implant users in our study.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03118297.
Retrospective Analysis of EMG-evoked Potentials in Cortical Bone Trajectory Pedicle Screws
Authors: Ashayeri Kimberly , Sahasrabudhe Nikhil , Galic Vladimir , Beric Aleksandar , Smith Michael
Published: August 2018

Study Design:

This is a retrospective analysis of electromyographic (EMG) stimulation thresholds of 64 cortical bone trajectory (CBT) screws.

Objective:

The authors seek to determine whether recordings below stimulation threshold correlate with CBT screw pedicle breach on computed tomographic imaging, and to explore which specific nerve roots are most at risk with this new trajectory.

Summary of Background Data:

Intraoperative EMG monitoring has been utilized to verify accurate placement of pedicle screws. Although CBT screws are becoming increasingly popular, to the authors’ knowledge there are no existing evaluations of the accuracy of intraoperative triggered EMG (tEMG) monitoring in this trajectory.

Materials and Methods:

Retrospective analysis of EMG stimulation thresholds of 64 CBT screws placed in patients at NYU Langone Medical Center from 2015–2017. EMG results including threshold values and muscle group stimulated were correlated with screw positioning determined on postoperative or intraoperative computed tomographic imaging.

Results:

In total, 4.7% of EMG threshold values indicated true breach, 1.6% were falsely positive for breach, 76.5% showed true absence of breach, 17.1% failed to reveal a present breach though 0% of medial breaches were undetected. L4 screws showed tEMG responses from adductor longus in 22%, L5 screws, from rectus femoris in 16.7%, and S1 screws from tibialis anterior in 50%.

Conclusions:

tEMG testing is effective for medial breaches in CBT screws. In addition, there is evidence that bicortical placement of these screws causes lower stimulation values due to distal breach. Importantly, it seems that this is due in part to stimulation of the exiting nerve root at the level above.
Evaluation of Repeated Quick Sepsis-Related Organ Failure Assessment Measurements Among Patients With Suspected Infection*
Authors: Kievlan Daniel R. , Zhang Li A. , Chang Chung-Chou H. , Angus Derek C. , Seymour Christopher W.
Published: August 2018

Objectives:

Among patients with suspected infection, a single measurement of the quick Sepsis-related Organ Failure Assessment has good predictive validity for sepsis, yet the increase in validity from repeated measurements is unknown. We sought to determine the incremental predictive validity for sepsis of repeated quick Sepsis-related Organ Failure Assessment measurements over 48 hours compared with the initial measurement.

Design:

Retrospective cohort study.

Setting:

Twelve hospitals in southwestern Pennsylvania in 2012.

Patients:

All adult medical and surgical encounters in the emergency department, hospital ward, postanesthesia care unit, and ICU.

Interventions:

None.

Measurements and Main Results:

Among 1.3 million adult encounters, we identified those with a first episode of suspected infection. Using the maximum quick Sepsis-related Organ Failure Assessment score in each 6-hour epoch from onset of suspected infection until 48 hours later, we characterized repeated quick Sepsis-related Organ Failure Assessment with: 1) summary measures (e.g., mean over 48 hr), 2) crude trajectory groups, and 3) group-based trajectory modeling. We measured the predictive validity of repeated quick Sepsis-related Organ Failure Assessment using incremental changes in the area under the receiver operating characteristic curve for in-hospital mortality beyond that of baseline risk (age, sex, race/ethnicity, and comorbidity). Of 37,591 encounters with suspected infection, 1,769 (4.7%) died before discharge. Both the mean quick Sepsis-related Organ Failure Assessment at 48 hours (area under the receiver operating characteristic, 0.86 [95% CI, 0.85–0.86]) and crude trajectory groups (area under the receiver operating characteristic, 0.83 [95% CI, 0.83–0.83]) improved predictive validity compared with initial quick Sepsis-related Organ Failure Assessment (area under the receiver operating characteristic, 0.79 [95% CI, 0.78–0.80]) (p < 0.001 for both). Group-based trajectory modeling found five trajectories (quick Sepsis-related Organ Failure Assessment always low, increasing, decreasing, moderate, and always high) with greater predictive validity than the initial measurement (area under the receiver operating characteristic, 0.85 [95% CI, 0.84–0.85]; p < 0.001).

Conclusions:

Repeated measurements of quick Sepsis-related Organ Failure Assessment improve predictive validity for sepsis using in-hospital mortality compared with a single measurement of quick Sepsis-related Organ Failure Assessment at the time a clinician suspects infection.
Intracrinology and menopause: the science describing the cell-specific intracellular formation of estrogens and androgens from DHEA and their strictly local action and inactivation in peripheral tissues
Authors: Labrie Fernand
Published: August 2018

The secretion of estrogens by the ovaries stops at menopause. Afterward, dehydroepiandrosterone (DHEA) becomes the only source of both estrogens and androgens during all the postmenopausal years. To maintain very low and biologically inactive concentrations of estrogens and androgens in the circulation, DHEA is transformed intracellularly into cell-specific small amounts of estrogens and androgens (except in the endometrium) which then act and are inactivated locally in the same cells, thus avoiding biologically significant systemic exposure to active sex steroids. The secretion of DHEA, however, mainly of adrenal origin, has already decreased by an average of 60% at the time of menopause and it continues to decrease thereafter with a parallel lowering in available intracellular estrogens and androgens. Consequently, after the arrest of estrogen secretion by the ovaries, the loss of DHEA becomes practically responsible for the symptoms and signs of menopause. Replacing what is missing, namely DHEA, at the right place, at the right time, and in the right amount, seems to be the logical and physiological approach for the treatment of menopausal symptoms and signs, as recently demonstrated for pain at sexual activity (dyspareunia), the most bothersome symptom of vulvovaginal atrophy due to menopause.
Successful long-term use of Gellhorn pessary and the effect on symptoms and quality of life in women with symptomatic pelvic organ prolapse
Authors: Mao Meng , Ai Fangfang , Kang Jia , Zhang Ye , Liang Shuo , Zhou Ying , Zhu Lan
Published: August 2018

Objective:

To evaluate the long-term continuation rate of the Gellhorn pessary and its effect on bothersome symptoms and quality of life (QOL) in women with symptomatic pelvic organ prolapse (POP).

Methods:

This was a prospective observational study. Ninety-one women with symptomatic POP were successfully fitted with Gellhorn pessaries (short stem) between June, 2015 and January, 2017. The participants were monitored at 3 and 6 months, and also every 6 months afterwards until February, 2018. Prolapse and urinary symptoms were assessed, and the Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) were administered at baseline and at each follow-up visit. Logistic regression was performed to identify independent predictors of discontinued pessary use. McNemar's test and paired t tests were used to evaluate the changes in symptoms and QOL in the continuation group.

Results:

In this study, 58.3% of participants continued to use the pessaries after a median follow-up time of 23.5 months. A total vaginal length <7.5 cm (odds ratio 0.03, 95% confidence interval 0.00-0.35, P = 0.01) was an independent predictor of pessary discontinuation. In the continuation group, almost all prolapse and voiding difficulty symptoms were resolved at the study endpoint. The changes in the urinary and prolapse scales of both the PFIQ-7 (mean [SD] changes were −21.2 [26.6] in the urinary scale and −32.5 [29.5] in the prolapse scale) and PFDI-20 (mean [SD] changes were −15.3 [21.3] in the urinary scale and −29.8 [22.8] in the prolapse scale) achieved clinical significance (effect size >0.5).

Conclusions:

More than half of the patients continued long-term use of the pessary. The Gellhorn pessary can resolve prolapse and voiding difficulty symptoms effectively. In addition, the Gellhorn pessary can significantly improve the QOL of women via long-term use. However, the Gellhorn pessary has a limited effect on defecatory symptoms.
Peripapillary Vessel Density in Glaucomatous Eyes: Comparison Between Pseudoexfoliation Glaucoma and Primary Open-angle Glaucoma
Authors: Park Ji-Hye , Yoo Chungkwon , Girard Michael J.A. , Mari Jean-Martial , Kim Yong Yeon
Published: August 2018

Purpose:

The aim of this study was to compare the peripapillary vessel density between eyes with pseudoexfoliation glaucoma (PXG) and eyes with primary open-angle glaucoma (POAG).

Methods:

Peripapillary vessel density in the radial peripapillary capillaries was assessed using optical coherence tomography angiography, and compared between patients with PXG and those with POAG, matched for age and mean deviation (MD) of standard automated perimetry. The vessel density was measured between the optic disc margin and 750 μm from the optic disc margin.

Results:

In total, 39 eyes with PXG were matched to 39 eyes with POAG. Mean untreated intraocular pressure was higher in the PXG group than in the POAG group (21.4±6.7 vs. 14.9±2.9 mm Hg; P<0.001), but there was no difference in age, refractive error, visual field MD, or average retinal nerve fiber layer thickness between the 2 groups. However, the average peripapillary vessel density in the radial peripapillary capillaries was lower in the eyes with PXG than in the eyes with POAG. Moreover, there was a significant correlation between peripapillary vessel density and both visual field MD and retinal nerve fiber layer thickness.

Conclusions:

Peripapillary vessel density was lower in eyes with PXG than in eyes with POAG of similar severity.
Delayed-onset Endophthalmitis Following Implantation of a XEN45 Glaucoma Device: A Case Report
Authors: Colás-Tomás Teresa , Pérez-Trigo Silvia
Published: August 2018

Purpose:

The aim of this study was to present a case of delayed-onset endophthalmitis occurring after the implantation of a XEN45 device.

Patients and Methods:

The patient was a 54-year-old man with bilateral elevated intraocular pressure. The patient underwent placement of a XEN45 implant in his left eye. One month postoperatively the patient required needling with adjuvant mitomycin C. Six months later, the intraocular pressure was well controlled with treatment.

Results:

Eight months after surgery, the patient presented to the emergency room and was diagnosed with left eye endophthalmitis. There was no history of trauma. The presence of erosions could not be thoroughly assessed due to significant conjunctival inflammation and friability, but a scleral necrosis patch was observed around the stent’s subconjunctival pathway. The vitreous culture was positive for Streptococcus oralis. The blood culture was negative, and physical examination excluded any other endogenous cause. Given the poor clinical progression, persistent site of infection, and no visual prognosis, an enucleation was performed.

Conclusions:

In the case presented, we hypothesize a perforation of the conjunctiva as the most probable cause of the patient’s endophthalmitis. This case, together with previous case reports, highlights the importance of periodic patient follow-up after the procedure. However, less invasive and seemingly safer new generation implants for glaucoma surgery are not fully devoid of complications.
Health Beliefs and Medication Adherence in Omanis With Hypertension
Authors: Al-Noumani Huda , Wu Jia-Rong , Barksdale Debra , Knafl George , AlKhasawneh Esra , Sherwood Gwen
Published: August 2018

Background:

Patients’ health beliefs are essential to improve medication adherence among patients with hypertension.

Objective:

Our objective was to examine the relationship between (1) patients’ beliefs about hypertension, medication, and self-efficacy and medication adherence and (2) medication adherence and blood pressure control in Oman.

Methods:

This cross-sectional study included 215 participants with hypertension. Participants completed 4 questionnaires (Arabic version) to measure medication adherence, beliefs about hypertension severity, beliefs about medication, and self-efficacy. Bivariate and multivariate logistic regression was used to conduct the analyses.

Results:

Higher self-efficacy (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.54–4.37), stronger beliefs about medication necessity (OR, 1.98; 95% CI, 1.21–3.23), increased age (OR, 1.06; 95% CI, 1.03–1.10), and fewer medication concerns (OR, 0.34; 95% CI, 0.20–0.57) were related to high medication adherence. Moreover, uncontrolled blood pressure was less likely in participants with high medication adherence (OR, 0.47; 95% CI, 0.24–0.93).

Conclusions:

Patients’ beliefs are important consideration to improve medication adherence. Clinically, patients’ beliefs should be assessed, and strategies to improve medication adherence should incorporate beliefs as a key component to improve antihypertensive medication adherence. Patient education and counseling regarding hypertension and necessity and side effects of medications are important to maximize positive beliefs and improve medication adherence.
Diagnostic and therapeutic yields of urgent balloon-assisted enteroscopy in overt obscure gastrointestinal bleeding
Authors: Rodrigues Jaime P. , Pinho Rolando , Rodrigues Adélia , Sousa Mafalda , Silva João Carlos , Gomes Catarina , Freitas Teresa , Pinto-Pais Teresa , Carvalho João
Published: August 2018

Background and aims

Balloon-assisted enteroscopy (BAE) is one of the diagnostic and therapeutic procedures in the algorithm for the evaluation of overt obscure gastrointestinal bleeding (OGIB). There is currently no consensus regarding the role of urgent BAE in overt OGIB. The aims of this study were to compare the diagnostic and therapeutic yields of urgent and nonurgent BAE in patients with overt OGIB.

Patients and methods

We conducted a retrospective, single-center study that included patients who underwent BAE for overt OGIB between January 2010 and December 2017. Urgent BAE was defined as an enteroscopy performed within 72 h of clinical presentation. Demographic, clinical, laboratory, and technical data were reviewed and the diagnostic and therapeutic yields evaluated and compared.

Results

Seventy BAEs were performed in 57 patients with overt OGIB [29 (50.9%) females, mean age: 68.0±11.1 years]. The diagnostic yield of urgent BAE was significantly higher than nonurgent BAE (84.5 vs. 50.0%, P<0.01). The most common diagnosis were angiodysplasias (30%), tumors (15.7%), erosions/ulcers (4.3%), and diverticula (4.3%). Endoscopic therapy was more frequently performed in urgent BAE patients (57.7 vs. 31.8%, P=0.03). The most commonly used endoscopic therapies were argon plasma coagulation (30.0%), hemostatic clips (5.7%), epinephrine injection (5.7%), and polypectomy (2.9%). In terms of urgent BAE, the diagnostic yield was similar when enteroscopy was performed at less than or equal to 24, 48, or 72 h (P>0.05), but the therapeutic yield was higher the earlier the enteroscopy was performed (100, 76.9, and 57.7% at ≤24, ≤48, and ≤72 h respectively; P=0.03).

Conclusion

The diagnostic and therapeutic impact of BAE was higher in an urgent setting. These data support an important role for urgent BAE in overt OGIB.